确认过眼神，当冬天遇上了C位出道的链球菌--猩红热

俗话说，一场秋雨一场寒，十场秋雨穿上棉。伴随着大雪节气的到来，气温逐渐下降，我国大部分地区正式入冬。冬季也是一些呼吸道传染病的高发节季，比如流感，水痘，手足口病，诺如病毒， 猩红热等。最近的儿科门诊见了不少猩红热的案例，今天就和大家来聊一聊这个儿童期的常见疾病。

猩红热是一种细菌感染引起的导致红色皮疹的传染性疾病。猩红热的皮疹是一种典型的 “砂纸样”皮疹，由略凸起于皮面的密集的红色细小皮疹组成。猩红热最常见发生于5到15岁之间的学龄儿童，传染性很强。一般一年四季都有，但最常见于冬春季节。

What is scarlet fever?

Scarlet fever is an bacteria infectious disease that causes a rash. The rash of scarlet fever is typically a fine, "sandpaper-like" rash that consists of small, red bumps. Scarlet fever most commonly occurs in school aged children between 5 and 15 years old. It occurs throughout the year, but common in winter and spring.

猩红热由链球菌感染引起的常见细菌感染性疾病。确切地说，这是由A组乙型溶血性链球菌感染引起。除了猩红热，这种细菌还会引起我们平时所知道的链球菌性咽炎和脓疱疮。猩红热的皮疹是机体对这种链球菌产生的红疹毒素发生皮肤反应的结果。

What causes scarlet fever?

Group A beta-hemolytic Streptococcus infection is a common infection that can cause scarlet fever, as well as Streptococcal (strep throat) or impetigo (school sores). Scarlet rash is a result of skin reaction to the erythrogenic toxin that are produced by these bacteria.

猩红热是通过与被感染的人直接接触而传播的。常常是通过鼻腔和口腔的分泌物，比如，咳嗽和喷嚏的飞沫，握手等。

How is it passed on?

It is spread from direct contact with a person who is infected, usually through saliva and nasal discharge, such as droplets from cough and sneezes and shaking hands.  

一般在感染链球菌后2-4天出现症状。猩红热患者会出现红色皮疹，通常也会发生链球菌性咽炎。常见的初始症状一般是咽部疼痛。以下列出了猩红热患儿在皮疹出现以前最常见的初始症状，每个孩子表现出的症状可能会有所差异：

猩红热的皮疹开始于初始症状或发热出现后的1-2天。皮疹特点为弥漫充血性针尖大小的丘疹，摸上去手感略显毛糙，压之褪色，并伴有痒感。这种砂纸样皮疹一般始于颈部，前额，及上胸部，然后迅速蔓延至手臂腿部到全身均匀分布。皮疹一般不会遍布脸部，可能仅有双脸颊充血，口鼻周围不明显，相比之下显得发白，称为口周苍白区。皮疹一般于2-7天内先后开始消退。疹退后一周内开始皮肤脱屑或脱皮，通常见于手掌足底。脱皮可能持续2-6周。

What are the symptoms of scarlet fever?

It takes around two to four days to develop symptoms after being infected. A person with scarlet fever has a red rash and usually has strep throat, too. It often starts with a sore throat. The following are the most common initial (before the rash develops) symptoms of scarlet fever. However, each child may experience symptoms differently. Symptoms may include:

• Fever

• Sore throat

• Headache

• Vomiting

• Stomachache

• Strawberry tongue: white coating on the tongue initially which peels a few days later leaving the tongue looking bright red and swollen with small bumps, like a strawberry.

• feeling tired and unwell

The rash begins approximately one to two days after the initial symptoms or fever. Scarlet fever rash is a fine pinkish-red rash on the body that feels slightly rough to touch. The rash is itchy and will blanche (turn white) if press on it. This sandpaper-like rash typically is noted on the neck, forehead, and chest and then may spread to the arms and back. The rash doesn’t usually cover the face but the child may have flushed cheeks, while the area around their mouth stays pale. The rash usually begins to fade after two to seven days. The outer layers of the skin may peel (usually on the hands and feet) after one week. This may last for up to two to six weeks after the original rash has faded.

