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

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

3. Group A hemolytic streptococcal pyogenes. Etiology GAS

5. 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

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

7. Epidemiology

8. 传染源：  患者  健康带菌者

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

10. Epidemiology 易感人群：  3~7 岁儿童

11. 流行季节 : Epidemiology Winter Spring

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

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

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

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

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

17. Prodromal period Purulent tonsillitis

18. Prodromal period White Strawberry tongue Normal tongue

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

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

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

23. Touch of the rash fine sandpaper

24. Circumoral pallor

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

26. Common Type Incubation period Prodromal period Rash period Convalescent period

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

28. 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

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

30. Desquamation

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

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

34. Differential diagnosis  Rubella 风疹

35.  Measles 麻疹 Differential diagnosis

36.  Varicella 水痘 Differential diagnosis

37. 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

38. 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.

39. 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

40. 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

41. 崔蕴璞 email:jessypupu@sina.com.cnjessypupu@sina.com.cn Tele:13521024549