Scarlet fever is an acute infectious disease caused by a rash toxin B insoluble streptococcal infection, fever, sore throat, skin rash characterized.Scarlet fever more common in winter and spring, a higher incidence of school-age children occur in nurseries and primary and secondary schools of the collective life of the local infectious patients and healthy carriers through breathing, coughing, sneezing, talking generate dropletsthe spread of bacteria through the respiratory tract.
Scarlet fever - basic disease
Scarlet fever, the incubation period of 2-5 days, rapid onset, fever, sore throat, early symptoms, heavier can be headache, vomiting, followed by a tongue mastoid swelling, first white tongue, then tongue turn yellow, rough, red spines, neck and submandibular lymph node swelling, tenderness at the same time, about 24 hours after the onset of the rash appears, the body can be between the red miliary rash, rash, and rash, redness of the skin, normal skin, the skin wrinkled intensive folding parts of the rash was linear, the lips around the no rash was pale, perioral pale circle formed around a generally reached a peak two days, gradually subside hair after 2-4 days retreat net, body temperature gradually decreased, rash back about seven days start off dander, the light was chaff debris shedding samples, the weight to see large areas of peeling.
Scarlet fever - etiology
Scarlet fever etiology and pathogenesis:
The main pathogen type B hemolytic streptococcus group A strains, and pharyngeal pathogens invading the body caused by purulent lesions and toxins into the blood causing sepsis, induce skin lesions in severe liver, spleen, kidney, cardiac muscle, lymph nodes inflammatory lesions. Allergic lesions in body organs and tissues of individual patients in stage of disease after 2 to 3 weeks.
Bacteria normally present in the nasopharynx of scarlet fever patients or carriers, droplets through the air (talking, coughing, sneezing) and direct transmission, but also by the indirect spread of contaminated toys, household items, and occasionally through contaminated milk or other food-borne.
Scarlet fever - epidemiology
Full year incidence of scarlet fever, but the winter and spring peak, more common in children aged 5 to 15. The source of infection is scarlet fever patients and carriers, and other B-type hemolytic streptococcus infection the patient can be regarded as a source of infection. Scarlet fever patients from the day before the onset of the rash of infectious strongest. Mainly spread through air droplets, due to scarlet fever virus does not heat for dry and weak resistance, so the possibility of small indirect contact. Was susceptible to SARS, coupled with the rash toxin serotypes, no cross-immunity, it is scarlet fever can be re-infection.
Scarlet fever - symptoms of type
Scarlet fever onset, a sharp, sudden high fever, headache, sore throat, nausea, vomiting and so on. Bacteria intrusion from the pharynx, tonsil swelling, exudative membrane gray easily wipe the soft palate mucosa congestion, a little erythema and scattered Emotion petechia. The early onset of rash before you can see the tongue hypertrophy, nipple swelling prominent white tongue coating, and known as the "white the Bayberry tongue". 3 to 4 days, white tongue off, bright red tongue, tongue, nipple swelling and prominent, the shape of red bayberry, red bayberry tongue, accompanied by submandibular lymph nodes. Small and intensive erythema, pressure fade, about 36 hours throughout the body. Elbow, armpits, groin folds, the rash is more intensive and the formation of dark red or purple petechia-like lines "Pap line. Cheeks and forehead congestion, flushing, rash, mouth and nose around the show characteristic perioral pale collar pale circle. The rash appears within 48 hours, reached a peak rash, rash showed diffuse scarlet, heavy bleeding rash. The rash lasts for 2 to 4 days, the rash subsided by order of appearance. Onset of the first seven to eight days, desquamation, systemic, especially after the palm, paw for the large peeling, like a glove, sock-like. In severe cases, hair loss.
