Scarlet fever Introduction 1 A kind of acute infectious 1 A kind of acute infectious disease of...

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Scarlet fever Scarlet fever Introduction Introduction 1 A kind of acute infectious 1 A kind of acute infectious disease of respiratory tract disease of respiratory tract 2 2 Group A Group A β-hemolytic β-hemolytic streptococcus streptococcus 3 Main 3 Main clinical manifestation: clinical manifestation: acute fever acute fever pharyngitis pharyngitis diffuse and red exanthem(ras diffuse and red exanthem(ras h) h)

Transcript of Scarlet fever Introduction 1 A kind of acute infectious 1 A kind of acute infectious disease of...

Page 1: Scarlet fever Introduction 1 A kind of acute infectious 1 A kind of acute infectious disease of respiratory tract disease of respiratory tract 2 Group.

Scarlet feverScarlet feverIntroduction Introduction 1 A kind of acute infectious1 A kind of acute infectious

disease of respiratory tract disease of respiratory tract

2 2 Group A Group A β-hemolyticβ-hemolytic

streptococcusstreptococcus

3 Main3 Main clinical manifestation:clinical manifestation:

acute fever acute fever

pharyngitis pharyngitis

diffuse and red exanthem(rash)diffuse and red exanthem(rash)

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desquamation and hyperpigmentationdesquamation and hyperpigmentation

**************

2~3weeks later2~3weeks later

rheumatic feverrheumatic fever

glomerulonephritisglomerulonephritis

arthritisarthritis

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Etiology Etiology Group A Group A β-hemolytic streptococciβ-hemolytic streptococci

1 Morphology and structure1 Morphology and structure Gram-positive spherical cocciGram-positive spherical cocci Diameter: 0.6~1.0 Diameter: 0.6~1.0 μmμm Capsule(+) flagellum and spore(-)Capsule(+) flagellum and spore(-)Streptococcus groups: A~H & K~U on the basis of Streptococcus groups: A~H & K~U on the basis of C-carbC-carb

ohydrateohydrate within the cell wall within the cell wall Group A : more than 80 immunologically distinct typeGroup A : more than 80 immunologically distinct type

s that are based on differences in the s that are based on differences in the M protein.M protein.

2 Pathogenecity 2 Pathogenecity M protein:M protein: resists phagocytosis resists phagocytosis

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the major virulence factorthe major virulence factor

to neutrophils and plateletsto neutrophils and platelets

Capsule:Capsule: resist phagocytosis resist phagocytosis

Lipoteichoic acid:Lipoteichoic acid: another another

virulence factorvirulence factor

bind to fibronectin on bind to fibronectin on

the surface ofthe surface of

epithelial cellsepithelial cells

Pyrogenic toxin:Pyrogenic toxin: produce rash, fever produce rash, fever

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resist phagocytosis,resist phagocytosis, promote Schwartzmanpromote Schwartzman reaction reaction StreptokinaseStreptokinase

StreptodornaseStreptodornase

Streptolysin O & S:Streptolysin O & S: WBC, RBC & platelet WBC, RBC & platelet

Hyaluronidase:Hyaluronidase: hyaluronic acid hyaluronic acid

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EpidemiologyEpidemiology 1 Source of infection: 1 Source of infection:

PatientsPatients in scarlet fever or in scarlet fever or

pharyngitispharyngitis

CarriersCarriers with streptococci in nasal and with streptococci in nasal and

pharyngealpharyngeal

2 Route of transmission: 2 Route of transmission:

droplet, skin lesion, food, milkdroplet, skin lesion, food, milk

and water and so on.and water and so on.

3 Susceptibility of population3 Susceptibility of population

Anti-bacterium immunityAnti-bacterium immunity anti-M anti-M

Anti-pyrogenic toxin immunityAnti-pyrogenic toxin immunity

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4 The feature of epidemiology4 The feature of epidemiology

season, age, endemic area, variation of this disease* season, age, endemic area, variation of this disease*

