猩红热4 visiting the 课件

Visiting the Doctor Your subtitle goes here 猩 红 热 Scarlet fever 北京大学第三医院 崔蕴璞 2. Epidemiology Contents 1. Etiology 4. Differential Diagnosis 3. Clinical Manifestations3. Clinical Manifestations Group A hemolytic streptococcal pyogenes. Etiology GAS 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 2. Epidemiology Contents 1. Etiology 4. Differential Diagnosis 3. Clinical Manifestations Epidemiology Epidemiology 传染源： q 患者 q 健康带菌者 Epidemiology 传播途径： q呼吸道飞沫 q食物、玩具间接经口 q皮肤伤口 Epidemiology 易感人群： q37岁儿童 流行季节: Epidemiology WinterSpring 2. Epidemiology Contents 1. Etiology 4. Differential Diagnosis 3. Clinical Manifestations3. Clinical Manifestations 分 期 Incubation period 潜伏期 Prodromal period 前驱期 Rash period 出疹期 Convalescent period 恢复期 Incubation period 17days,mean 3days No symptoms and signs Common Type Incubation period Prodromal period Rash period Convalescent period Prodromal period Fever Headache Abdominal pain Swollen glands in the neck Sore throat White strawberry tongue Prodromal period Purulent tonsillitis Prodromal period White Strawberry tongue Normal tongue Common Type Incubation period Prodromal period Rash period Convalescent period Rash period Rash appears Whithin 24 48h after onset of fever In 1224h diffused to the whole body Pastias lines Pastias lines Modality of the rash a difffuse,fine papular Sunburn with goose pimples Touch of the rash fine sandpaper Circumoral pallor Red Strawberry tongue By the 3rd or 4th day the white coat peel off Common Type Incubation period Prodromal period Rash period Convalescent period Convalescent period Rash Vanish in 24 days Rash begin to fade at the end of the 1st week 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 Desquamation usually the last to desquamate not until the 2nd or 3rd week Desquamation Desquamation Characteristic Manifestations Fever Typical rash Strawberry tongue Pastias lines Circumoral pallor Desquamation 2. Epidemiology Contents 1. Etiology 4. Differential Diagnosis 3. Clinical Manifestations Differential diagnosis vRubella 风疹 vMeasles 麻疹 Differential diagnosis vVaricella 水痘 Differential diagnosis Case p A seven year old boy presents with fever for one day, the temperature rises to 39.5 , p He felt unwell flesh and fell, and complaining sore throat and headache, p Rash was detected in this morning Case p PE: T 38.6, RR 32/min, HR 110 beats/min. p The mantal status is fine p The throat is red, and the tonsils are enlarged, reddened, and covered with patches of exudate. p The skin is covered with tiny red spots p No abnormal sign is found in lung, heart and abdomen. Summary Scarler fever is an acute infectious disease caused by group A hemolytic streptococcal pyogenes Clinical features :Fever, Sore throat, Typical rash, Pastias lines, Circumoral pallor, Desquamation STSS: invasive GAS, shock