Spatial clustering analysis of scarlet fever incidence in China from 2016 to 2020 / 南方医科大学学报

OBJECTIVE@#To investigate the incidence trend and spatial clustering characteristics of scarlet fever in China from 2016 to 2020 to provide evidence for development of regional disease prevention and control strategies.@*METHODS@#The incidence data of scarlet fever in 31 provinces and municipalities in mainland China from 2016 to 2020 were obtained from the Chinese Health Statistics Yearbook and the Public Health Science Data Center led by the Chinese Center for Disease Control and Prevention.The three-dimensional spatial trend map of scarlet fever incidence in China was drawn using ArcGIS to determine the regional trend of scarlet fever incidence.GeoDa spatial autocorrelation analysis was used to explore the spatial aggregation of scarlet fever in China in recent years.@*RESULTS@#From 2016 to 2020, a total of 310 816 cases of scarlet fever were reported in 31 provinces, municipalities directly under the central government and autonomous regions, with an average annual incidence of 4.48/100 000.The reported incidence decreased from 4.32/100 000 in 2016 to 1.18/100 000 in 2020(Z=103.47, P < 0.001).The incidence of scarlet fever in China showed an obvious regional clustering from 2016 to 2019(Moran's I>0, P < 0.05), but was randomly distributed in 2020(Moran's I>0, P=0.16).The incidence of scarlet fever showed a U-shaped distribution in eastern and western regions of China, and increased gradually from the southern to northern regions.Inner Mongolia Autonomous Region and Hebei and Gansu provinces had the High-high (H-H) clusters of scarlet fever in China.@*CONCLUSION@#Scarlet fever still has a high incidence in China with an obvious spatial clustering.For the northern regions of China with H-H clusters of scarlet fever, the allocation of health resources and public health education dynamics should be strengthened, and local scarlet fever prevention and control policies should be made to contain the hotspots of scarlet fever.

Analysis of the epidemiological characteristics of scarlet fever in Yantai City, Shandong Province from 2015 to 2019 / 中华预防医学杂志

From 2015 to 2019, the annual average incidence rate of scarlet fever was 7.80/100 000 in Yantai City, which showed an increasing trend since 2017 (χ2trend=233.59, P<0.001). The peak period of this disease was from April to July and November to January of the next year. The ratio of male to female was 1.49∶1, with a higher prevalence among cases aged 3 to 9 years (2 357/2 552, 92.36%). Children in kindergartens, primary and middle school students, and scattered children were the high risk population, with the incidence rate of 159.86/100 000, 25.57/100 000 and 26.77/100 000, respectively. The global spatial auto-correlation analysis showed that the global Moran's I index of the reported incidence rate of scarlet fever in Yantai from 2015 to 2019 was 0.28, 0.29, 0.44, 0.48, and 0.22, respectively (all P values<0.05), suggesting that the incidence rate of scarlet fever in Yantai from 2015 to 2019 was spatial clustering. The local spatial auto-correlation analysis showed that the "high-high" clustering areas were mainly located in Laizhou City, Zhifu District, Haiyang City, Fushan District and Kaifa District, while the "low-high" clustering areas were mainly located in Haiyang City and Fushan District.

Paying attention to the epidemic of group A Streptococcus infections in multiple European and American countries / 中国当代儿科杂志

At the end of 2022, the World Health Organization reported an increase in group A Streptococcus (GAS) infections, such as scarlet fever, in multiple countries. The outbreak primarily affected children under 10 years old, and the number of deaths was higher than anticipated, causing international concern. This paper reviews the current state of the GAS disease outbreak, its causes, and response measures. The authors aim to draw attention from clinical workers in China and increase their awareness and vigilance regarding this epidemic. Healthcare workers should be aware of the potential epidemiological changes in infectious diseases that may arise after the optimization of control measures for coronavirus disease 2019 to ensure children's health.

Incidence of Scarlet Fever in Children in Jeju Province, Korea, 2002-2016: An Age-period-cohort Analysis / 예방의학회지

OBJECTIVES: Outbreaks of scarlet fever in Mexico in 1999, Hong Kong and mainland China in 2011, and England in 2014-2016 have received global attention, and the number of notified cases in Korean children, including in Jeju Province, has also increased since 2010. To identify relevant hypotheses regarding this emerging outbreak, an age-period-cohort (APC) analysis of scarlet fever incidence was conducted among children in Jeju Province, Korea. METHODS: This study analyzed data from the nationwide insurance claims database administered by the Korean National Health Insurance Service. The inclusion criteria were children aged ≤14 years residing in Jeju Province, Korea who received any form of healthcare for scarlet fever from 2002 to 2016. The age and year variables were categorized into 5 groups, respectively. After calculating the crude incidence rate (CIR) for age and calendar year groups, the intrinsic estimator (IE) method was applied to conduct the APC analysis. RESULTS: In total, 2345 cases were identified from 2002 to 2016. Scarlet fever was most common in the 0-2 age group, and boys presented more cases than girls. Since the CIR decreased with age between 2002 and 2016, the age and period effect decreased in all observed years. The IE coefficients suggesting a cohort effect shifted from negative to positive in 2009. CONCLUSIONS: The results suggest that the recent outbreak of scarlet fever among children in Jeju Province might be explained through the cohort effect. As children born after 2009 showed a higher risk of scarlet fever, further descriptive epidemiological studies are needed.

Scarlet fever associated with hepatitis in pediatrics: a case report / Hepatitis asociada a escarlatina en pediatría: reporte de caso

INTRODUCCIÓN: La escarlatina es una enfermedad común en Pediatría, causada por Estreptococo beta hemolítico grupo A (SBHGA), la cual generalmente se presenta después de un episodio de faringitis, y con excelente pronóstico general. La hepatitis secundaria a escarlatina es una complicación, descrita muy rara vez en niños. Nuestro objetivo fue reportar la ocurrencia de hepatitis secundaria a escarlati na en un paciente pediátrico. CASO CLÍNICO: Varón de 12 años cursando escarlatina, quien se presentó con una historia de 4 días de ictericia, coluria y disminución del apetito. Los exámenes de laboratorio revelaron elevación de las transaminasas y de los niveles de bilirrubina total y directa, y estudios vira les negativos para Hepatitis A, B y C, Virus de Epstein Barr, Parvovirus B19, Citomegalovirus, Virus Herpes 6 y Herpes simplex 1 y 2. Ecografía abdominal fue normal. DISCUSIÓN: La hepatitis es una complicación inhabitual de la escarlatina, cuya patogénesis aún no está clara. La producción de citoquinas a través del daño celular mediado por la exotoxina pirógena estreptocócica, se ha propuesto como un posible mecanismo de hepatotoxicidad en infecciones por SBHGA. CONCLUSIÓN: La hepati tis asociada a escarlatina continúa siendo una entidad rara, pero de curso benigno, con recuperación plena en semanas a meses.

INTRODUCTION: Scarlet fever is a common illness in pediatrics caused by group A beta-hemolytic streptococcus (GABHS), which usually occurs after an episode of pharyngitis, and has an overall excellent prognosis. Hepatitis secondary to scarlet fever is a rare complication described in adults and even less frequently in children. Our objective was to describe a case of hepatitis secondary to scarlet fever in a pediatric patient. CLINICAL CASE: A 12-year-old male with scarlet fever presented with a 4-day history of jaundice, dark urine, and decreased appetite. Laboratory tests revealed elevated liver enzy mes and total and direct bilirubin levels, and negative studies for hepatitis A, B and C, Epstein Barr virus, parvovirus B19, adenovirus, cytomegalovirus, human herpes virus-6, and herpes simplex virus 1 and 2. Abdominal ultrasound examination was normal. DISCUSSION: The pathogenesis of scarlet fever associated hepatitis remains unclear. Streptococcal pyrogenic exotoxin mediated cellular injury via cytokine production has been proposed as a possible mechanism of hepatotoxicity in GABHS infections. CONCLUSION: Hepatitis secondary to scarlet fever remains a rare but benign entity, with complete recovery expected over weeks to months.

