We recently had three cases of scarlet fever in our clinic. Today, we will talk about the past life of scarlet fever. Scarlet fever is one of the most common infections caused by viruses, but it can also be caused by bacteria. Scarlet fever is called “rotten throat gua” or “rotten throat dan gua” in Chinese medicine. As the name implies, the clinical manifestations of scarlet fever in children are mainly fever (inflammation), pharyngitis (rotten throat), and a diffuse bright red rash (gua sha, dan gua sha) over the whole body, with flaky skin flaking during the recovery period. It is an acute rash whistling infectious disease caused by infection with group A beta-hemolytic streptococcus that produces red rash virus. In some children, non-suppurative metaplastic diseases such as rheumatic fever and glomerulonephritis can occur 2-3 weeks after the disease. Why does the doctor insist on taking antibiotics for 10 days-2 weeks after getting scarlet fever? This is to prevent rheumatic fever and glomerulonephritis, which are possible sequelae of scarlet fever! Once you get rheumatic fever (joint swelling and pain with fever soon after streptococcal infection), it can involve the heart valves, and heart valve disease can stay with the patient for the rest of his or her life, and the same is true for kidney disease. Erysipelas-producing group A beta-hemolytic streptococcus is a bacterium that is very close to us and can often be examined in the pharynx of healthy children. 100 healthy children may have this bacterium found in the pharynx of at least 5 children. Usually this germ has little effect on the child’s body, but it can become ill when they become too strong or when some reason allows them to multiply. Typical clinical manifestations of scarlet fever: incubation period (the period between when the virus invades the body and the onset of the disease) 1-12 days, rapid onset, fever mostly lasting about 39°C, sore throat, headache, abdominal pain, and general malaise. However, there is usually no runny nose or cough. Physical examination shows redness and swelling of the pharyngeal isthmus and tonsils, with dotted and flaky yellowish-white exudate on the surface. The mucous membrane of the soft palate is congested and edematous, and the tongue body is covered with white moss, and the red and swollen tongue papillae protrude beyond the white moss, which is obvious at the tip of the tongue and the front edge of the tongue, becoming a strawberry tongue; after 2-3 days, the tongue moss falls off, and the tongue surface is smooth and bright beef-colored, with the papillae still protruding, called “prune tongue”. The lymph nodes in the neck and jaw may be enlarged and have pressure pain. The rash appears 1-2 days after symptoms such as sore throat and fever (some children may not have fever or sore throat), first behind the ears, neck and upper chest, and rapidly throughout the body within a day. Some itch but it is not severe. The skin is diffusely congested with a dense, evenly spaced, congested rash with uniformly elevated hair follicles, a “chicken skin rash”. There is no normal skin between the rashes, and the rashes all fade with hand pressure and reappear after removal of pressure. Rarely, a hemorrhagic rash can be seen. In the axillae, elbow folds and other skin folds, purplish red lines are formed. The flushing of the face and the relative pallor around the mouth and lips are called “circumpapillary pallor circles”. The rash peaks within 48 hours of presentation and then fades in the order of appearance, fading in 2-4 days. In a few cases, the rash may last up to a week. Most children begin to have flaky or large flakes of peeling skin at the end of the first week. The trunk is mostly bran-like peeling, the palms and soles of the feet where the skin is thick see more large membrane peeling, nail end chap-like peeling is the typical performance, peeling can last 2-4 weeks. In addition, the atypical symptoms are: 1, light (one of three cases): low fever or no obvious fever, short fever duration, pharyngitis, rash is not obvious. 2. Toxic: rapid onset with severe toxemia symptoms, such as high fever, headache, violent vomiting, confusion, and may be accompanied by toxic myocarditis and infectious shock. The rash is often purplish red or hemorrhagic. 3, surgical type: bacteria invade through the injured skin, so there is no pharyngitis and strawberry tongue, but localized purulent lesions, the rash first appears in the skin near the wound, and then spreads to the whole body. The tests that must be done in cooperation with the doctor are: 1, blood routine: the total number of white blood cells increased, most up to 10 to 20 × 109 / L, neutrophils increased by more than 80%, CRP increased. Eosinophils were not seen at the beginning, but increased during the recovery period. 2, urine routine: 1 week, 2 weeks, and 2 months after the disease is not regularly tested. If necessary, pathogenic/serological tests: anti-chain “O” positivity can be detected from 1-3 weeks after infection to several months after recovery. Since scarlet fever is a Class B infectious disease (i.e., an infectious disease that requires strict management) in China, parents must actively cooperate with the doctor to prevent the spread of the disease.