Visiting the Doctor Your subtitle goes here 猩 红 热 Scarlet fever 北京大学第三医院 崔蕴璞

2. Epidemiology Contents 1. Etiology 4. Differential Diagnosis 3. Clinical Manifestations

Group A hemolytic streptococcal pyogenes. Etiology GAS

Extracellular Enzymes and Toxins: Streptococcal pyogenic exotoxins(SPE) 红疹毒素 Streptolysin O and S 溶血素 Streptokinase(SK) 链激酶 DNAases DNA 酶 Hyaluronidase 透明质酸酶 Proteinase 蛋白酶

2. Epidemiology Contents 1. Etiology 4. Differential Diagnosis 3. Clinical Manifestations

Epidemiology

传染源：  患者  健康带菌者

Epidemiology 传播途径：  呼吸道飞沫  食物、玩具间接经口  皮肤伤口

Epidemiology 易感人群：  3~7 岁儿童

流行季节 : Epidemiology Winter Spring

2. Epidemiology Contents 1. Etiology 4. Differential Diagnosis 3. Clinical Manifestations

分 期  Incubation period 潜伏期  Prodromal period 前驱期  Rash period 出疹期  Convalescent period 恢复期

Incubation period 1~7days,mean 3days No symptoms and signs

Common Type  Incubation period  Prodromal period  Rash period  Convalescent period

Prodromal period Fever Headache Abdominal pain Swollen glands in the neck Sore throat White strawberry tongue

Prodromal period Purulent tonsillitis

Prodromal period White Strawberry tongue Normal tongue

Common Type  Incubation period  Prodromal period  Rash period  Convalescent period

Rash period Rash appears Whithin 24 ~48h after onset of fever In 12~24h diffused to the whole body Pastia’s lines

Modality of the rash a difffuse,fine papular Sunburn with goose pimples

Touch of the rash fine sandpaper

Circumoral pallor

Red Strawberry tongue By the 3 rd or 4 th day the white coat peel off

Common Type Incubation period Prodromal period Rash period Convalescent period

Rash Vanish in 2~4 days Rash begin to fade at the end of the 1 st week

Desquamation at the end of the 1st week to the 2nd week desquamation occur comes off as fine flakes like bran 糠屑样脱皮

Desquamation usually the last to desquamate not until the 2 nd or 3 rd week

Desquamation

Characteristic Manifestations Fever Typical rash Strawberry tongue Pastia’s lines Circumoral pallor Desquamation

2. Epidemiology Contents 1. Etiology 4. Differential Diagnosis 3. Clinical Manifestations

Differential diagnosis  Rubella 风疹

 Measles 麻疹 Differential diagnosis

 Varicella 水痘 Differential diagnosis

Case  A seven year old boy presents with fever for one day, the temperature rises to 39.5 ℃,  He felt unwell flesh and fell, and complaining sore throat and headache,  Rash was detected in this morning

Case  PE: T 38.6 ℃, RR 32/min, HR 110 beats/min.  The mantal status is fine  The throat is red, and the tonsils are enlarged, reddened, and covered with patches of exudate.  The skin is covered with tiny red spots  No abnormal sign is found in lung, heart and abdomen.

Summary Scarler fever is an acute infectious disease caused by group A hemolytic streptococcal pyogenes Clinical features :Fever, Sore throat, Typical rash, Pastia’s lines, Circumoral pallor, Desquamation STSS: invasive GAS, shock and multiple organ dysfunction

两天出疹猩红热， 咽痛皮疹伴发热， 红布喷点深红色， 疹退皮脱还原色。 多饮水，早退热， 七天抗菌别吝啬。 多休息，床上卧， 预防肾炎风湿热。 猩红热歌谣

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