Study on the super-antigen genes of group A Streptococcus pyogenes strains isolated from patients with scarlet fever and pharyngeal infection, in Beijing, 2015-2017 / 中华流行病学杂志

Objective: To analyze the characteristics of super-antigen (SAg) of group A Streptococcus pyogenes (GAS), isolated from patients with scarlet fever or pharyngeal infections in Beijing between 2015-2017. Methods: Throat swab specimens from patients with scarlet fever or pharyngeal infections were collected and tested for GAS. Eleven currently known SAg genes including SpeA, speC, speG, speH, speI, speJ, speK, speL, speM, smeZ and ssa were tested by real-time PCR while M protein genes (emm genes) were amplified and sequenced by PCR. Results: A total of 377 GAS were isolated from 6 801 throat swab specimens, with the positive rate as 5.5%. There were obvious changes noticed among speC, speG, speH and speK in three years. A total of 45 SAg genes profiles were observed, according to the SAgs inclusion. There were significant differences appeared in the frequencies among two of the highest SAg genes profiles between emm1 and emm12 strains (χ(2)=38.196, P<0.001; χ(2)=72.310, P<0.001). There also appeared significant differences in the frequencies of speA, speH, speI and speJ between emm1 and emm12 strains (χ(2)=146.154, P<0.001; χ(2)=52.31, P<0.001; χ(2)=58.43, P<0.001; χ(2)=144.70, P<0.001). Conclusions: Obvious changes were noticed among SAg genes including speC, speG, speH and speK from patients with scarlet fever or pharyngeal infections in Beijing between 2015-2017. SAg genes including speA, speH, speI and speJ appeared to be associated with the emm 1 and emm 12 strains. More kinds of SAg genes profiles were isolated form GAS but with no significant differences seen in the main SAg genes profiles, during the epidemic period.

Outbreak Investigation of Scarlet Fever in a Kindergarten / 감염과화학요법

No abstract available.

Investigation of Scarlet Fever Outbreak in a Kindergarten / 감염과화학요법

BACKGROUND: Scarlet fever is caused by a group A streptococcal (GAS) infection. On April 3, 2017, an outbreak among children in a kindergarten was reported to the local health department. An epidemiologic investigation was conducted to identify the possible transmission route of this outbreak and to recommend appropriate control measures. MATERIALS AND METHODS: A retrospective cohort study was conducted using questionnaires including age, sex, the classroom attended at a kindergarten, and date and type of symptoms developed. A case-patient is defined as a child having sore throat, fever, skin rash, or strawberry tongue with or without laboratory confirmation of GAS infection between March 28 and April 28, 2017. RESULTS: The index case-patients developed symptoms on March 28, 2017, and this outbreak persisted over a period of 16 days. The outbreak affected 21 out of 158 children (13.3%) in the kindergarten, with the mean age of 4.2 (range 3–5) years; 12 (57.1%) of them were boys. The common symptoms reported were fever (71.4%), sore throat (71.4%), reddened tonsil (57.1%), and skin rash (52.4%). The epidemiologic analysis showed that children attending one of the classrooms in the kindergarten were 14.12 times affected than the other classrooms (relative risk, 14.12; 95% confidence interval, 4.99–33.93; P 24 hours after starting appropriate antibiotic treatment, and all the children in the kindergarten were instructed to keep strict personal hygiene practices. CONCLUSION: Our results suggest that the outbreak likely affected from the index case-patients who attended to one of the classrooms in the kindergarten. This highlights the importance of immediate notification of outbreak to prevent large number of patients.

Outbreak Investigation of Scarlet Fever in a Kindergarten / 감염과화학요법

No abstract available.

