Incidence and Characteristics of Scarlet Fever, South Korea, 2008-2015.

The incidence rate for scarlet fever in South Korea is rising. During 2008-2015, we collected group A Streptococcus isolates and performed emm and exotoxin genotyping and disk-diffusion antimicrobial tests. Scarlet fever in South Korea was most closely associated with emm types emm4, emm28, emm1, and emm3. In 2015, tetracycline resistance started increasing.

Spread of a highly mucoid Streptococcus pyogenes emm3/ST15 clone.

BACKGROUND: Hyaluronic acid capsule plays a key role in Streptococcus pyogenes virulence. Circulation of mucoid or highly encapsulated strains has been related to rheumatic fever epidemics and invasive disease in several countries. In 2009, an outbreak of mucoid S. pyogenes isolates was detected in northern Spain. The aim of the study was to describe clinical and molecular characteristics of mucoid strains causing this outbreak and to compare them with a sample of non-mucoid S. pyogenes isolates obtained during the same period of time. METHODS: All S. pyogenes isolates with a mucoid colony morphology (n = 132), 10% of non-mucoid (n = 144) and all invasive S. pyogenes isolates (n = 7) obtained in 2009 were included. Characterization was performed by T-agglutination, emm typing, pulsed field gel electrophoresis and multilocus sequence typing. RESULTS: One clone characterized as emm3.1/ST15 comprised 98.5% (n = 130) of all mucoid isolates. Subjects of all ages were affected. Main clinical manifestations were pharyngitis and scarlet fever, but this clone also caused invasive disease: two cases of streptococcal toxic shock syndrome, one arthritis, and one celullitis with a fatal outcome. Mucoid isolates were more prone to cause invasive disease than non-mucoid isolates (p = 0.001). CONCLUSIONS: Although no acute rheumatic fever cases were detected, the most worrisome characteristics of this clone were the success for causing invasive disease and the merge of two virulent features: the serotype, emm3, and capsule hyper-production, expressed as a mucoid morphology.

[Diagnostic image (281). A girl with fever, a sore throat and a rash]. / Diagnose in beeld (281). Een meisje met koorts, keelpijn en huiduitslag.

Scarlet fever was diagnosed in a girl with high fever, a sore throat and exanthema marginatum.

Scarlet fever associated with hepatitis--a report of two cases.

Infection with group A beta-hemolytic streptococci (GABHS) is the most common bacterial cause of acute pharyngitis and tonsillitis beyond infancy. We report on two patients with scarlet fever associated with hepatitis. The patients (boys aged 6 and 7 years) both presented with a scarlatiniform rash, dark urine and light-colored stools. Laboratory studies revealed elevated liver transaminases and negative antibody tests against hepatitis viruses A, B and C, cytomegalovirus and Epstein-Barr virus. Both patients were treated with antibiotics and recovered completely within a few days. Although the association between scarlet fever and hepatitis has been known for many decades, the pathogenesis is still unknown. Physicians treating patients with group A beta-hemolytic streptococcal infections should be aware of possible hepatic involvement.

A case of varicella complicated by cellulitis and scarlet fever due to Streptococcus pyogenes.

We report a 4-year-old boy with cellulitis and scarlet fever due to streptococcal infection following the onset of varicella. He developed a painful ulcer and subcutaneous induration on the left shoulder and a small, light-red-colored rash on the trunk at approximately the same time as the development of vesicles over the entire body. Streptococcus pyrogenes was isolated from samples from the posterior intranasal space and the ulcer on the shoulder. The clinical symptoms improved with the administration of antibiotics and intravenous drip infusion, but it took approximately one month from the first visit for the subcutaneous induration to disappear and the ulcer to heal with epithelialization. The complication of secondary streptococcal infection in varicella is relatively rare in Japan, but in Western countries there have been many reported cases of life-threatening necrotizing fasciitis and necrotizing pyomyositis due to secondary streptococcal infection following varicella. Close attention should be paid to streptococcal infection as a complication of varicella.

Inhibition of the scarlet fever exanthem in concurrent varicella and group A streptococcus infection.