Scarlet fever - clinical diagnosisWhite blood cell count to increase, the majority of the 10 ~ 20 × 109 / L, neutrophils increased by more than 80%, a left shift, and the cytoplasm visible toxic particles and sinus Le's (Dohle) body, and eosinophils in early but not , convalescence increased.Scarlet fever diagnosis(A) contact history with scarlet fever or history of exposure to angina patients, the diagnosis.(B) clinical manifestations of a sudden, fever, angina, typical rash, perioral pale the loganberry tongue, Pap line, recovery peeling, scarlet fever characteristics.(C) laboratory tests white blood cell count increased up to 10 ~ 20 × 109 / L, neutrophils accounted for more than 80%. The rash toxin test early for the positive. Pharyngeal test sub-pus culture available to group A streptococci.Scarlet fever - differential diagnosis(A) early measles have obvious upper respiratory catarrhal symptoms, and 3 to 4 disease rash, measles and scarlet fever - rash between normal skin, facial rash. Buccal mucosal plaques and white blood cell count was reduced to an important distinction.(B) of the rash onset of the first day of the rash. Was morbilliform, confluent, like scarlet fever, diffuse skin flushing. Retreat rash without desquamation. Ear and suboccipital lymph nodes. Rubella virus-specific antibody titer rise to help diagnosis.(C) useful drug eruption caused by the rash of drug history. The rash sometimes diverse performance, uneven distribution of the rash on the order of the trunk to the limbs. Systemic symptoms are mild and not commensurate with the severity of the rash. The disease without angina, the loganberry tongue, neck lymph nodes, white blood cell count normal or decreased.(D) of Staphylococcus aureus infection of some Staphylococcus aureus can also produce the rash toxins can cause scarlet fever-like rash. Identification depends mainly on the bacterial culture. The rapid progression of the disease, the prognosis is poor, should be vigilant.(5) Kawasaki disease (also known as mucocutaneous lymph node syndrome) disease occurs in 4 years of age for infants and pathological features of vasculitis. Mainly as acute febrile onset, heat about 1 to 2 weeks; conjunctival hyperemia, tongue like scarlet fever of strawberries, the congestion of the oral mucosa; lymph nodes (neck, jaw, groin), no suppuration, no adhesions; fingers and (toe) end of the symmetry of edema; rash were pleomorphic, mainly found in the trunk-like performance of scarlet fever, itching or mild itching, rash have subsided after the bran-like or membranous desquamation. The disease is often associated with cardiovascular disease, gastrointestinal disorders, urinary diseases. Laboratory tests showed WBC, increased neutrophils, sometimes the platelet increase in ESR.
Scarlet fever - complications
(A) of suppurative complications by the pathogen or other bacteria, direct invasion of nearby tissues and organs. Common, such as otitis media, mastoiditis, paranasal sinusitis, neck soft tissue inflammation, cellulitis, pneumonia. Due to the early use of antimicrobial therapy, such complications are rare.
(B) toxic complications caused by the bacteria of various biological factors more common in one week. Such as viral myocarditis, pericarditis. Lesions, and the prognosis is good.
(C) allergic complications usually found in the recovery period, rheumatoid arthritis, myocarditis, endocarditis, pericarditis and acute glomerulonephritis. General disease complicated by acute nephritis light, more able to heal and rarely become chronic.
Scarlet fever treatment:
(1) antibiotic therapy of penicillin is the drug of choice for the treatment of scarlet fever and streptococcal infection, the early application can shorten the course of the disease and reduce complications. 40000 to 80000 U / (kg.d), two injections. Severe cases can increase the dose. For the complete elimination of pathogens, reduce complications, treatment for at least 10 days. Penicillin G allergy erythromycin 20 ~ 40mg / (kg · d), three times a day orally, in severe cases can also be administered intravenously, the course of 7-10 days.
(2) symptomatic treatment: high fever can be used smaller doses of antipyretics or physical cooling methods. Older children, sore throat can be used saline mouthwash or Du Miefen lozenge. (3) the treatment of severe symptoms of myocarditis, shock, see the relevant sections.
(1) antibiotic therapy of penicillin is the drug of choice for the treatment of scarlet fever and streptococcal infection, the early application can shorten the course of the disease and reduce complications. 40000 to 80000 U / (kg.d), two injections. Severe cases can increase the dose. For the complete elimination of pathogens, reduce complications, treatment for at least 10 days. Penicillin G allergy erythromycin 20 ~ 40mg / (kg · d), three times a day orally, in severe cases can also be administered intravenously, the course of 7-10 days.
(2) symptomatic treatment: high fever can be used smaller doses of antipyretics or physical cooling methods. Older children, sore throat can be used saline mouthwash or Du Miefen lozenge. (3) the treatment of severe symptoms of myocarditis, shock, see the relevant sections.
