*For medical professionals only
Beware of this infectious disease
Written by | Yang Yunfei, Wu Jun
Your child presents with a high fever and rash
At 7 p.m., a 7-year-old boy, Ning Ning, came to the outpatient clinic.
Chief complaint: fever for 5 days, rash for 4 days.
History of present illness: Ning Ning had fever without obvious cause 5 days ago, body temperature reached about 39.5 °C, no chills, chills, no limb convulsions, no cough and sputum, no vomiting and diarrhea, a rash appeared 4 days ago, and gradually spread to the trunk and limbs, with a miliary red rash that faded under pressure. During the course of the disease, the child was in good spirits, had poor food intake, sleep, and normal bowel and bowel movements.
Physical examination: clear consciousness, spirited, dense miliary red rash on the skin of the whole body, protruding skin surface, fading of pressure, palpable little swollen lymph nodes on both sides of the neck, soybean-like size, mobile, no tenderness, no deformity of the skull, equal pupils of equal size, sensitive to light, chapped lips, bayberry tongue, pharyngeal congestion, enlargement of tonsils II.-III.°, soft neck, no resistance, steady breathing, no inspiratory reveal signs, slightly coarse breath sounds in both lungs, no obvious dry and wet rales were heard, heart rate 106 beats/min, rhythm, There was no obvious murmur in the auscultation area of each valve, the abdomen was soft, there was no tenderness, no rebound tenderness, muscle tension, not reaching the mass, the liver and spleen were not subcostal, the fingers (toes) were hard and swollen, the molt could be reached, there was no molting around the anus, there was no edema in both lower limbs, the Pap sign was negative, the Brinell sign was negative, and the Klinefelter sign was negative.
Ancillary tests: blood routine + CRP: leukocytes 20.1x109/L↑, neutrophil percentage 70.9%↑, platelets 312x109/L, hemoglobin 129g/L, hypersensitive C-reactive protein 100mg/L ↑.
Fig.1 Pinpoint rash
Fig.2 Bayberry tongue
Fig.3 Flaky peeling after the rash recedes
Q
Seeing this, do you know what Ning Ning's diagnosis is? How can it be treated?
Bibliography:
[1]. Scarlet fever protocol (2023 edition)
[2]. YU Dingle, LU Qinghua, YOU Yuanhai, et al. Expert consensus on the diagnosis, treatment and prevention of diseases related to group A streptococcal infection in Chinese children. Chinese Journal of Practical Clinical Pediatrics, 2022, 37(21): 1604-1618. DOI: 10.3760/cma.j.cn101070-20220815-00974
[3]. Li Jia. Clinical diagnosis and treatment of scarlet fever in children[J]. International Journal of Pediatric Research, 2022, 2(2). DOI:10.12208/j. ijped. 20220015.
[4]. Pan Shanshan, Wang Jing, Clinical diagnosis and treatment thinking of general medicine: Pediatric fever with rash. Chinese Journal of General Practice, 2021, 24(11): 1441-1444. DOI: 10.12114/j.issn.1007-9572.2020.00.524
Editor in charge: Moon
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