級課件-兒傳猩紅熱

Scarlet猩紅 ScarletfeverisanacuterespiratoryinfectioncausedbyGroupAβ-hemolyticstreptococci(GAS,S.Pyogenes)whichproduceerythrogenictoxins. Fever,pharyngitis,scarletmaculesovergeneralizederythema,anddesquamationinconvalescentstage.Streptococciaregram-positivecoccithatgrowinpairsorvariable-lengthchainsCompleteβ-hemolyticPartiallyα-hemolyticNoγ-hemolytic一、 不溶血丙型 部份溶 甲型 完全溶血乙型C抗

A~HK~V20群（組M蛋 猩紅熱病原：A組乙型（β）溶血性鏈球菌VirulenceofGroupAβ–hemolytic(S.StructuralcompositionsofLipoteichoicacid(LPA)MproteinFibronectin-bindingprotein(proteinF)ThecellwallreceptorErythrogenictoxinsErythrogenictoxinsareresponsiblefortherash,fever,pusformationofscarletfever.Therearethreeantigenicallydistincterythrogenictoxins:typeA,B,andC. Antibodiestotheerythrogenictoxinspreventdevelopmentofarashbutdonotprotectagainsttheunderlyinginfection.VirulenceofGroupAβ–hemolytic(S.StructuralcompositionsofExtracellularproductsofErythrogenictoxins(Pyogenicexotoxins)HyaluronicAcidCapsuleHemolysinO,HemolysinS(SLO&SLS)Streptokinase(SK)Streptodornase(SD)SourcesofInfectionHighlyinfectivestagerangesfrom24hoursbeforesymptomappearingtothefastigiumofBacterianose,mouth,throat,respiratorytractandskinRoutesofrespiratorydropletsdirectindirectPopulation Thediseasemostcommonlyaffectspre-schoolageandschoolagechildren. 80%of10-years-oldchildrenhasdevelopedlifelongprotectiveantibodiesagainstErythogenicIncidenceislowestamongPopulationpost-infectiousantibacterialantitoxic抗菌免 抗毒免post-infectious+-+--++-sufferfrom????Epidemic Circulatingtrend:casesofscarletfeverhavebeendecreasingandbecamemilderinthelastfiftyyears.Themortalitydroppedfrom10-20%in1930stolessthan1%in1990s.Severecasesrarelyhappennowadays. Peakseason:casescanbeobservedaroundthewholeyearbutaremostprevalentinwinterandspring.咽峽炎、化膿性扁桃A組乙溶血 飛

釋 毒血癥狀：發(fā)紅 入毒皮

全身不真皮層毛細(xì)血管 皮膚彌漫性充血發(fā) 毛囊周圍 粟粒膚表皮細(xì)胞角化、壞 脫屑或脫Incubation1-7daysfromexposuretotheonsetofTheaverageis2-4TypicalscarletMildscarlet LikeSyndrome(STSS) SurgicalScarletFeverandPuerperalScarletProdromalRashConvalescentProdromalperiod:1~2----Whitestrawberry--Toxicsymptoms:Chills,headache,vomiting,myalgias,andmalaise--TenderSubmaxillary&cervicalRash

Within24-48hoursafter----Redstrawberry----Toxic----TenderSubmaxillary&cervicalConvalescent--Feverandsubsidewithdisappearanceof--Thedurationandextentofdesquamationvarywiththeintensityoftherash.Itmaycontinueforaslongas6wk.------Mildscarlet Actuallymanychildrenwithactiveinfectionmayhavemildersymptoms,withonlyafewofslight Highrateofmisdiagnosisandmisseddiagnosisintheout-patientclinic. Somemildcasesofscarletfeverwillgoawayinaboutaweekevenwithouttreatment.------StreptococcalToxicShock-LikeSyndrome Beassociatedwithstreptococcalstrainsthatproducethepyrogenicexotoxins paniedbysystemDifficulttodistinguishfromstaphylococcalTSSuntilresultsofculturesareobtained------Surgicalscarlet-----Surgicalscarlet-----Puerperalscarlet Scarletfeveroccasionallyhappensaftertheinfectionofsomepartofthefemalereproductiveorgans(,vaginaanduterus)followingachildbirthoranabortion,alsocalledchildbedfever. Casesoffeverof38℃andhigherduringthefirst10daysfollowingdeliveryormiscarriage.ExtensionfromtheSinusitis,Otitismedia,Mastoiditis,Cervicallymph-adenitis,Retropharyngealorparapharyngealabscess,Peritonsillarabscess,Bronchop HematogenousSepsis,Meningitis,Osteomyelitis,Septicarthritis,Brainabscess,IntracranialvenoussinusthrombosisToxichepatitis,toxictoxicmyocarditis,toxicThroatswabThroatcultureisthecriterionstandardforconfirmationofgroupAstreptococcalDirectantigenRapidantigenStreptococcalantibodyAnincreaseinanti–streptolysinO(ASO)titerscanbeobservedwithinthefirst3-6wkafterinfection.ASOtestisusedtoconfirmpreviousgroupAstreptococcalinfection.ASOtitersmaybemodifiedorabolishedearlyandeffectiveantibioticCompletebloodWhitebloodcell(WBC)countinscarletfevermayincreaseto12,000-16,000/mm3,withadifferentialofupto95%neutrophilExposuretoscarletTheabruptonsetofFever,pharyngitis,headache,vomiting,malaise, Atypicalofthesandpaper-likerashin24-48hrfollowingtheonsetoffeverandspreadingalloverthebodywithin24hrPastia'sCircumoral WhitestrawberrytongueorredstrawberrySepsiscausedbyErythrogenictoxin-producingstrainsofStaphylococcusaureus.DrugKawasakiDiseaseKeyPointsfor(1).Pharyngitis(2).24-48hrintervalbetweenfeverandonsetof (3).Specificrash(4).IncreasedWBCcountandNC Pre-schoolageandschoolagechildren(6).GoodcurativeeffecttoPenicillinPenicillinPenicillin50,000-200,000u//kgddividedbidfor7-20~30mg/kg/ddividedbidfor7-10Completionoftheantibioticregimenisquiteessential!Afterantibiotictreatmentfor1-2days,thefever,rash,andothersystemicmanifestationswillsubsiderapidly,andthechildrenmaylookwell,buttheregimenofantibioticshouldbecontinuetoeliminatethesmallamountofbacteriaremainedinthebodyinordertopreventrelapseandcomplications.Anti-pyretic(paracetamol)canbewhennecessaryforfever,headacheorthroatEatingsoftfoodsanddrinkingplentyofcoolliquids,particularlyifthethroatisverypainful.Oralantihistaminesorcalaminelotiontorelievetheitchofrash.Patientshouldbeisolateduntil24hafterantibiotictreatedControlofsourcesofAbruptthewaysofProtectthe Itisaseverediseaseinthepre-antibioticerabecauseofitscomplications.Theprognosisforadequa