Tanglao, Jeffrey B.

BSN215 HOMEWORK

NCM106 Mam E. Delgado

Scarlet Fever Outbreaks in China Have Yet to Peak

Posted by Alex Heigl on June 21, 2011 4:49 PM

Scarlet fever has struck parts of southern China, killing a child in Hong Kong and making hundreds sick. Health authorities said on Tuesday that the outbreak has not yet peaked and is expected to get worse. "Mainland China and Macau are also suffering from unusually high numbers of scarlet fever cases and we believe it may be a regional phenomenon," a spokeswoman from the Health Department in Hong Kong told Reuters. "The outbreak hasn't shown signs of slowing down and we may continue to see more cases this summer." Scarlet fever is caused by group A streptococcus bacteria and mostly afflicts children under the age of 10. It spreads through contact with contaminated respiratory secretions. Patients with scarlet fever develop a sore throat, fever and a red rash on their trunk, neck and limbs. Scarlet fever can be treated with antibiotics but complications can result in shock, heart and kidney illnesses. Hong Kong has reported over 419 cases of scarlet fever this year, by far the highest number in years. Cases in Hong Kong 4 and a half times higher than they were during the same period last year. A seven-year-old girl died in late May and two boys, aged six and 11, developed complications but have progressed to stable condition. Scientists in Hong Kong isolated the fever's bacteria in a six-year-old boy and found that a slight change in its genetic structure may have enhanced its ability to spread, the Health Department said in a news release. Half of group A streptococcus bacteria in Hong Kong are resistant to the antibiotics erythromycin and clindamycin, but all are vulnerable to penicillin, according to Hong Kong's Center for Health Protection.

(http://www.thirdage.com/news/scarlet-fever-outbreaks-in-china-have-yet-topeak_06-21-2011)

SCARLET FEVER
Scarlet fever, also known as scarlatina, is a disease caused by a toxin (erythrogenic exotoxin) released by Streptococcus pyogenes or group A beta-hemolytic

streptococcus - the disease occurs in a small percentage of patients with strep

infections, such as strep throat or impetigo. The bacterial illness, scarlet fever, causes a distinctive pink-red rash, which occurs when the bacteria release toxins. Scarlet fever is extremely contagious - people can catch it by breathing in the bacteria in airborne droplets that come from an infected individual's sneezes or coughs. Infection may also occur as a result of touching the skin of an infected person, or touching surfaces or objects that the infected person has touched. Scarlet fever is much more common among children aged 5 to 15 years than other people. It used to be considered a serious childhood illness. However, modern antibiotics have made it a much less threatening disease. If left untreated scarlet fever can sometimes lead to serious conditions that affect human organs, including the heart and kidneys. Signs and Symptoms: A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. Signs and symptoms generally appear about one to four days after initial infection. The first symptoms are usually: A fever of 101 F (38.3 C) or higher, frequently with chills. 12 to 48 hours later the rash will appear. Rash - red blotches appear on the skin; they then turn into a fine pink-red rash that looks like sunburn. The skin feels rough, like sandpaper, when touched.

 A very sore and red throat (sometimes with white or yellowish patches). The rash spreads to the ears, neck, elbows, inner thighs and groin, chest and some other parts of the body. Although the rash does not usually appear on the face, the patient's cheeks will become flushed and the area around his/her mouth appear pale. If a glass is pressed on the skin the rash will turn white (blanche). Scarlet fever may also have the following signs and symptoms: Difficulty swallowing General malaise Headache Itching Loss of appetite Nausea Pastia's lines - broken blood vessels in the folds of the body, for example the armpits, groin, elbows, knees and neck. Stomachache Swollen neck glands (lymph nodes) that are tender to the touch Tongue - a white coating forms on the tongue. This eventually peels away leaving a strawberry tongue; the tongue is red and swollen. Vomiting

Risk Factors:
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. Children - aged from 5 to 15 years have a higher risk of developing scarlet fever compared to other people. Close contact - the strep bacteria can spread more easily among people in close contact. If somebody in the household carries the bacteria, infection may spread more readily among household members (and colleagues at school).

Mode of Transmission:
Scarlet fever transmits from human-to-human by fluids from the mouth and nose. When an infected individual coughs or sneezes the bacteria become airborne in droplets of water

and can be inhaled. The bacteria may land on surfaces, such as drinking glasses, work surfaces and doorknobs and infect people who touch them with their hands and then touch their own nose or mouth. The bacteria may also be inhaled. If you touch the skin of an individual with a streptococcal skin infection there is a risk of becoming infected. People who share towels, baths, clothes or bed linen with an infected person risk becoming infected themselves.

Period of Communicability: A person with scarlet fever who is not treated may be contagious for several weeks, even after symptoms have gone. It is also possible for somebody to carry the infection and be contagious, even though they never had any symptoms - only people who are susceptible to the toxins released by streptococcal bacteria develop symptoms. These factors make it harder for individuals to know whether they have been exposed.

Diagnosis:
The characteristic rash and symptoms usually make it fairly easy for a doctor to diagnosis scarlet fever. The doctor may take a throat swab in order to determine which bacteria caused the infection. Sometimes a blood test is also ordered. Rapid DNA test - a throat swab is taken. Results are returned within a day at the most. In the United Kingdom and many other countries scarlet fever is a notifiable disease. This means that any confirmed cases must be reported to local health authorities.

Treatment:
Antibiotics - a 10-day course of antibiotics is the most common treatment for scarlet fever. In the UK, and many other countries this involves taking oral penicillin. Patients who are allergic to penicillin may take erythromycin instead. Patients are advised to stay at home during the course of the antibiotic treatment. The fever will usually go away within 12 to 24 hours of taking the first antibiotic medication.

According to the Mayo Clinic, USA, a child with scarlet fever may be prescribed one of the following antibiotics: Penicillin, in pill form or by injection Amoxicillin (Amoxil, Trimox) Azithromycin (Zithromax) Clarithromycin (clarithromycin extended-release tablets). Clindamycin (clindamycin phosphate). A cephalosporin such as cephalexin (Keflex)

It is important to complete the full course of antibiotics, even if symptoms go away before it is finished. Otherwise, the infection may not be completely eradicated, raising the risk of subsequent post-strep disorders. Within 24 hours of starting the antibiotics the patient will no longer be contagious. Other treatments - it is important to drink plenty of liquids, especially if there is no appetite. The room should be kept cool. Tylenol (paracetamol) may help relieve aches and pains, as well as bringing the fever down. Calamine lotion may help with itchy skin.

Complications:
In the majority of cases there are no complications. If any occur, they may include: Ear infection, including otitis media Pneumonia Throat abscess - a pus-filled sac in the throat Sinusitis Inflammation of the kidney(s) - poststreptococcal glomerulonephritis, resulting from certain byproducts of strep bacteria. In some cases there may be long-term kidney disease. Rheumatic fever Some skin infections Acute kidney (renal) failure

Meningitis - inflammation of the membranes and fluid that surround the brain and spinal cord. Necrotizing fasciitis - commonly known as flesh-eating disease Toxic shock syndrome Endocarditis - infection of the heart's inner lining Osteomyelitis