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Abstract: The child was 6 years old and was in good health. He came to the hospital with a fever and rash for 1 day. He had a fever with sore throat and skin rash 1 day ago and came to our hospital for further consultation.
Basic information】Male, 6 years old
Type of disease】Scarlet fever
Hospital】The 988th Hospital of the People’s Liberation Army Joint Security Force
Time of consultation】December 2019
Treatment plan】Medication (anti-infection with sodium penicillin for injection + antipyretic patch + Shuanghuanglian oral solution + 5% glucose injection + vitamin C injection)
【Treatment cycle】Inpatient treatment for 9 days, 2 weeks follow-up
Treatment effect] The condition has been controlled, clinically cured, and the symptoms are relieved
I. Initial consultation
The child developed fever with a maximum temperature of 39℃, accompanied by sore throat, and was given oral symptomatic treatment with Shuanghuanglian oral liquid, Lianhua Qingfei granules and acetaminophen extended-release tablets. On examination, the pharynx was congested, the tonsils were not enlarged, purulent secretions were visible, the tongue was covered with white moss, and the papillae were red and swollen and elevated. Blood test: WBC: 12.4×10^9/L, neutrophil ratio: 85.3%, lymphocyte ratio: 10.9%. On examination, diffuse, congested, pinpoint-sized papules with uniform distribution were seen all over the body, discolored by pressure and accompanied by pruritus. A thread-like rash was seen in the axillae and thigh folds. The child’s mother complained of having received measles vaccination, and the preliminary diagnosis of scarlet fever was made on the basis of the child’s condition.
Treatment
After admission, further examination of the purulent pharyngeal secretions was performed, and streptococci were cultured. On the third day after the onset of fever, the child developed a pronounced prune tongue. The final diagnosis of scarlet fever was made by combining the relevant examination and changes in the child’s condition. The child was given anti-infection penicillin sodium for injection, antipyretic patch and Shuanghuanglian oral solution to reduce fever, and 5% glucose injection plus vitamin C injection for rehydration.
III. Treatment effect
After the above comprehensive treatment, the child’s fever was gradually improved, the rash began to subside, accompanied by obvious flaking, the tongue coating returned to normal, and the sore throat symptoms also gradually improved, no discomfort after eating, and continued anti-infection and symptomatic treatment. 1 week later, the child’s condition returned to normal, the rash subside, and a small amount of flaking was visible. The child’s condition gradually improved, the symptoms of painful pharynx and purulent discharge basically disappeared, no obvious discomfort symptoms, diet and sleep returned to normal, and normal daily activities were not affected, and the routine blood tests returned to normal, and the child was discharged after 9 days of hospitalization. The child was discharged from the hospital with no discomfort symptoms for 2 weeks after discharge.
IV. Notes
I am really happy that the child has recovered so well. After the discharge, we instructed the child’s family to pay attention to the following points.
1. Pay close attention to the child’s symptoms and seek medical consultation if similar symptoms appear again.
2, wear a good mask when in contact with other people, to do a good job of protection and isolation, to reduce the chance of re-infection.
3. Pay attention to ventilation in the room to maintain fresh air and circulation.
4. Disinfect dishes and toys of children with the disease, preferably for separate use.
5.Avoid going to public places during the epidemic season of the disease. The disease is generally not contagious 24 hours after the child uses antibiotics, so do not worry too much.
V. Personal insights
Scarlet fever, like streptococcal pharyngitis, is more common in children than adults, and is common in children aged 5-15 years old. It is mainly transmitted by droplets and is clearly diagnosed by testing for streptococci. In winter and spring, children aged 5-15 years with fever, rash, sore throat and pus in the pharynx should consider the disease, and if some children have obvious tongue changes, the diagnosis is basically confirmed. In this case, the child has a prune tongue, which is a manifestation of the disease. The disease is preventable and treatable, but there are some children with severe cases. If a child develops this condition in winter and spring, it is important to actively seek medical attention in order to prevent delays.