Scarlet fever

Scarlet fever
Scarlet fever is an acute respiratory tract infectious disease, regard generate heat, pharyngitis and rash as the characteristic.



The cause of disease is studied

Dissolve courageous and upright streptococcus for different the intersection of A and the intersection of group and , because the intersection of protein and difference of antigen, M of germ, divide for being 80 type (t y p e) ,Various can produce the corresponding specific antibody, the immunity that do not cross. Cause the hot toxin to have three kinds A, B, C, after infecting one kind of them, meets other any ones, can still take place the second time or the third scarlet fever, but this kind of chance is few.


Pathology changes

It is causing inflammation and suppurative change that products such as pathogens and the toxin,etc. are invading position and surrounding tissue, and enter blood circulation and cause septicaemia, cause the hot toxin to cause generating heat and red rash. The main pathologic change one layer of capillaries of dermis of skin congests, edema, it by inflammation ooze out,skin around hair follicle edema, at soak cell cell hyperplasia and inflammations leather, shown as papule and one kind of chicken's rashes, angle of convalescent epidermis, necrosis, the film is lossed. Minority can be seen poisoning myocarditis, changes such as liver, spleen, lymph node congestion,etc..


Clinical manifestation

Incubation period is generally 2- 4 days, only 1 most days, it is the 7 days longest. Get up disease to be worried and sudden, shiver with cold, generate heat, body temperature 38-39 generally, can reach over 40 while being getting in weight. Infant and pre-school children have persons who happens fainting from fear or delirium. Infant's whole body discomfort, swallow and ache obviously, influence and take food. Swallow and the tonsil is prominent and congested, also can see suppuration and ooze out things. Tongue quality red, papilla if red swelling raise berry, call the intersection of berry and tongue Yang. The lymph gland increases under shank and jaw, touch a tender spot.

Rash presents after having illness coming on rapidly, see in the armpit, groin and shank at first in about 24 hours, spread all over whole body in 24 hours. For fill the air getting scarlet to invite the intersection of syringe needle and large light papule, touch like the coarse sandpaper kind rash, or cover one kind of rashes of chicken like cold hour, the skin is flush among rash, can turn white to press temporarily with hands. The cheek one is flush and having no papule, but the skin is pale around the mouth, it is a pale circle of week of mouth. Wrinkle and roll over the place such as axillary, elbow, groin of place on the skin, rash is intensive, the color is dark and red, there is great bleeding of pinpoint that is clicked during that time, take shape dark red walk crosswise " Solicit the handkerchief " ,( Pastia 's sign) . The mucous membrane of oral cavity also can see mucomembranous rash, congest or bleed some. The rash one happens to still generate heat.

The course of disease begins to take off the bits on the first weekend, it is characteristic one of the symptoms scarlet fever, first published on the face, time and truck, then reach limb and hand vola. The face takes off the bits, truck and brothers' possible large stretch of decortication, take the form of glove ankle socks. It relates to weight of rash to take off the intensity of bits, generally take off netly in 2- 4 weeks, does not leave over pigmentation.

The skin is transferred to testing in vain to cause the hot toxin antibody through intradermal injection, observe whether infant's rash is in order to cause due to hot toxin. Dick (Dick) The test is injected and caused the hot toxin, measure and have in the body for the general type, but the clinical weight is with a wide gap, having especially had treatments of specific penicillin, very great change takes place in the manifestation of scarlet fever, infect and seldom happen seriously.

(1) Lack characteristic symptom in all light courses of disease, last 1- 2 days or not generate heat, rash is not extremely typical, can be only limited to the armpit, groin, rash is rare and the color is light, 1- retreat promptly in 2 days. Have the intersection of berry and tongue Yang. After the 1 week such as onset, mean toe end find and take off the bits or peel slightly in denomination portion, the intersection of ear and shell, brothers, just consider the diagnosis of scarlet fever at this moment. Because easy to leak, examine, fail, go on, treat fully, continue, send to have more more possibilities instead nephritis.

(2) The poisoning unexpected body temperature is entered and up to over 40.5 , it is obvious to be poisoned symptom all over, faint from fear, vomit, have a headache commonly, swallowing department and soft palate congest seriously, and there are red macule, the tonsil has suppuration natures that oozes out things, or form necrosis, ulcer, present one kind of damages of false membrane. Rash presents quickly, often more silt are clicked. If can amalgamate suppuration and poisonous symptom if not treating in time, swallow a part of abscess forming, amygdaline ulcer around, can expand to infect to the auris media, mastoid process, upper jaw sinus; The lymph node is obviously swelling or weaves inflammation; It is septicaemia, shock to be getting serious, can also continue and send the migrating purulent focus.


Diagnosis

The typical case is diagnosed relatively briefly, infant's peripheral blood leucocyte and neutral cells increase. Make a definite diagnosis of and need to swallow and wipe away and train group A and dissolve the courageous and upright streptococcus positively. There is no enough antibody. Because the toxin is more than one kind, it diagnoses the meaning is limited.


Differential diagnosis

It can cause pharyngitis that a lot of etiologies are infected with, a lot of diseases present rash or scarlet fever and one kind of rashes too, should pay attention to distinguishing in clinic. If viral pharyngitis, infective monocyte increase disease, diphtheria; Rash disease measles, nettle rash, drug rash, prickly heat in summer happen; And golden yellow staphylococcus is infected with, lopsided and ill, etc in Sichuan.


Prevent

There is not active immunity preparation in this disease at present, ones that prevented from focusing on controlling infecting were disseminated. Isolate infants, remove and isolate after to swallow training continuously negatively twice. To weak close contact with low immunological function person, should obey the compound new promise bright or inject penicillin to prevent. The carrier should accept the penicillin treatment of 10 days.


Prognosis

Find early, can be cured to treat quickly with penicillin for a long time. Serious disease patient and already seldom seeing with the serious purulent focus person, but nephritis or rheumatic fever of allergy takes place after scarlet fever resumes.


Treat the measure

Penicillin treats the first-selected antibiotic that scarlet fever and all streptococcus are infected, generally inject penicillin G, 7- 10 days of course of treatment, swallowed and trained after medicines stopped. Can take the allergic one of penicillin orally with erythromycin, or the very beginning spore's fungus plain type medicine, the course of treatment is no less than 7 days. The heavy one can be intravenous to give medicines or two kinds of antibiotic to unite application.

Acute infants should stay in bed, bigger children are included and gargled with warm light brine; The diet is with the liquid, semi-fluid; The skin keeps clean, can give lotion of calamine in order to reduce pruritus.


Scarlet fever
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