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PathogenesisPathogenesis 1 Suppurative change1 Suppurative changePathogen----epithelial cells----diffusion in local tissuePathogen----epithelial cells----diffusion in local tissue LTA hyaluronidaseLTA hyaluronidase M protein streptokinase, streptodornaseM protein streptokinase, streptodornase capsule streptolysincapsule streptolysin -----------suppurative change-----------suppurative change pharyngitis, tonsillitispharyngitis, tonsillitis peritonsillar abscessperitonsillar abscess retropharyngeal abscessretropharyngeal abscess otitis media, sinusitisotitis media, sinusitis lymphangitic-----lymphadenitislymphangitic-----lymphadenitis bacteremia(sepsis, osteomyelitis,bacteremia(sepsis, osteomyelitis, pneumonia)pneumonia)

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2 Toxic change2 Toxic change pyrogenic exotoxin (erythrogenic exotoxin)pyrogenic exotoxin (erythrogenic exotoxin)

feverfeverscarlatina rash scarlatina rash

other toxic symptomsother toxic symptoms

3 Allergic reactive change3 Allergic reactive change

2~3weeks later, 2~3weeks later, Heart-------rheumatic feverHeart-------rheumatic fever Kidney-----glomerulonephritisKidney-----glomerulonephritis joint---------arthritisjoint---------arthritis reason: 1)similar antigen----crossed immunereason: 1)similar antigen----crossed immune reactionreaction 2)immune complex2)immune complex

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Clinical manifestationClinical manifestation

Incubation periodIncubation period 2~3days(1~7days)2~3days(1~7days)

Character of clinical manifestation:Character of clinical manifestation:

Fever Pharyngitis scarlatina rashFever Pharyngitis scarlatina rash

1 Fever1 Fever

1) feature: persistent, 1) feature: persistent,

fever & rash*fever & rash*

2) tem. : 39~40℃2) tem. : 39~40℃ 3) accompanied symptoms: 3) accompanied symptoms:

headache, weakness, poor appetite headache, weakness, poor appetite

4) course: 1 week4) course: 1 week

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2 Pharyngitis2 Pharyngitis symptomsymptom signsign3 Rash3 Rash 1) fever & rash**: 1) fever & rash**: 24 hours24 hours 2) initial position: ear , neck, upper chest2) initial position: ear , neck, upper chest 3) feature: diffuse papular(punctate or finely)3) feature: diffuse papular(punctate or finely) miliary sudamina (not so many)miliary sudamina (not so many) circumoral pallorcircumoral pallor strawberry tonguestrawberry tongue red strawberry tonguered strawberry tongue Pastia lines(antecubital fossate)Pastia lines(antecubital fossate) desquamation and hyperpigmentationdesquamation and hyperpigmentation

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Type of clinical manifestationType of clinical manifestation

light typelight type

toxic typetoxic type

sepsis typesepsis type

surgery typesurgery type

obstetrics typeobstetrics type

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Laboratory examinationLaboratory examination

1 peripheral picture: WBC, neutrophil 80%1 peripheral picture: WBC, neutrophil 80%

2 Urine allergic reaction : protein RBC, 2 Urine allergic reaction : protein RBC,

WBC, cylindruria WBC, cylindruria

3 bacteriology test: Immunological3 bacteriology test: Immunological

fluorescence fluorescence

assay(IFA) assay(IFA)

bacteria culturebacteria culture

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ComplicationComplication 2~3 weeks later2~3 weeks later

rheumatic feverrheumatic fever

glomerulonephritisglomerulonephritis

arthritisarthritis

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DiagnosisDiagnosis

1 clinical data: fever, pharyngitis, rash 1 clinical data: fever, pharyngitis, rash

2 laboratory test: peripheral picture,2 laboratory test: peripheral picture,

UrineUrine

Bacteriology testBacteriology test

Dick test ( pyrogenic test)Dick test ( pyrogenic test)

3 epidemiology data3 epidemiology data

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Differential diagnosisDifferential diagnosis

1 staphylococcus infection1 staphylococcus infection

2 drug rash 2 drug rash

3 Virus rash3 Virus rash

measles, rubella etc.measles, rubella etc.

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TreatmentTreatment

1 penicillin adult: 801 penicillin adult: 80 万万 U/ time, bid 5~7days.U/ time, bid 5~7days.

child:20child:20 万万 U/(kg d), 10daysU/(kg d), 10days

800800 万万 U/d(adult)U/d(adult)

2 erythromycin2 erythromycin

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Prevention Prevention

1 Isolation: patients in scarlet 1 Isolation: patients in scarlet

feverfever

2 protection: 2 protection: