GB 15993-1995 Scarlet fever diagnostic criteria and treatment principles
Some standard content:
GB15993—1995
Scarlet fever is an acute respiratory infectious disease caused by group A streptococci. It often affects children aged 5 to 15 years. It is a common infectious disease in children. A small number of patients may develop allergic heart and kidney complications after the disease, which, to a certain extent, affects the health of children. It is one of the statutory infectious diseases of Class B in my country.
Appendix A and Appendix B of this standard are both standard appendices; Appendix C of this standard is a suggestive appendix.
This standard is proposed by the Ministry of Health of the People's Republic of China. The drafting unit of this standard is Beijing You'an Hospital, and the main drafters of this standard are Lin Xiuyu, Xu Lianzhi and Wu Changming. This standard is interpreted by the Ministry of Health's technical management unit, the Office of Infectious Disease Supervision and Management of the Ministry of Health. 353
1 Scope
National Standard of the People's Republic of China
Diagnostic criteria and principles of management for scarlet fever
Diagnostic criteria and principles of management for scarlet fever This standard specifies the diagnostic criteria and management principles for scarlet fever. This standard applies to the diagnosis and prevention of scarlet fever by medical and health epidemic prevention institutions at all levels. 2 Diagnostic criteria for scarlet fever
2.1 Diagnostic principles
GB15993-1995
A comprehensive diagnosis must be made based on epidemiological data, symptoms and signs, and laboratory tests. Confirmation must rely on etiological examinations. 2.2 Diagnostic criteria
2.2.1 Epidemiological data
The disease occurs and spreads locally, and there may be a history of contact with scarlet fever patients, or with tonsillitis, pharyngitis, otitis media, and erysipelas during the incubation period.
2.2.2 Symptoms and signs
2.2.2.1 Common scarlet fever
2.2.2.1.1 Acute onset, fever, pharyngitis, and strawberry tongue. 2.2.2.1.2 Scarlet fever-like rash appears within 1~~2 days of onset, with diffuse congestion and flushing of the skin, with pinpoint-sized scarlet red spots in between, which fade when pressed, and may also appear as "chicken rash" or "miliary rash". There are dense red spots in the skin folds. There are red lines of skin folds (i.e., Babinski lines). There is also bayberry tongue and pallor around the mouth. The rash disappears after 2~5 days. After the rash disappears, the skin desquamates or peels. 2.2.2.2 Mild scarlet fever: fever, pharyngitis, and rash are all very mild, lasting for a short time, and the desquamation is also mild. 2.2.2.3 Toxic scarlet fever: severe toxemia, toxic myocarditis and septic shock may occur. 2.2.2.4 Septic scarlet fever: manifested as severe suppurative lesions. Pharyngitis is obvious, and there may be necrosis and ulcers. Pharyngeal inflammation often spreads to surrounding tissues, causing purulent lesions in adjacent organs and tissues or bacteria entering the blood circulation, causing sepsis and migratory purulent lesions. 2.2.2.5 Surgical or obstetric scarlet fever: The rash often first appears and is obvious around the wound, and then spreads throughout the body, often without pharyngitis. 2.2.3 Laboratory tests (see Appendix A for details) 2.2.3.1 Total white blood cell count and neutrophil granulocyte increase. 2.2.3.2 Culture of pharyngeal swabs or pus, isolation of group A streptococci. 2.2.4 Case classificationwwW.bzxz.Net
2.2.4.1 Suspected cases: fever, scarlet fever-like rash + 2.2.3.1. 2.2.4.2 Clinically diagnosed cases: any one of 2.2.4.1 + 2.2.2. 2.2.4.3 Confirmed cases meet the requirements of 2.2.4.2 + 2.2.3.2. 3 Principles of scarlet fever treatment
3.1 Principle of prevention (see Appendix B)
Approved by the State Administration of Technical Supervision on December 15, 199535
Implemented on July 1, 1996
GB15993-1995
Should start from controlling the source of infection, cutting off the transmission route and protecting susceptible populations. 3.2 Principles of treatment (see Appendix C)
3.2.1 General and symptomatic treatment.
3.2.2 Antibiotics should be used in time for pathogen treatment, with penicillin G as the first choice, and the course of treatment is 5 to 7 days. 3.2.3 In addition to active antibacterial treatment, anti-shock and necessary supportive therapy should be given for the treatment of toxic, septic and surgical types, and surgical treatment should be given if necessary.
Isolation of A1A group streptococci
GB15993-1995
Appendix A
(Standard Appendix)
Experimental diagnosis of scarlet fever
A1.1 Specimen collection: Take specimens such as throat swabs and wound inflammatory secretions. A1.2 Isolation and culture: Blood agar plates can be streaked directly for isolation and culture. Observe the colony morphology and hemolysis phenomenon, and form small colonies with grayish white, transparent or opaque, smooth surface, opalescent, diameter of 0.5-0.75mm, and round protrusions. A 2-4mm wide, clearly defined, completely transparent hemolysis ring is formed around the colonies. Further smears are stained with Gram staining and confirmed to be Gram-positive cocci arranged in chains. The bacteria are round or oval, with a diameter of 0.5-1.0μm, arranged in chains, and of varying lengths. Further identification after purification. Identification of A2A group streptococci
A2.1 General identification: The following tests can be used for identification. A2.1.1 Bacitracin sensitivity test: More than 95% of the strains are sensitive to bacitracin (each paper contains 0.04 units), that is, the inhibition zone is above 10mm. The method is to smear the broth culture of the test bacteria on the blood agar plate with a sterile cotton swab, stick the bacitracin paper on the plate with sterile tweezers, and culture it at 35-37℃ for 18-24h to observe the results. The inhibition zone is greater than 10mm for sensitive, and less than 10mm for resistant. A2.1.2 S×T sensitivity test: S×T paper contains 1.25mg of trimethoprim-sulfamethoxazole and 23.75mg of sulfamethoxazole. Group A streptococci are not sensitive to S×T. The operation method is the same as above. A2.1.3 Sugar fermentation test: This bacterium ferments glucose, maltose, lactose, sucrose and salicin, produces acid but not gas, and does not ferment inulin, arabinose and raffinose.
A2.2 Serological grouping method identification:
A2.2.1 Precipitation method: First prepare the polysaccharide group antigen. There are many extraction methods, including Lancefield's hot hydrochloric acid extraction method, formamide extraction method, high pressure extraction method, enzyme extraction method and nitrite extraction method. The high pressure extraction method is the simplest. After inoculating streptococci in 30mL Todd-Hewitt broth, place it at 35-37℃ for 24h, centrifuge it at 3000r/min for 30min, and discard the supernatant. Suspend the precipitate in 0.5mL of 0.85% saline. Steam it at 1.05kg/cm2 under high pressure for 15min, centrifuge it, and the supernatant is the C antigen, which can be stored in a sterile test tube or bottle for later use. It is best to operate in a test tube with a small inner diameter. First add the antiserum to a small test tube, and then slowly add the above extract (C antigen, which can be diluted with saline 1:10, 1:20, ·) along the tube wall. After 15 to 20 minutes, a white precipitation ring appears on the contact surface of the two liquids, which is positive, otherwise it is negative. A2.2.2 Staphylococcus A protein (SPA) coagulation grouping method: First prepare SPA stabilization solution, inoculate Staphylococcus aureus on agar slant, culture at 35C for 24 hours, wash the culture with 20mL of pH7.4PBS, centrifuge and precipitate, wash twice repeatedly, add to the original capacity, and then add formaldehyde solution to make the final concentration of 0.5%, place at room temperature for 3 hours, and then put it in an 80C water bath for 30 minutes, wash with PBS for more than 2 times, prepare a 10% solution, add thimerosal, and make the final concentration of 1:10000. During sensitization, add 0.1mL of group A streptococcal antiserum to 1mL of 10% SPA stabilizing solution, place at room temperature for 30 minutes, wash twice with PBS, and then suspend in 10mL PBS, and add thimerosal for preservation. During operation, take 10mL of culture solution that has been cultured for 4 hours, centrifuge and precipitate, and discard the supernatant. Suspend the precipitated bacteria in 0.3mL of pH8.0 Tris buffer, add 0.1mL (5mg/mL) pancreatic enzyme solution, and culture at 35℃ for 1 hour. Take 1 drop and place it on the slide, mix it with 1 drop of sensitized SPA suspension, shake the slide gently, and observe whether agglutination occurs within 2 minutes. The results are expressed as ten to ten ten ten. Ten ten or more is positive. 356
B1 Management of infection sources
GB15993--1995
Appendix B
(Standardized Appendix)
Prevention of scarlet fever
B1.1 Patients should be isolated for respiratory tract treatment for 6 days. Patients with acute pharyngitis and acute tonsillitis should also be isolated for scarlet fever. Close contacts of susceptible populations need to be under medical observation for 12 days. B1.2 Drug prevention: Generally, there is no need for universal medication. For close contacts of susceptible populations, 400,000 to 800,000 units of penicillin per day can be used, intramuscularly, for 34 consecutive days. Or 1.2 million units of penicillin can be used, intramuscularly once. For those who are allergic to penicillin, co-trimoxazole can be used. B1.3. Group A Streptococcus carriers among nursery staff should be temporarily removed from their posts and receive 10 days of penicillin treatment, with a base of 800,000 units, twice daily, intramuscularly, and can only return to work after three consecutive negative cultures of pathogens. Those who are ineffective should be treated locally, and if there is no effect, they should be removed from their posts.
