Case Study Scarlet Fever

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

I was well versed with the patient’s medical history and current treatment, as I was the Long Call IM PGY – II Resident who supervised the medical intern when this patient was being downgraded from the ICU to the medical floor on 5/20/17 (and even suggested to the medical intern to add in her notes that the patient would benefit from statins, ACE inhibition and Spironolactone given CAD, CVA and HFrEF (LVEF < 35%.) The medical team subsequently started the patient on Atorvastatin 40 MG PO QHS, Lisinopril 10 MG PO QD and Spironolactone 12.5 MG PO QD.

Scarlet fever and diphtheria among many others were two of the most common diseases to effect children in the early part of the 1900s. Scarlet fever occurred mainly in those between the ages of 2 and 8, and was spread by droplets from carriers and affected individuals. Despite sore throat, headache, and fever, with red spots in the mouth and on the body, children would often continue to play with friends in the street and to mix with neighbours, thus allowing the disease to spread. Diphtheria was likewise highly contagious, generally affecting the throat but occasionally other mucous membranes and the skin.

Scarlet fever is a bacterial infection that causes a red rash on the skin. It is caused by a toxin producing organism called Streptococcus pyogenes. This organism is rarely seen in well developed countries. The age group it affects is typically six to twelve year olds, however; all age groups can have the infection. The modern form of scarlet fever “...in children is now causing toxic shock-like syndrome (TSLS), an acute and

Primary treatments include antibiotic therapy, Fluid resuscitation, and crystalloid. Potential treatments depending on patient status include vasopressors and steroids, ventilator, renal dialysis, blood transfusion, and surgery.

The general health of the patient is currently being compromised due to present illness mentioned above, but is stable. L.H. reports his usual health to be, “normal and not too crazy like this”. Patient has some fatigue noted while conducting daily activities; No recent weight change, fever or sweat. The skin noted to some discoloration on upper right side of back. There is no pruritus, rash or lesions present. Bruises noted bilateral on arms. Patient reported taking baby aspirin as daily medication. His hair is greying and thinning with no hair loss.

Could I have an prescription for an antipyretic, and do you want to continue the

Due to the description of the disease, Scarlet fever seems to have been dated back almost 2,500 years even back to the time of Hippocrates. Supposedly there has been 3 major epidemics of Scarlet Fever. The first uncontested account of scarlet fever came in 1553 similar to measles, diphtheria and other rashes however some say it was seen as early as 430 B.C. Scarlet fever brought about a death rate then as high as one hundred and fifty out of one hundred thousand, which is a very morbid death rate.

The past few days have been especially hard for me and my town, Willoughby, Pennsylvania. Scarlet Fever has swep through the town, over twenty people are sick. It started with just one case, a little boy of the age of six. I was rushed over to the little child but there was nothing I could do for him, the only thing I could good was give him some whiskey to help with his pain.

Mr. J. reports having unprotected sex with one monogamous male partner for the last 4-5 weeks. Mr. J. reports having anal Herpes with an outbreak 4 weeks ago, during this time he was having unprotected anal intercourse. Mr. J. denies any other STD’s.

Cephalexin and Gentamicin would be effective since they are equally sensitive to the pseudomonas aeruginosa microbe which implies they will kill the microbe and work against the bacteria.

If a streptococcal infection such as pharyngitis or scarlet fever is left untreated, there is a small (~3%) chance that within approximately 20 days, the patient will present with rheumatic fever. After the first bout of rheumatic fever, if the host acquires a second untreated S. Pyogenes infection, the chance of coming down with rheumatic fever jumps substantially to ~50%. Most often this secondary disease will strike people aged 6-15 years old, roughly 20 days after the streptococcal infection, with a 2-5% mortality rate. One of the major diagnostic symptoms of this disease is Erythema Marginatum, snake- or ring-like eruptions covering the trunk, upper arms, and legs. Other symptoms include fever, arthritis (elbows, knees, wrists, and ankles), swollen joints, pain in the abdomen, nodules

Genital herpes is reported as a "common and highly contagious infection usually spread through sex." (WebMD, 2012) Herpes is an infection resulting from the herpes simplex virus-2 (HSV-2) which is similar to herpes simplex virus-1 (HSV-1) which is the virus that causes cold sores. Individuals infected with the herpes virus have recurrent outbreaks in fact 90% of individuals infected with the herpes virus report repeated outbreaks with some reporting only two outbreaks each year. However, some individuals report up to eight outbreaks per year with the herpes virus. (Shiel, 2011, p.1)

The release of two exotoxins from certain strains of S. aureus can lead to Staphylococcal scaled skin syndrome (SSSS), which is characterized by blistering skin. Invasion into the body can lead to more serious health problems including pneumonia (a frequent complication of influenza), mastitis, phlebitis (inflammation of the veins), meningitis, and urinary tract infections. If the bacterium is allowed to colonize even deeper tissues more serious conditions such as osteomyelitis and endocarditis may result. The most serious consequences of these deeper tissue infections occur when the bacterium invades the bloodstream leading to septic shock and possibly death.

It is an infection caused by pathogens such as viruses, but more likely bacteria, especially when children are getting sick. In particular, the "responsible" is the number one affection Streptococcus, to be defeated, as we shall see in a moment, with the right