Scarlet Fever

Case

Patient no. 1Oyugerel a 4 year old girl was brought in on ambulance with a high fever and rashes spreading from face throughout the entire body. The throat showed the symptoms of soreness and pain.

Patient no. 2Batdorj is a 4 year old boy was brought in by ambulance with the complaint of fever, rashes spreading from face to chest and neck. Showed additional symptoms of losing an appetite and vomiting a day prior.

Additional information

• G. Oyugerel• 4 years old• Does not attend

kindergarten • Was admitted on

19.03.15 17:15

• B. Batdorj• 4 years old• Goes to kindergarten• Was admitted on

13.03.15 16:00• Has tonsillitis

Physical Examination Findings• Respiratory rate 26/min• Heart rate 96/min• Reddened cheeks • Small, spotted blot like, red rashes

on the face, neck, trunk and extremities

• Rashes were itchy• Crimson lips• Circumorial pallor• Reddened tongue and tonsils• Coating on the tongue which

disappeared after a day of treatment

• Started with the fever of 39.5° C

• Respiratory rate 20/min• Heart rate 88/min• Reddened cheeks• Small, blot like, multiple red

rashes on face, and entire body• Circumorial pallor• The rashes are rough on the

touch• Rashes were itchy• Reddened tongue• A fever of 38.9° C prior to the

admittance

Progression 18.03.15 – faint red marks on the neck19.03.15 morning – fever reached 39.5° C,

red rashes starting from the neck (there’s a blood from scratching)

19.03.15 17:15 – admitted into the hospital

19.03.15 evening – entire body is covered in the rashes

19-20.03.15 – the coating on the tongue fades after the treatment

18-22.03.15 – the fever of 38° C persists through the nights

20-22.03.15 - rashes begin to disappear by peeling off of the skin (desquamation)

22.03.15 afternoon – a slight soreness in the mouth still remains

11.03.15 evening – fever of 38.9° C, vomiting, headache

12.03.15 afternoon – face redness, rashes begin to spread down neck to the chest and entire body, tongue is red. Ambulance.

13.03.15 – admitted into hospital17-18.03.15 – the rash begins to

lessen and thin (desquamation, starting from the fingertips)

19-20.03.15 – lessens further21-22.03.15 - the rash is gone but the

skin of the leg still remains a bit rough (like a sandpaper)

Laboratory TestingSG 1.015 1.015

PH 5 5

LEU 500/µl 3+

NIT Neg Neg

PRO 25 mg/dl 1+

GLU Norm Neg

KET 50 mg/dl 3+

UBG Norm Neg

BIL Neg Neg

ERY 10/µl 1+

Color Yellow

Clarity clear

Laboratory Testing (changes)HCT 31.3 35.0-55.0

MPV 7.2 8.0-11.0

WBC 25.4 3.5-10.0

HGB 10.8 11.5-16.5

GRAN 23.7 1.2-8.0

LYM% 4.4 15.0-50.0

GRA% 93.2 35.0-80.0

RDW% 17.0 11.0-16.0

MPV 6.7 7.0-11.0

WBC 11.1 3.5-10.0

GRAN 8.3 1.2-8.0

Treatment

• Ampicillin injections• Nurofeni• Chlorphenamini• Ascorutini• Viferoni (suppositorium)• Tamedini• Paracetamol

• Ampicillin injections• Chlorphenamini• Groprinosini• Ascorutini• Tamedini