Investigation of Scarlet Fever Outbreak in a Kindergarten / 감염과화학요법

BACKGROUND: Scarlet fever is caused by a group A streptococcal (GAS) infection. On April 3, 2017, an outbreak among children in a kindergarten was reported to the local health department. An epidemiologic investigation was conducted to identify the possible transmission route of this outbreak and to recommend appropriate control measures. MATERIALS AND METHODS: A retrospective cohort study was conducted using questionnaires including age, sex, the classroom attended at a kindergarten, and date and type of symptoms developed. A case-patient is defined as a child having sore throat, fever, skin rash, or strawberry tongue with or without laboratory confirmation of GAS infection between March 28 and April 28, 2017. RESULTS: The index case-patients developed symptoms on March 28, 2017, and this outbreak persisted over a period of 16 days. The outbreak affected 21 out of 158 children (13.3%) in the kindergarten, with the mean age of 4.2 (range 3–5) years; 12 (57.1%) of them were boys. The common symptoms reported were fever (71.4%), sore throat (71.4%), reddened tonsil (57.1%), and skin rash (52.4%). The epidemiologic analysis showed that children attending one of the classrooms in the kindergarten were 14.12 times affected than the other classrooms (relative risk, 14.12; 95% confidence interval, 4.99–33.93; P 24 hours after starting appropriate antibiotic treatment, and all the children in the kindergarten were instructed to keep strict personal hygiene practices. CONCLUSION: Our results suggest that the outbreak likely affected from the index case-patients who attended to one of the classrooms in the kindergarten. This highlights the importance of immediate notification of outbreak to prevent large number of patients.

Infectious Pseudoaneurysm Caused by Group A Streptococcus in a Child without Underlying Disease

Group A streptococcus is a common cause of upper respiratory infection in children; however, it is a rare cause of pseudoaneurysm in pediatrics with only limited reports of cases associated with cardiac surgery and underlying disease. We report a case of infectious pseudoaneurysm of the right internal iliac artery caused by group A streptococcus in a previously healthy 5-year-old boy who presented with scarlet fever and group A streptococcal bacteremia. He was admitted to the hospital with fever, rash on the whole body, and sore throat, accompanied by severe leg pain. He was treated with surgical removal and antibiotics. Because a pseudoaneurysm may develop in children without vascularrelated underlying diseases, we should consider the possibility of this important clinical diagnosis in patients with scarlet fever.

Infectious Pseudoaneurysm Caused by Group A Streptococcus in a Child without Underlying Disease

Group A streptococcus is a common cause of upper respiratory infection in children; however, it is a rare cause of pseudoaneurysm in pediatrics with only limited reports of cases associated with cardiac surgery and underlying disease. We report a case of infectious pseudoaneurysm of the right internal iliac artery caused by group A streptococcus in a previously healthy 5-year-old boy who presented with scarlet fever and group A streptococcal bacteremia. He was admitted to the hospital with fever, rash on the whole body, and sore throat, accompanied by severe leg pain. He was treated with surgical removal and antibiotics. Because a pseudoaneurysm may develop in children without vascularrelated underlying diseases, we should consider the possibility of this important clinical diagnosis in patients with scarlet fever.

The validity of the McIsaac clinical decision rule in the detection of group A beta hemolytic streptococcus pharyngitis using throat culture as the reference standard