B2. Cut off the transmission route
When streptococcal respiratory tract infections are prevalent in the local area, group activities should be avoided to reduce the chance of infection caused by droplet transmission of pathogens. Improve environmental hygiene and pay attention to personal hygiene. Appendix C
(Suggested Appendix)
Treatment of scarlet fever
C1. General treatment
Emphasis on bed rest, after recovery, the course of the disease should still be observed for three weeks to detect various allergic complications early. C2. Antimicrobial treatment
Penicillin G is the first choice. The use of other broad-spectrum penicillins and cephalosporins is not necessary. Early application can shorten the course of the disease and reduce complications. Adults: 800,000 units/time, intramuscular injection, once every 6 hours; children: 20,000-40,000 units/kg/day, divided into four intramuscular injections. Those who are allergic to penicillin can use erythromycin or azolincomycin, 1-2g/day for adults, 40mg/kg/day for children, divided into four oral administrations, and the course of treatment is 7-10 days. Patients with severe symptoms of poisoning can be given intravenously, and the dose should be slightly larger, 1.6 million units of penicillin, twice a day, and the course of treatment is at least 10 days. C3 Treatment of septic and toxic scarlet fever: The dose of penicillin is increased to 6 million to 8 million units/day, intravenous drip, and fresh plasma or whole blood is given. If an abscess is formed, it must be incised and drained. For those with secondary infection, the corresponding antibiotics can be selected according to the pathogen. The course of treatment for this type of antibiotics is not less than two weeks. If septic shock occurs, rescue is performed according to septic shock. C4 Treatment of septic shock
The patient should be treated with active pathogenic treatment. For antibiotic treatment, the dose of penicillin should be increased to 6 million to 8 million units/day, and intravenously dripped. Anti-shock treatment should be given at the same time as active supportive therapy, such as: expanding blood volume, correcting acidosis, using vasoactive drugs, using adrenocortical hormones for a short period of time when necessary, protecting heart and kidney function, etc. 357
C5 Treatment of complications
GB15993-1995
About three weeks after recovery from scarlet fever, a small number of patients may develop allergic complications of the heart and kidney, such as rheumatic fever and glomerulonephritis. Once complications occur, the patient should rest in bed during the acute phase and be given penicillin G (same dose as C2), with a course of no less than two weeks, or use penicillin, 1.2 million units for adults and 600,000 to 1.2 million units for children, intramuscularly, once a month, until the condition stabilizes. If the patient cannot adhere to the long-term treatment, throat swab culture can be performed regularly. If group A streptococci are found, penicillin G should be given, 400,000 to 800,000 units per day, intramuscular injection, 10 to 14 days as a course of treatment. For those who are allergic to penicillin, erythromycin can be given, the dosage for children is 40 mg/kg, and for adults, 1 to 2 g per day, orally in 4 doses, and the course of treatment is the same as above. Rheumatoid arthritis should be given salicylic acid preparations, and if there is severe myocarditis, hormone treatment can be used. For specific treatment methods for rheumatic fever and acute glomerulonephritis, please refer to the relevant treatment methods in pediatrics and internal medicine.
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