Far East Scarlet-like Fever Masquerading as Adult-onset Kawasaki Disease.

A previously healthy 31-year-old man was referred to us with refractory septic shock accompanied by bilateral conjunctival congestion and erythema of his right lower limb. Nine days after admission, he had bilateral desquamation of the fingertips, and his presentation satisfied the criteria for Kawasaki disease. A serological examination was positive for Yersinia pseudotuberculosis, and he was diagnosed with Far East scarlet-like fever (FESLF). Interestingly, his 11-month-old baby boy had similar symptoms around the same time, indicating the intrafamilial transmission of the pathogen. We should consider FESLF when we encounter a familial occurrence of systemic manifestations of Kawasaki disease.

Scarlet fever.

Essential facts Scarlet fever is characterised by a rash that usually accompanies a sore throat and flushed cheeks. It is mainly a childhood illness. While this contagious disease rarely poses a danger to life today, outbreaks in the past led to many deaths.

Escarlatina estafilocócica como manifestación atenuada del síndrome de escaldadura estafilocócica / Staphylococcal scarlet fever as a mild manifestation of Staphylococcal Scalded Skin Syndrome

Se presenta el caso de un niño de cuatro años con fiebre, adenopatías y faringoamigdalitis con exantema escarlatiniforme. Se trató con amoxicilina/ácido clavulánico y evolucionó favorablemente. Se aisló Staphylococcus aureus en la faringe y dos semanas después presentó descamación en dedo de guante. Parece tratarse de una forma abortada del síndrome de escaldadura estafilocócica (AU)

We report the case of a four years old child with fever, adenopathies, pharyngitis and scarlet micropapular exanthema. He was treated with amoxicillin/clavulanic acid and he had a favourable outcome. Staphylococcus aureus was isolated from his throat. Two weeks later he presented exfoliation. It seems to be an abortive form of Staphylococcal Scalded Skin Syndrome (AU)

Respiratory alkalosis in children with febrile seizures.

PURPOSE: Febrile seizures (FS) are the most common type of convulsive events in children. FS are suggested to result from a combination of genetic and environmental factors. However, the pathophysiologic mechanisms underlying FS remain unclear. Using an animal model of experimental FS, it was demonstrated that hyperthermia causes respiratory alkalosis with consequent brain alkalosis and seizures. Here we examine the acid-base status of children who were admitted to the hospital for FS. Children who were admitted because of gastroenteritis (GE), a condition known to promote acidosis, were examined to investigate a possible protective effect of acidosis against FS. METHODS: We enrolled 433 age-matched children with similar levels of fever from two groups presented to the emergency department. One group was admitted for FS (n = 213) and the other for GE (n = 220). In the FS group, the etiology of fever was respiratory tract infection (74.2%), otitis media (7%), GE (7%), tonsillitis (4.2%), scarlet fever (2.3%) chickenpox (1.4%), urinary tract infection (1.4%), postvaccination reaction (0.9%), or unidentified (1.4%). In all patients, capillary pH and blood Pco(2) were measured immediately on admission to the hospital. KEY FINDINGS: Respiratory alkalosis was found in children with FS (pH 7.46 ± 0.04, [mean ± standard deviation] Pco(2) 29.5 ± 5.5 mmHg), whereas a metabolic acidosis was seen in all children admitted for GE (pH 7.31 ± 0.03, Pco(2) 37.7 ± 4.3 mmHg; p < 0.001 for both parameters). No FS were observed in the latter group. A subgroup (n = 15; 7%) of the patients with FS had GE and, notably, their blood pH was more alkaline (pH 7.44 ± 0.04) than in the GE-admitted group. During the enrollment period, eight of the patients were admitted on separate occasions because of FS or GE. Consistent with the view that generation of FS requires a genetic susceptibility in addition to acute seizure triggering factors, each of these patients had an alkalotic blood pH when admitted because of FS, whereas they had an acidotic pH (and no FS) when admitted because of GE (pH 7.47 ± 0.05 vs. pH 7.33 ± 0.03, p < 0.005). SIGNIFICANCE: The results show that FS are associated with a systemic respiratory alkalosis, irrespective of the severity of the underlying infection as indicated by the level of fever. The lack of FS in GE patients is attributable to low pH, which also explains the fact that children with a susceptibility to FS do not have seizures when they have GE-induced fever that is associated with acidosis. The present demonstration of a close link between FS and respiratory alkalosis may pave the way for further clinical studies and attempts to design novel therapies for the treatment of FS by controlling the systemic acid-base status.

Report and analysis of a scarlet fever outbreak among adults through food-borne transmission in China.

BACKGROUND: Scarlet fever is caused by group A beta-hemolytic streptococci (GAS). The clinical syndrome has receded in recent years, but occasionally explosive outbreaks do occur likely due to the emergence of GAS with virulence factors peculiar to this syndrome. METHODS: Following the notification of an unexpectedly large number of scarlet fever cases amongst adults associated with a school in Ningbo, China, in June 2006, the epidemiological and clinical features of the outbreak were investigated. Logistic regression was conducted to investigate the risk factors of the outbreak and its transmission route. RESULTS: Forty five individuals suffered scarlet fever with an attack rate of 4.98% (45/904). There was a single peak in the epidemic curve, with the majority of the cases occurring during the first two days of the outbreak. The median age of cases was 35.5 years (range 17-65). Most patients had fever (43/45), sore throat (40/45), scarlatinoid rash (39/45) and strawberry-like tongue (30/45). In laboratory detection, 45 cases' throat swabs samples were collected and GAS were isolated from 8 throat swabs samples. All of the cases, except for 2, had eaten the Plain Boiled Chicken (PBC) for lunch on June 6th, and teaching staff and students who had not eaten the PBC were not affected by the epidemic. Logistic regression analysis indicated that PBC was a key risk factor (OR=21.0, P<0.05). The chef of the school refectory was responsible for washing, braising, cutting, and distributing the PBC, and was identified as the likely source. CONCLUSIONS: We describe an outbreak of scarlet fever caused by GAS-contaminated food.

[Present-day Clinical characteristics of scarlatina]. / Klinicheskaia kharasteristika skarlatiny v nasotoiashchee vremia.

AIM: To study present-day clinical manifestations of scarlatina. MATERIAL AND METHODS: The authors have reviewed 138 case histories of children with scarlatina treated outpatiently and 51 case histories of hospitalized scarlatina children as well as social and age characteristics of 1657 children and 108 adults hospitalized in the infectious hospital N 1 in 1962-2001. Official data on scarlatina morbidity in Moscow and Russia for 1991-2001 are presented. Antibiotic sensitivity of 414 cultures of group A streptococci (GAS) isolated in 1987-1995 and 1996-2001 was investigated. RESULTS: Overall and seasonal scarlatina morbidities in 7-14-year-olds appeared to rise significantly. In the majority of cases scarlatina took a mild course but in the adults clinical picture of the disease was rather severe. GAS demonstrated high sensitivity (about 100%) to betalactamic antibiotics. The percentage of erythromycin-resistant streptococcal cultures increased more than 9-fold and reached 1.9% (1996-2001). There is a marked trend to a proportional increase of GAS cultures resistant to tetracycline and gentamycin. CONCLUSION: Recently, changes have occurred in scarlatina epidemiological and clinical features. Different sensitivity of GAS to antibiotics must be taken into consideration for prescription of etiotropic treatment and prevention of scarlatina at jobs.