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> During a monthly morbidity and mortality report in family medicine it was noted that one of the most frequent illness encountered was sore throat or acute pharyngitis. It accounted among the top five most common comorbidities in out-patient consults and emergency room admissions in 2015-2016.<br /><strong>OBJECTIVE:</strong> This study was conducted in Chong Hua Hospital to evaluate if a sore throat scoring system such as the McIsaac Decision Rule was valid in detecting group A beta hemolytic streptococcus pharyngitis and was reliable as a clinical approach in managing sore throat.<br /><strong>DESIGN:</strong> A prospective, descriptive survey was done among patients who consulted and eventually admitted at the emergency room and OPD under the family medicine department at Chong Hua Hospital Cebu City.<br /><strong>METHODS:</strong> A total of 23 patients; children and adults who presented with sore throat were assessed. A data extraction form utilizing criteria from the McIsaac clinical rule known as "Sore Throat Encounter Form" was used for each patient encounter. The following criteria were accounted; fever >38°C, swollen, tender anterior cervical lymph nodes, tonsillar exudate and absence of cough. A corresponding point was assigned based on the patient's age. Points are summed up and used as basis of management; patients presenting with a score of -1 and 0 could be managed without antibiotic treatment and no throat culture is required. For scores of 1-3 throat culture is indicated and positive results should be treated. For 4-5 scores on an empiric antibiotic treatment should be initiated without the need of throat culture. A throat swab for culture was obtained as a reference standard. In addition, physicians' prescribing practices and their recommendations for obtaining throat swabs were compared with score-based recommendations.<br /><strong>RESULTS:</strong> Categorical data were expressed in frequency and percentages. McIsaac clinical decision rule assessment results and findings of gold standards were tested for association using 2x2 Fisher's exact test wherein the p-value lesser than 0.05 alpha was considered significant. Accuracy of McIsaac clinical decision rule assessment was computed using sensitivity, specificity, likelihood ratio positive, negative, and positive predictive values.<br /><strong>CONCLUSION: </strong>The McIsaac Clinical Decision Rule has demonstrated clinically acceptable diagnostic accuracy in predicting streptococcus pharyngitis. Thus, it can be a reliable and valid risk assessment tool to predict and rule out Group A Beta Hemolytic Streptococcus Pharyngitis.</p>

The validity of the McIsaac clinical decision rule in the detection of group A beta hemolytic streptococcus pharyngitis using throat culture as the reference standard

BACKGROUND: During a monthly morbidity and mortality report in family medicine it was noted that one of the most frequent illness encountered was sore throat or acute pharyngitis. It accounted among the top five most common comorbidities in out-patient consults and emergency room admissions in 2015-2016.OBJECTIVE: This study was conducted in Chong Hua Hospital to evaluate if a sore throat scoring system such as the McIsaac Decision Rule was valid in detecting group A beta hemolytic streptococcus pharyngitis and was reliable as a clinical approach in managing sore throat.DESIGN: A prospective, descriptive survey was done among patients who consulted and eventually admitted at the emergency room and OPD under the family medicine department at Chong Hua Hospital Cebu City.METHODS: A total of 23 patients; children and adults who presented with sore throat were assessed. A data extraction form utilizing criteria from the McIsaac clinical rule known as "Sore Throat Encounter Form" was used for each patient encounter. The following criteria were accounted; fever >38°C, swollen, tender anterior cervical lymph nodes, tonsillar exudate and absence of cough. A corresponding point was assigned based on the patient's age. Points are summed up and used as basis of management; patients presenting with a score of -1 and 0 could be managed without antibiotic treatment and no throat culture is required. For scores of 1-3 throat culture is indicated and positive results should be treated. For 4-5 scores on an empiric antibiotic treatment should be initiated without the need of throat culture. A throat swab for culture was obtained as a reference standard. In addition, physicians' prescribing practices and their recommendations for obtaining throat swabs were compared with score-based recommendations.RESULTS: Categorical data were expressed in frequency and percentages. McIsaac clinical decision rule assessment results and findings of gold standards were tested for association using 2x2 Fisher's exact test wherein the p-value lesser than 0.05 alpha was considered significant. Accuracy of McIsaac clinical decision rule assessment was computed using sensitivity, specificity, likelihood ratio positive, negative, and positive predictive values.CONCLUSION: The McIsaac Clinical Decision Rule has demonstrated clinically acceptable diagnostic accuracy in predicting streptococcus pharyngitis. Thus, it can be a reliable and valid risk assessment tool to predict and rule out Group A Beta Hemolytic Streptococcus Pharyngitis.

