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Abstract: Since there are many types of streptococci, some are part of the normal flora of the respiratory and gastrointestinal tracts, and some are important pathogenic bacteria. And among them, group A streptococci are septic streptococci, which are β-hemolytic streptococci and can cause pharyngitis, impetigo, scarlet fever, and other diseases. In this case, the patient came to the clinic with a head, face, and neck rash, sore throat, cough, and yellow sputum, and was diagnosed with scarlet fever caused by group A streptococcal infection, which improved with anti-infective treatment with penicillin and medications such as pantoprazole sodium.
Basic information】Male, 15 years old
Type of disease】Scarlet fever
Hospital】Liaoning Provincial People’s Hospital
Date of Consultation】January 2018
Treatment plan】Isolation + anti-infective treatment (penicillin) + nutritional support (conversion sugar) + symptomatic treatment (pantoprazole sodium, suhuang cough capsules, antimicrobials)
[Treatment period] Hospitalization for 4 days, outpatient follow-up after 7 days
Treatment effect】Symptoms were relieved, all indicators returned to normal, and the condition improved
I. Initial consultation
A junior high school student, accompanied by his family, had a dense rash on the head, face and neck. The patient had a fever with no obvious cause 2 days ago, with a maximum temperature of 39.0℃, accompanied by sore throat, cough, and yellow sputum, and took paracetamol twice on his own. Last night, he found a rash around his body and went to the hospital. On examination, he had a body temperature of 37.6℃, a dense pinpoint-sized corn-like congested rash on his head, face, neck, trunk and extremities, a markedly congested pharynx, an enlarged right tonsil, no pus spots, no strawberry tongue, and a Papanicolaou line in the axilla. Based on many years of clinical experience, we made a preliminary diagnosis of scarlet fever and recommended hospitalization in isolation, to which the patient’s family agreed.
II. Treatment history
After admission to the hospital, relevant biochemical and bacteriological tests were further improved to clarify the pathogenic diagnosis. The clinical diagnosis of scarlet fever was confirmed after a review by a senior physician. The diagnosis was based on the following.
1. adolescents and of acute onset, presenting with the main morbid features of fever, pharyngitis and rash.
2. the patient had a congested pharynx with a typical congestive corn rash, the size of a pinpoint, and paresthesia lines visible in the axilla.
3. Routine blood tests suggested elevated white blood cells, predominantly neutrophils, and elevated calcitoninogen, both indicating bacterial infection, and bacteriological testing for group A streptococci.
According to the principles of treatment for scarlet fever, penicillin was given first. The patient had a negative penicillin skin test, so penicillin sodium was applied intravenously by drip. At the same time, due to the patient’s fever, weakness and little food intake, sodium pantoprazole was given to inhibit gastric acid, protect the gastric mucosa, improve the gastrointestinal symptoms, and give some nutritional support treatment, such as intravenous injection of conversion sugar, as well as oral administration of Su Huang cough capsules to stop the cough.
III. Treatment effect
Since the patient often exercised and was in good health, the effect of the medication was obvious, and no fever appeared after admission. Three days after admission, various abnormal indicators were improved and blood routine was completely normal. The family proposed to monitor the treatment at home, so it was suggested that the patient should be discharged home and isolated in a single room to avoid infecting others, and continue oral antimicrobial therapy, especially to observe changes in the condition to avoid the emergence of allergic diseases, causing plasma inflammation of the heart, kidneys and joint bursae. The family agreed to isolate the patient at home until 1 week of treatment and then follow up with the outpatient clinic. The patient will be discharged by appointment at the end of 4 days of hospitalization.
IV. Notes
We are glad that the patient’s symptoms resolved and her condition improved, and she was successfully discharged from the hospital, but we need to pay attention to the following matters.
1. scarlet fever is a bacterial infection, and special attention needs to be paid to the possible development of metaplastic disease at 2-3 weeks after discharge, manifesting as plasmacytic inflammation of the heart, kidneys, and joint bursae, which requires observation of changes in the condition after discharge and review at the hospital one week later.
2. Patients are advised to still pay attention to rest after discharge, maintain a light diet, gradually increase exercise, because the disease is contagious, so it is best to live in a single room at home, while paying attention to frequent indoor ventilation and disinfection of contact items, generally at least 7 days from the start of treatment is not contagious, and family members are advised not to resume school prematurely to avoid causing mass infection in school.
V. Personal insight
Scarlet fever is a typical infection of group A hemolytic streptococci, which can occur at any age, but is more common in children, and the prognosis is mostly good. However, the infection caused by group A streptococci is complicated, and can be a combination of septic, toxic, and allergic lesions, so it can be complicated by diseases such as myocarditis and glomerulonephritis, and can also be infected with life-threatening diseases such as toxic shock, and needs to be taken seriously. Usually pay attention to personal protection, enhance their own immunity to avoid infection. Once infected, actively seek medical examination and treatment to avoid post-infection sequelae and delayed treatment.