1. SCARLET FEVER  Definition Definition  Etiology  Epidemiology  Pathogenesis and pathology Pathogenesis and pathology  Clinical manifestation Clinical manifestation  Laboratory findings  Complications  Diagnosis and Different Diagnosis  Treatment  Prevention

2. DEFINITION  Hemolytic streptococcus B group A  Acute respiratory infectious disease  Clinical features:Fever,pharyngitis, genernal diffused fresh red eruption and obvious desquamation  Complication:heart,kidney and joints diseases  return return

3. Etiology  Belong to Group A, Hemolytic streptococcus B Gram(+) 0.6-1.0um in diameter  Culture:grow in media contained blood  Group:depend on the different somatic polysaccharide Ag in cell wall,the bacteria are divided into 19 group(A-U,no I and J).Group A is major.  Serum type:Group A is divided into 80 types according to the protein M on surface.  Resistance:weak resistance,sensitive to heat,drying,common disinfectant.Live in sputum and pus for several weeks.

4.  Pathogenic substances 1.LTA (lipoteichoic acid):adherence to epithelial cells. 2.Erythrogenic toxin:fever,rash and others 3.Strptokinase:resolve clot,protect blood from coagulation. 4.Hyaluronidase:extension in tissue,resolve hyaluronid. 5. M protein :toxic to WBC and PLT return

5. Epidemiology  Source of infection patients and carriers pharyngitis—major source  Route of transmission air-borne: respiratory tract wound,birth caral-surgical and puerperal type.  Susceptability after infection of group A streptococcus, two Ab produce.antibacterial Ab-type specific no cross reaction,antitoxic Ab-five serotype persist no crass reaction

6. So,reinfection is possible especially pharyngitis Epidemic features 1.season:every season,winter and spiring 2.age: every age,children 3.distribution of district Change of disease

7. Pathogenesis and pathology  Suppurative lesion:local-streptococcus LTA adhere to epithelial cells and go into tissue M protein resists phagocytosis(facilitate) Hyaluronidase,streptokinase and hemolysins result in extension of inflammation and tissue necrosis  Toxic lesion:general and organs-erythrogenic toxin erythrogenic toxin and other substances- general toxic symptoms:fever, headache and bad appeptite,

8. skin:vascular congestion,eruption signs:hepatomegaly and splenomegaly lymphonode fatty degeneration and congestion,myocardia and kidney injury.  Allergic lesion:complications myocarditis,myo calves and joints,base membrane of kidney are injured  return return

9. Clinical manifestation  Incubation period:2-3days(1-7days)  Typical type: 1) Fever:39 ℃,1week 2)Pharyngitis:red exudation sore 3)Rash:24h after fever,diffuse erythema,1mm,pastauricular-neck-chest-limbs 4)companied signs:circumoral pallor,pastia’s lines,raspberry tongue-strawberry tongue. 5)desquqmqtion 6)No pigmentation  return return

10. type  Septic type  Toxic type  Surgical or puerperal type  Mild type  Typical type

11. Complications  Rheumatic fever  Glumerulonephritis  Arrhritis

12. Laboratory findings  Blood Routine:WBC10-20X10 9 /L,N>80%  Urine Rt: protein uria,cast renal complication  Bacteriological examination: swab or secretion-culture  Dick test:

13. Diagnosis and Differential Diagnosis  Staphylococcus aureus infection Primary septic site or transmission site or no pharyngitis or pathogen  Drug eruption using drug or no pharygitis or relieve after stopping or pathogen  Streptococcus mi ti infection sever or liver and kidney injury-shock or pathogen

14. Treatments  General therapy Isolation 7 days, temperature, puls, BP, glucose, liquid  Treatment according to symptoms  Pathogen therapy penicillin or erythromycin or cefotomycin adult: 5-7d; child: 10d  Complications therapy  Carrier penicillin 7days

15. Prevention  Control the source of infection isolation patient, treat carriers and pharyngitis for 7 days  Interruption of route of transmission mask,disinfect to secrations and infection substances  Protect to susceptible populations no vaccine  END