Scarlet fever - diet and diet Taboo(1) the flow of the Yishi high calorie, high protein food. Containing high quality protein foods such as milk, soy milk, egg drop soup, egg soup, but also to supplement the heat of the lotus root starch, almond tea, lotus porridge, malted milk.(2) The recovery period should be a gradual transition to high-protein, high-calorie liquid diet. Such as chicken mud, mess, mud shrimp, liver paste, Cai Yu, small Thin film, poached, Longxumian and so on.(3) her condition improved and can be changed to the soft rice. But should still pay attention to the less greasy and spicy food.(4) fever pay attention to the added water, beverages, fruits and vegetables.(5) with acute nephritis, should be given to salt, low protein, semi-liquid diet. In short, more than skin smallpox-like illness in children, the diet should be fine, soft, rotten, little cellulose, and note that vitamin B12 from your diet in order to speed up the recovery of smallpox.Yi Shi foodEdible food: meat, shellfish, fish, poultry and eggs. Liver class and fermented soy products, fermented bean curd vitamin B12 content is high.Scarlet fever therapeutic side five juice drink: of pears, water chestnuts, lotus root, Ophiopogon, reed, one can always drink.Luo Han Kuo drink: Luohanguo, sliced tea drink.Mint green bean soup: Take 50 grams of green beans, add water, cooked, take the soup 500 ml, add mint to 3 grams, boil for 1 to 2 minutes, often Beverage.Green olives, eucalyptus leaves, sugar, mint: green olives, eucalyptus leaves, sugar, mint is often the mouth including taking relieve the sore throat.Raw mix of white radish: white radish cut added sugar, table consumption. Heat, ventilation, and appetizing effect.Taboo food(1) avoid-hair thing likely to help the fire phlegm products, ingestion of fat things will increase in body temperature, rash intensified, exacerbations, these foods have a dog, lamb, bird meat, male chicken, blackfish , carp, eel, shrimp, crab, parsley, pumpkin and so on.
(2) avoid spicy things spicy thing to help the fire, and directly stimulate the throat tonsil pain got worse, pepper, chili sauce, chili oil, mustard, mustard, curry, ginger, green onions, allspice and other such food.
(3) avoid too sweet and salty foods over sweet food and more food will encourage the body warm, and lead to indigestion, loss of appetite, such as chocolate, sugar balls, fruits, sugar, candy, sweet syrup, without diluted honey; salty foods such as salted fish, pickles, bacon, the leading baked, these foods can stimulate the throat, so that an increase in mucus secretion, aggravate the condition.
(4) avoid stimulating the nervous system of food tea, coffee, alcohol can stimulate the nervous system so as to excite the scarlet fever patient must remain quiet due to high fever, nervous system, after the ingestion of these foods will lead to increased excitability, so that the sick child irritability.
Avoid a long-fiber vegetables and fruits of scarlet fever in children with pharyngeal hyperemia (5) swelling, swallowing negative, because of high fever often poor digestion, so eat vegetables and fruits of a long fiber, these foods include bamboo shoots, hair bamboo shoots, scallions, bean sprouts, garlic, pineapple, onions, potherb mustard, water spinach, sweet potatoes, taro, etc..
(6) Avoid cold in children with fever should be added the water, but should drink warm and cool water, avoid drinking all kinds of frozen drinks, such as ice cream, ice cream for frozen orange juice, frozen Sprite, popsicles, ice cream and frozen boiled water. Cold eating into the post will enable people momentary happiness, but to impede the disadvantages of the stomach, leading to loss of appetite, digestion disorders.
Partial temperature (7) avoid heat fruit longan, Lizi, dates, raisins, oranges and other sexual taste, the food can easily light a fire in the high fever during the cut.
(8) Avoid fried and basting of the product where the fried food such as pork cutlet, fried steak, Ma ball, cannabis, fritters, roast duck, roast lamb, grilled fish are cut out things, fried grilled goods skin is hard on the throat; for barbecue thing is easy to fire, easy to cause the fever to aggravate.
(9) drug contraindications scarlet fever is a streptococcal infection, highly concurrent gastritis, so the use of antibiotics should be chosen on the kidneys to stimulate the smaller drugs, avoid the use of sulfa drugs. In addition, oral erythromycin is gastrointestinal reactions, chloramphenicol, co-neomycin causes neutropenia should be noted that when used.
(2) avoid spicy things spicy thing to help the fire, and directly stimulate the throat tonsil pain got worse, pepper, chili sauce, chili oil, mustard, mustard, curry, ginger, green onions, allspice and other such food.
(3) avoid too sweet and salty foods over sweet food and more food will encourage the body warm, and lead to indigestion, loss of appetite, such as chocolate, sugar balls, fruits, sugar, candy, sweet syrup, without diluted honey; salty foods such as salted fish, pickles, bacon, the leading baked, these foods can stimulate the throat, so that an increase in mucus secretion, aggravate the condition.
