27 一位一歲二個月男童持續發燒六天，有草莓舌與雙側頸部淋巴結腫大，身上出現許多針頭至豌豆大小稍微突起之紅斑，發燒在第六天消退後，手指尖端開始出現脫皮。上述臨床表現中，那一點不符合猩紅熱的典型臨床表現，而比較符合川崎病的表徵？

年齡 草莓舌 皮膚紅斑外觀 手指脫皮

KAWASAKI DISEASE DIAGNOSTIC CRITERIA

Kawasaki is also called Muco Cutaneous Lymph Node Syndrome or MCLNS

Diagnostic criteria are

• Fever for > 5 days

+ at least 4 of the following 5 criteria

MCLNS

• M = Mucous membrane changes: injected pharynx, strwberry tongue, injected dry cracked lips
• C = Conjunctivitis: non purulent and bilateral (D/D w scarlet fever)
• L = Limb changes: edema, erythema and periungueal desquamation
• N = Nodes enlargement in the Neck: usulally > 1.5 cm in diameter
• S = Scarlattiniform rash

kawasaki:

Age

Eighty-five percent of children with Kawasaki disease are younger than 5 years.¹ The majority of "incomplete" cases (see below) occur in very young children.⁹

scarlet fever

Age

• Peak incidence of scarlet fever occurs in children aged 4-8 years.
• By the time children are 10-years-old, 80% have developed lifelong protective antibodies against streptococcal pyrogenic exotoxins.
• Scarlet fever is rare in children younger than 2 years because of the presence of maternal antiexotoxin antibodies and lack of prior sensitization.

s. fever

Pathophysiology

Usually, the sites of group A beta-hemolytic streptococcal replication in scarlet fever are the tonsils and pharynx. Clinically indistinguishable, scarlet fever may follow streptococcal infection of the skin and soft tissue, surgical wounds (ie, surgical scarlet fever), or the uterus (ie, puerperal scarlet fever).

Group A beta-hemolytic streptococci secrete a number of toxins, enzymes, and erythrogenic toxins. Release of erythrogenic toxin causes the pathognomonic rash of scarlet fever. Local lesions reveal a characteristic inflammatory reaction, specifically hyperemia, edema, and polymorphonuclear cell infiltration.

The organism is able to survive extremes of temperature and humidity, which allows spread by fomites. Geographic distribution of skin infections tends to favor warmer or tropical climates and occurs mainly in summer or early fall in temperate climates.