Effectiveness of Varicella Vaccination Program in Preventing Laboratory-Confirmed Cases in Children in Seoul, Korea

A universal one-dose varicella vaccination program was introduced in 2005 in Republic of Korea. However, the incidence of varicella in Korea has tripled over the last decade. We conducted a community based 1:1 matched case-control study to assess the effectiveness of one MAV strain-based vaccine and three Oka strain-based vaccines licensed for use in Korea. All cases were children in Seoul, Korea with varicella who were reported to the National Notifiable Disease Surveillance System in Seoul during 2013. The controls were age-matched children with mumps or scarlet fever but no history of varicella. We included 537 cases and 537 controls. The overall effectiveness of one dose of varicella vaccination was 13% (95% confidence interval [CI], −17.3–35.6). Of the four licensed varicella vaccines, only one was highly effective (88.9%; 95% CI, 52.1–97.4). The vaccine effectiveness for the other vaccines were 71.4% (95% CI, −37.5–94.1), −5% (95% CI, −61.9–31.9), and −100% (95% CI, −700–50.0). The overall effectiveness of vaccination was 75.8% (95% CI, 22.8–92.4) in the first year after vaccination and decreased thereafter; the effectiveness became −7.2% (95% CI, −130.9–59.2) in the fourth year after vaccination. Further studies are warranted to investigate reduced effectiveness of varicella vaccines in Korea.

emm types of mutation in scarlet-fever-related group A streptococcal, among children in Beijing, 2011-2014 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the distribution of emm gene types related to group A streptococcus-caused scarlet fever among children in Beijing and to analyze the relationship between the mutation of the emm types and scarlet fever.</p><p><b>METHODS</b>Nasopharyngeal swab samples were collected from the scarlet fever cases diagnosed in 36 hospitals in Beijing to isolate the GAS strains from May to July, betgween 2011 and 2014. Genotyping of emm gene was performed with PCR and N-terminal gene fragments of M protein were sequenced. Data of all the scarlet fever cases in Beijing that reported through the National Notifiable Infectious Disease Surveillance System (NNIDSS) , were gathered and analyzed.</p><p><b>RESULTS</b>Among the collected 2 161 nasopharyngeal swabs, 762 GAS strains were identified (35.3%). In addition, 7 emm types were detected, in which emm12 accounted for 69.4% (529/762) , emm1 accounted for 29.8% (227/762) , and other five types (emm 11, 22, 75, 89, and 128) accounted for 0.8% (6/762) , respctively. Compared with the emm types detected between 2011 and 2014, emm12, emm1 and other types accounted for 82.2% (295/359) , 16.7% (60/359) and 1.1% (4/359, including emm11, 22 and 89) in 2011 respectively.emm12, emm1 and emm75 accounted for 77.3% (123/163) , 23.9% (39/163) and 0.6% (1/163) respectively in 2012. emm12 and emm1 accounted for 50.7% (38/75) and 49.3% (37/75) in 2013 while emm12, emm1 and emm128 accounted for 44.2% (73/165) , 55.2% (91/165) and 0.6% (1/165) respectively in 2014. The differences of the constitution of emm types from 2011 to 2014 appeared statistically significant (P<0.001). In 2011 and 2012, major type appeared as emm12, but in 2014, emm1 became predominant. A total of 6 152 cases were reported in 2011, while 2 908, 2 048 and 3 918 cases were reported in 2012, 2013 and 2014 respectively. Age specific differences were noticed in the distribution of emm types GAS strains in 2011, with the number of emm12 strains detected higher in 1-5 year olds than in age group > 5 years (P<0.05). There were area specific differences in distribution of emm types of GAS strains seen in 2011 and 2013. In 2011, the number of emm1 strains detected in urban area was higher than in suburb area (P<0.05). However, in 2013, the number of emm1 strains detected in suburb area was seen higher than in urban area (P< 0.05).</p><p><b>CONCLUSION</b>GAS with emm12 and GAS emm1 appeared interchangeably predominant in Beijing from 2011 to 2014. Changes in predominant emm types seemed also related to the trends of incidence rates on scarlet fever.</p>

To Discern the Medical Thoughts of Heo Joon, the Best Physician in Korean History: An Analysis of Disease Experiences and Treatment Cases in the Treasured Mirror of Eastern Medicine / 의사학

Heo Joon is one of the best-known physicians of the Chosun Dynasty, the last imperial dynasty (1392~1910) of Korea. He had served King Seonjo during his practice, and has produced many publications on medicine. Then, how did he actually treat the patients? So far, other than the case when he treated Gwanghaegun's smallpox, it is not clearly known how and when he attended and treated the ill. In his most famous book, the Treasured Mirror of Eastern Medicine (TMEM), he details the physiopathological mechanisms, diagnoses, treatments or prescriptions, and treatment cases, however, it is not clear if they're from his own clinical experiences. Nevertheless, based on the written method, the original information is reconstituted according to its respective editors of the TMEM, a particular case being included may be considered as an agreement and acceptance of an actual treatment executed. This research analyzes what type of medicinal theory that the main writer Heo Joon employed in his real treatments, as well as how he diagnosed and treated diseases. After analyzing the complete series of the TMEM, we found a total of 301 clinical cases. Here, one may wonder, why does the Section of Inner and External Bodily Elements, that deal with diseases and the structure of the body, have far outnumber cases than the Section of Miscellaneous Disorders? Why does the TMEM introduce the various types of disease experiences and treatment cases, medical cases, simple treatments, nurturing life, materia medica, and also include supernatural phenomena? Why does the TMEM include the experiences and cases from the book published in the Song, Jin, Yuan dynasty of China, moreover in the Ming Dynasty of its time. These questions can be answered to the extent that Heo Joon and the others who participated in completing the book sought to justify the new clinical medicine practices, and because it had to be acceptable to the Confucius beliefs which dominated the society, and also because the book came to light in a time when tensions between the pre-existing Chosun medicine and the newly introduced Chinese medicine were evident. Among the clinical cases in the TMEM, there are only 41 cases that can be considered as Medical Cases which include the pathology and treatment mechanism. After analyzing these mechanisms, we were able to discover that they cover not only the theories of the 4 great physicians of Jin-Yuan Dynasty, but also the theories of the Danxi's Medical Current, a big trend in the Early Ming Dynasty, and some of the most recent clinical cases that had been just reported at the time. However, Heo Joon did not lean towards a particular theory of medicine; rather, he insisted on establishing a classical medicine based on the traditional medicinal scriptures such as the Yellow Emperor's Inner Canon or Shennong's Classic of Materia Medica, and had created his own Body-Viscera medicine, as Shin Dongwon's recent research. Moreover, he successfully secured his own right to be a clinical physician by customizing the amount of medication in prescriptions for the people of Chosun. Heo Joon was one of the chief physicians for the Royal Family of the Chosun Dynasty. Despite the tendency of traditional medicine to lean towards Taoism or Fangshu, for him the most important thing was the actual treatment of diseases. As a result, Heo Joon successfully treated smallpox by utilizing traditional medicinal methods, by breaking the taboo of not using medication on such diseases, as well as he was able to treat an unknown disease, scarlet fever, by discovering the pathological mechanism of the illness. Also he made bold decisions on altering existing prescriptions to treat diseases more efficiently. The TMEM consists of not only justified methods that integrate the different and scattered medicinal and clinical practices, which many insisted their originality, but also was backed with Heo Joon's such credible and endeavored clinical medicine.

Molecular types of group A Streptococcus isolated from scarlet fever patients and asymptomatic carriers in Shandong province, 2013 / 中华流行病学杂志

<p><b>OBJECTIVE</b>To describe the molecular characteristics of group A Streptococcus (GAS) isolated from patients and asymptomatic carriers of scarlet fever in Shandong province, 2013, and to explore the relationships between emm types and other molecular types.</p><p><b>METHODS</b>72 strains of GAS were isolated from throat swabs of children with scarlet fever or asymptomatic carriers of GAS. All the strains were typed by emm typing, multilocus sequence typing (MLST), super-antigen (SAg) genes detections and pulsed-field gel electrophoreses (PFGE).</p><p><b>RESULTS</b>Among the 72 strains, emm1 (41.67%) and emm12 (56.94%) were the most common emm types. Two ST types were found, including ST28 (43.06%) and ST36 (56.94%). Additionally, emm1 was also found correlated to ST28, while emm12 was associated with ST36. Eight super-antigen genes were detected, including smeZ (100.00%), ssa (100.00%), speG (97.22%), speC (95.83%), speL (54.17%), speJ (41.67%), speA (38.89%) and speH (38.89%), while speK, speM, speL were not found (0%). Both speA and speJ genes were detected primarily in emm1 strains (all P < 0.05), while speH and speI genes were not detected in emm 1 strains (all P < 0.05). And emm12 strains were inclined to harbor speH and speL (all P < 0.05) but not speA or speJ (all P < 0.05). Twenty different genotypes were identified by PFGE.</p><p><b>CONCLUSION</b>All the emm types of GAS isolated from scarlet fever patients and asymptomatic carriers in Shandong province 2013 were mainly emm1 and emm12 and carrying speC, speG and smeZ, ssa. ST types mainly exsited in ST28 and ST36. In addition, there were correlations between emm types and super-antigen genes, ST types, PFGE types.</p>

A Comparison of Clinical Characteristics between Adenoviral and Group A Streptococcal Pharyngitis in Children / 소아감염

PURPOSE: To compare the clinical characteristics and laboratory finding between adenoviral and group A streptococcal (GAS) pharyngitis. METHODS: A retrospective review of medical records was performed in the patients with adenovirus infection among those who were admitted for febrile respiratory disease from January 2011 to July 2013 and GAS pharyngitis among those who visited for symptoms of scarlet fever from August 2006 to July 2013. RESULTS: 179 patients (AV1 group) were diagnosed with adenoviral pharyngitis and 37 (AV2 group) of these patients had adenovirus single infection. 26 patients (GAS group) were diagnosed with scarlet fever. Adenoviral infection (AV2 group) developed in younger patients compared to GAS group (2.8+/-2.1 years vs. 5.4+/-1.8 years, P=0.000). Total durations of fever and admission were longer in AV2 (6.3+/-2.6 days vs. 3.3+/-1.9 days, P=0.000; 4.1+/-1.2 days vs. 1.9+/-1.8 days, P=0.000, respectively). WBC counts were higher in AV2 (11,449+/-5,680 cells/mm2 vs. 6,722+/-6,941 cells/mm2, P=0.000). CRP was not significantly different between AV2 and GAS group (3.8+/-3.2 mg/dL vs. 5.2+/-5.1 mg/dL, P=0.368). No difference was found between two groups in the percentage of antibiotics use (91.9% vs. 100%, P=0.261). CONCLUSION: Clinical characteristics and measures of inflammation in the laboratory findings were similar between adenoviral and GAS pharyngitis group. It is necessary to conduct the test for respiratory virus and bacteria in early stage to differentiate in the pharyngitis patients with leukocytosis and elevation of CRP level.

Molecular epidemiological characteristics of Streptococcus pyogenes strains involved in an outbreak of scarlet fever in China, 2011 / 生物医学与环境科学（英文）

<p><b>OBJECTIVE</b>To investigate molecular characterization of streptococcus pyogenes isolates involved in an outbreak of scarlet fever in China in 2011.</p><p><b>METHODS</b>Seventy-four Streptococcal pyogenes involved in an outbreak of scarlet fever were isolated from pediatric patients in the areas with high incidence in China from May to August of 2011. Emm genotyping, pulsed-field gel electrophoresis (PFGE), superantigen (SAg) genes and antimicrobial susceptibility profiling were analyzed for these isolates.</p><p><b>RESULTS</b>A total of 4 different emm types were identified. Emm12 was the most prevalent type which contained four predominating PFGE patterns corresponding to four different virulence and superantigen profiles. Emm12 (79.7%) and emm1 (14.9%) accounted for approximately 94% of all the isolates. The speA gene was all negative in emm12 isolates and positive in emm1 isolates. All strains were resistant to erythromycin, and 89.4% of them were resistant to erythromycin, tracycline, and clindamycin simultaneously.</p><p><b>CONCLUSION</b>Several highly diversified clones with a high macrolide resistance rate comprise a predominant proportion of circulating strains, though no new emm type was found in this outbreak. The data provide a baseline for further surveillance of scarlet fever, which may contribute to the explanation of the outbreak and development of a GAS vaccine in China.</p>