(4) avoid stimulating the nervous system of food tea, coffee, alcohol can stimulate the nervous system so as to excite the scarlet fever patient must remain quiet due to high fever, nervous system, after the ingestion of these foods will lead to increased excitability, so that the sick child irritability.
Avoid a long-fiber vegetables and fruits of scarlet fever in children with pharyngeal hyperemia (5) swelling, swallowing negative, because of high fever often poor digestion, so eat vegetables and fruits of a long fiber, these foods include bamboo shoots, hair bamboo shoots, scallions, bean sprouts, garlic, pineapple, onions, potherb mustard, water spinach, sweet potatoes, taro, etc..
(6) Avoid cold in children with fever should be added the water, but should drink warm and cool water, avoid drinking all kinds of frozen drinks, such as ice cream, ice cream for frozen orange juice, frozen Sprite, popsicles, ice cream and frozen boiled water. Cold eating into the post will enable people momentary happiness, but to impede the disadvantages of the stomach, leading to loss of appetite, digestion disorders.
Partial temperature (7) avoid heat fruit longan, Lizi, dates, raisins, oranges and other sexual taste, the food can easily light a fire in the high fever during the cut.
(8) Avoid fried and basting of the product where the fried food such as pork cutlet, fried steak, Ma ball, cannabis, fritters, roast duck, roast lamb, grilled fish are cut out things, fried grilled goods skin is hard on the throat; for barbecue thing is easy to fire, easy to cause the fever to aggravate.
(9) drug contraindications scarlet fever is a streptococcal infection, highly concurrent gastritis, so the use of antibiotics should be chosen on the kidneys to stimulate the smaller drugs, avoid the use of sulfa drugs. In addition, oral erythromycin is gastrointestinal reactions, chloramphenicol, co-neomycin causes neutropenia should be noted that when used.
Scarlet fever - convalescent and nursing care
Scarlet fever 1) bed rest; bed rest can reduce the body's consumption and the burden of the heart, kidneys, joints with fewer complications.
2) diet: a sore throat, you should eat porridge, less oil foods such as porridge, soup, soup, milk, chopped vegetables. To drink plenty of water, to rule out bacterial toxins.
3) oral cleaning: more concentrated in the throat caused by bacteria, oral cleaning is very important. Older children, with warm salt water rinse after each meal or sleep to wake up the voice. Younger children. Tweezers rely on gauze or cotton wool dipped in warm salt water to clean the oral cavity.
4) skin care: skin rash, children with skin itching will not only affect the children to rest, if scratched, can also cause skin infections. To children with short nail clippers, scrub the skin with warm water to help relieve itching. Do not pay attention to the rash with soap. Peeling force, do not rub or tear strip to avoid infection of skin lesions.
5) observation of the disease; attention to discovering the symbol of complications. The rash of attention to children with or without palpitation, shortness of breath, pulse quickened and even breathing difficulties and other symptoms, in order to detect complications of myocarditis.
Incidence of about one week, pay attention to children, such as persistent fever, neck or submandibular lymph swelling, pain, and may be complicated by suppurative lymphadenitis; ear may be complicated by suppurative otitis media.
Incidence of about two weeks, pay attention to the phenomenon of children with or without joint swelling and pain. This is a symbol of arthritis, if not treated early, can also lead to rheumatic heart disease.
Incidence of about three weeks, pay attention to children with or without dark urine, with or without swelling, low back pain phenomenon, which is a symbol of the nephritis. Found the symbol of the more suspicious complications, should immediately go to the hospital diagnosis, treatment, prevention of progression of the disease.
Scarlet fever - prevention measures
(1) of isolated
1, children stay home, do not close with the other children. Isolation period from the date of onset of less than 7 days.
Two children, if suppurative complications, should be isolated to the inflammation healed.
(2) disinfection
l, children room should always open the window for ventilation, at least three times a day, every 15 minutes.
Two children with the disease, nose to spit or move in a paper burned. Dirty handkerchief used to use boiling hot.
3, everyday objects can be exposure, at least 30 minutes. Utensils sterilized by boiling.
4, the children recovered, to conduct a thorough disinfection, toys, furniture, use soapy water or lysol scrub again, can not scrub, in the outdoor exposure of 1 to 2 hours.
5, kindergartens and nurseries in the epidemic of seriously do a good job the morning. Afternoon inspection, early detection of suspicious persons.
(3) exercise
Children to strengthen the physical exercise and do more outdoor activities, and continuously improve their resistance to disease.
