The decline in the incidence of TSS in the late 1980s was closely followed by the emergence of an even more serious illness. Initially classified as streptococcal toxic shock-like syndromes (TSLS) by the CDC, a consensus definition was formulated in 1993. It was identical to the case definition for TSS except that TSLS develops in association with a severe soft-tissue infection and culture results from a normally sterile site must be positive for Streptococcus pyogenes [group A streptococcus (GAS)]. In 1995, the CDC published a new case definition for streptococcal toxic shock syndrome (STSS); the current case definition, as published in 1997, is shown in Table 138-3.8,9
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