An atypical scarlet fever exanthem was noted in a 5-year-old child with varicella complicated by secondary group A beta-hemolytic streptococcus pneumonia and empyema. The rash consisted of symmetrical, concentric, circular exanthem-free zones surrounding individual varicella vesicles. The possible role of virus-induced interferon in locally modifying the effect of streptococcal pyrogenic exotoxin is explored.

[Manifestations of Streptococcus infection resulting from various serologic groups of streptococcus]. / O nekotorykh osobennostiakh proiavlenii streptokokkovoi infektsii, vyzvannoi raznymi serogruppami streptokokka.

44 autopsy cases (from 1985 to 1990) are studied out of which in 38 cases the diseases were produced by streptococcus of group A. In 18 cases there was a pharyngeal or extra-pharyngeal generalized streptococcus infection (scarlet fever). Moderately pronounced local damage, mainly pneumonia, were found in 20 cases. In 3 other cases the disease was produced by group B streptococcus, in 2 cases by streptococcus D and in 1 case by streptococcus of G group. Group A streptococcus was encountered mainly in children older than 6 months (31 cases), B and D at an earlier age (particularly B streptococcus). Morphologically, there were no essential differences connected with different streptococcus groups. The infection in most cases was correlated with a respiratory diseases, more frequently with influenza or respiratory-syncytial infection this favouring more grave course of streptococcus infection.

The six classic childhood exanthems: a review and update.

The six classic exanthems of childhood have many similar physical findings. Familiarity with them, as well as with important laboratory data, allows early and accurate diagnosis of these often confusing diseases. Recognition and treatment of possible sequelae also improve prognosis. In this review we discuss epidemiology, etiology, clinical manifestations, pathologic and laboratory findings, differential diagnosis, therapy, and prevention of each of the exanthems.

[Streptococcal infection: variants and morphological manifestations]. / Streptokokkovaia infektsiia: formy i ikh morfologicheskie proiavleniia.

82 cases of streptococcal infection (SI) in children who died in 1977-1985 are studied. Higher incidence of SI in children particularly in those who died at home is emphasized. As a rule, the proper diagnosis was not established clinically. By manifestations the observations were divided into two groups: 1) SI with a pronounced generalization including a pharyngeal one (31 cases), 4 of them with a rash (scarlet fever); extrapharyngeal (7 cases), 6 of them with a rash (scarlet fever); 2) SI without pronounced generalization (localized) including 33 cases with the involvement of the lungs and tonsilla and having an ordinary course and 11 cases of a sudden death. SI structural manifestations involved development of necrotic or purulent-necrotic inflammation of a various degree in the area of the primary focus, regional lymph nodes as well as in the foci resulting from lymphohaematogenic and intracanalicular dissemination. The first symptoms of the septic process could be found even in case of death during the first day of the disease. The role of viral respiratory infection being the background for the SI development, especially for its pharyngeal variant and lung affection, is shown. The significance of thymomegaly and adrenal hypoplasia in the development of a sudden death is revealed.

Acute exanthems in children. Clues to differential diagnosis of viral disease.

The numerous viral skin diseases that affect children present a diagnostic challenge to the clinician. Most of these diseases may be conveniently grouped according to the clinical appearance of the exanthem as maculopapular, petechial, papular, or vesicular. In some situations, viral infection may be difficult to differentiate clinically from nonviral disease; thus, extensive laboratory evaluation is sometimes necessary to pinpoint the virus involved. Nonviral disease should be considered in the differential diagnosis of a patient with skin eruptions, especially of the maculopapular type. Common nonviral causes include Kawasaki disease, toxic shock syndrome, and drug reactions.

[Toxic staphylococcal cutaneous necrolysis (scalded skin syndrome) (author's transl)]. / Le syndrome toxique staphylococcique cutané dit des enfants ébouillantés (scalded skin syndrome).

The exfoliating exotoxin of serotype II staphylococci is responsable of three diseases with prevailing dermatologic symptoms: staphylococcal scarlet fever, staphylococcal Lyell syndrom and Ritter-Lyell disease. Melish demonstrated the effect of staphylococcal exotoxin on new-born mice less than five days old. This experimental model allowed to study the characteristics of the toxin. Precocious antistaphylococcal antibiotherapy is necessary.