Scarlet fever Introduction 1 A kind of acute infectious 1 A kind of acute infectious disease of...
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Transcript of Scarlet fever Introduction 1 A kind of acute infectious 1 A kind of acute infectious disease of...
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)
desquamation and hyperpigmentationdesquamation and hyperpigmentation
**************
2~3weeks later2~3weeks later
rheumatic feverrheumatic fever
glomerulonephritisglomerulonephritis
arthritisarthritis
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
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
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
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
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*
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)
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
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
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
Type of clinical manifestationType of clinical manifestation
light typelight type
toxic typetoxic type
sepsis typesepsis type
surgery typesurgery type
obstetrics typeobstetrics type
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
ComplicationComplication 2~3 weeks later2~3 weeks later
rheumatic feverrheumatic fever
glomerulonephritisglomerulonephritis
arthritisarthritis
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
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.
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
Prevention Prevention
1 Isolation: patients in scarlet 1 Isolation: patients in scarlet
feverfever
2 protection: 2 protection: