闭合性骨折后发生全身剥脱性皮损而病原学阴性的猩红热患者一例

Diagnosis and treatment of a rare and severe complications of scarlet fever after closed fracture of humerus: exfoliative skin lesions

目的提高对特殊临床表现猩红热的认识。方法通过1例罕见的肱骨闭合性骨折后发生全身剥脱性皮损、病原学阴性的猩红热患者的临床诊疗情况,强调与葡萄球菌烫伤样皮肤综合征(SSSS)、川崎病、麻疹鉴别诊断的必要性。结果通过临床症状、体征、辅检,患者得到准确诊断。经科学隔离、规范治疗而达到临床治愈。结论鉴于猩红热的主要病原为A组β型溶血性链球菌(GABHS),具有传染性,因而快速诊断、消毒隔离极为重要。

Objective To improve the recognition of scarlet fever with special clinical manifestations. Methods A rare and severe complications of scarlet fever （pathogen was not isolated） after closed fracture of humerus： exfoliative skin lesions were investigated, and a reference for the clinical diagnosis and treatment of such patients were provided. Although the presentation of scarlet fever could be clinically diagnosed, most common pathogens were group A β-hemolytic streptococcus （GABHS）, further detection may be required to distinguish it from other illnesses, such as measles, Kawasaki disease （KD） and Staphylococcal scalded skin syndrome （SSSS）. Results Through the clinical symptoms, signs, auxiliary examination, the diagnosis of the patient were determined accurately. The patient was treated after isolation and achieved clinical cure. Conclusions GABHS could be spread in local area, it is necessary to improve rapid diagnostic ability for GABHS, and active disinfection and isolation measures should be adopted.