猩红热的诊断是根据孩子的病史和体格检查结果。猩红热的皮疹是具有特征性而且比较容易识别的。另外，医生可能会做一个咽拭子做快速链球菌检查以帮助确定是否存在链球菌性咽炎，这个可以帮助快速诊断链球菌感染。如果结果是阴性的，医生可能会加送咽拭标本做咽部细菌培养检查以确认是否存在A组链球菌感染。

猩红热是一个需要传报的传染性疾病。在就诊明确诊断后医生必须要报告给地方的疾控中心以作为监测传播的数据。

How is scarlet fever diagnosed?

Your child's doctor will make the diagnosis based on a complete medical history and physical exam. The rash of scarlet fever is unique and may be easily recognized by your child's doctor. In addition, your child's doctor may order a throat swab and perform a rapid strep test to confirm the diagnosis of strep throat as the source of the scarlet fever. This may immediately test positive for Group A Streptococcus. However, if it is negative, part of the throat swab may be sent for a throat culture to further identify if there is any Group A Streptococcus present.

Scarlet fever is a notifiable disease. This means your doctor must report each case to the local Centers for Disease Control, so the spread of the disease can be monitored.

猩红热的治疗与链球菌性咽炎一样，医生会处方合适的抗生素给家长，服药后数天内就会明显好转。一般来说，青霉素类药物是是猩红热的首选抗生素，但如果对青霉素过敏的话，医生会考虑选择头孢类或者大环内酯类的抗生素。

重要的是，一定要完成医生给开的抗生素疗程以彻底有效地清除感染。未治疗或未彻底治疗的猩红热可能会引起心脏，关节等严重的并发症, 比如风湿热。所以记住，

完成整个疗程的抗生素很重要！

完成整个疗程的抗生素很重要！

完成整个疗程的抗生素很重要！

• 保证充足的液体摄入

• 温盐水漱口缓解咽痛

• 对乙酰氨基酚或布洛芬类药物帮助退烧或缓解咽痛

根据上海疾控的规定，猩红热的隔离期是从发病之日起10天，不能去学校及幼托机构。并且，需要通知密切接触者注意观察有无症状出现。

What is the treatment for scarlet fever?

Antibiotics

Treatment for scarlet fever is the same as for strep throat. Your child's doctor will often prescribe an appropriate antibiotic which should improve the infection within a couple of days. Generally, penicillin is the first choice. A cephalosporin or macrolide antibiotic may be used if your child is allergic to penicillin. It is important to complete the entire courses of antibiotics you are prescribed to make sure the infection cleared effectively and thoroughly. Untreated scarlet fever can lead to several serious conditions involving the heart, kidneys, and joints. When the heart is involved, it is called rheumatic fever, so it is very important to finish the full course of antibiotics.

Other treatment options may include:

l  Increased fluid intake

l  Warm saline mouth gargles to relieve the sore throat

l  Acetaminophen or ibuprofen to bring down fever or relieve throat pain.

Separate and contact precautions

According to Shanghai CDC regulation, it is important to not send your child back to school or day care for 10 days from the condition occurred. Also, be sure to notify others who may have been expose.

猩红热的并发症少见，绝大多数的孩子可以完全恢复没有任何影响。偶尔情况下，猩红热可能会引起中耳炎，肺炎，或风湿热。风湿热会影响到心脏以及肾脏。抗生素足疗程治疗可以预防绝大多数的这些问题。感染过猩红热一次以后通常意味着孩子将来对这个疾病有免疫力，但是有些时候可能会因为感染了这类细菌的不同亚型而再次发生猩红热。

What’s the outlook?

Complications are rare. Most children recover fully with no lasting effects. Occasionally, scarlet fever can lead to an ear infection, pneumonia, or rheumatic fever which can affect the heart, and kidney disease. Treatment with antibiotics can prevent most of these health problems. One episode of scarlet fever will usually mean the child will be immune from the disease in the future. However, it is occasionally possible for scarlet fever to recur due to different forms of bacteria causing the infection.

目前猩红热没有疫苗预防。任何人有咽痛症状都要注意多洗手。如果孩子得了猩红热，须要在家隔离10天才可以返校。同时家长也要注意接触防护，避免接触患者咳嗽和喷嚏的飞沫，经常用温肥皂水洗手，与患者的餐具和杯具需要分开并单独清洗。

Preventing the disease from spreading

There is no such vaccine to prevent scarlet fever. It is especially important for anyone with a sore throat to wash his or her hands often. If the child has scarlet fever, parents should keep them off school and away from other people for 10 days. Keep away from the coughing and sneezing droplets. Wash hands often with warm soapy water. Separate and wash glasses, eating utensils and drinking cups.