| The case of an otherwise well 9-y-old boy with fever, papular rash, jaundice and impaired liver function is presented. streptococcus mitis sensitive to penicillin grew in blood culture. The boy had an excellent outcome. The clinical spectrum of viridans streptococci may be wider than currently anticipated, and Streptococcus mitis may cause septicaemia and hepatitis in immunocompetent individuals. ( info) |
2/30. 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. ( info) |
3/30. Kawasaki disease: a diagnostic challenge. Kawasaki disease (KD) is an acute, self-limited, febrile, multi-system vasculitis that predominantly affects the the pediatric population, and is the leading cause of acquired heart disease in children. No etiologic agent for the disease has been identified, there are no diagnostic tests available, and the diagnosis is established by fulfilling a defined set of clinical criteria. We report on a 9-year-old boy who presented initially with symptoms felt to represent a streptococcal infection. He was subsequently shown to meet the criteria for KD, developed cardiac complications of the disease and subsequently demonstrated recovery over a year's period of time. The diagnostic criteria for KD, differential diagnosis, pitfalls in diagnosis, therapeutic recommendations and outcomes are discussed with relevance to this case. Recent print and electronic information sources and references are provided. ( info) |
| 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. ( info) |
5/30. Kawasaki disease before kawasaki at tokyo university hospital. OBJECTIVE: Kawasaki disease (KD) was first reported by Tomisaku Kawasaki in 1967 in japan. Large-scale nationwide epidemiologic surveys have been conducted continuously by the japan Kawasaki disease research Committee; however, there were very few reports of KD before 1967. This study was performed to clarify when KD appeared in japan. DESIGN: We investigated the medical charts of patients who had been hospitalized at tokyo University Hospital between 1940 and 1965. RESULTS: We identified 10 patients whose clinical signs fulfilled the criteria for KD. The ages of the patients ranged from 8 months to 5 years, and their final diagnoses were stevens-johnson syndrome, allergic toxic erythema, Izumi fever, scarlet fever, and cervical lymphadenitis. These 10 patients presented between 1950 and 1964, and no confirmed cases were seen between 1940 and 1949. CONCLUSIONS: Our findings suggested that KD patients were rare before 1950 in japan. ( info) |
| scarlet fever is a common and usually benign course when treated properly. Hepatitis due to scarlet fever has been described mostly in adults. A 2 1/2-year-old boy presented with scarlet fever and jaundice, hematuria and elevated liver enzymes. ( info) |
7/30. Varicella complicated by scarlet fever. We report a 3-year-old boy with varicella complicated by cellulitis and scarlet fever. He developed a typical rash of scarlet fever following the onset of varicella. streptococcus pyogenes was isolated from the ulcers due to varicella. The present case suggests that scarlet fever may rarely develop following varicella and should be considered in children with complicated varicella. ( info) |
| We describe a case of toxic scarlet fever in a healthy adult with streptococcal cellulitis of the right elbow as a result of skin abrasion. The clinical picture mimicked that of drug eruption after treatment of cellulitis with antibiotics. Among the five cases of scarlet fever complicating cellulitis, including the present one, reported in the English literature, four had severe systemic complications and two died. As a result of re-emergence of invasive streptococcal infections, clinicians should be aware of the differential diagnosis of scarlet fever in patients presenting with cellulitis and skin rash. Early clinical diagnosis is crucial to exclude drug eruptions, prompt initiation of antibiotic treatment, and prevention of the potentially fatal outcome. ( info) |
| Two cases of scarlet fever are described, both following super-infection of chickenpox. Enterotoxin B and C producing staphylococci were the only pathogens identified. The role of staphylococcal and streptococcal toxins in the pathogenesis of scarlet fever and toxic shock syndrome is discussed. ( info) |
| A 25-year-old female meeting all six criteria for Kawasaki disease is reported. A total of 22 reported cases of adult Kawasaki disease, including the present case, are reviewed. In adult Kawasaki disease, arthralgia, gastrointestinal complications and hepatic dysfunction are seen more frequently than in childhood cases. Cardiac complications are rarely seen in adult Kawasaki disease. Two cases have been positive for anti-nuclear antibody (ANA). The present patient had increased levels of serum IgE and was positive for ANA, suggesting involvement of an immune mechanism. adult Kawasaki disease is rare but appears to be on the increase; internists treating adults must be aware of this disease. ( info) |