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Yu W, Guo L, Shen X, Wang Z, Cai J, Liu H, Mao L, Yao W, Sun Y. Epidemiological characteristics and spatiotemporal clustering of scarlet fever in Liaoning Province, China, 2010-2019. Acta Trop 2023; 245:106968. [PMID: 37307889 DOI: 10.1016/j.actatropica.2023.106968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND To explore the epidemiological characteristics and spatiotemporal distribution of scarlet fever in Liaoning Province, which could provide scientific evidence for the formulation and improvement of prevention and control strategies and measures. METHODS Data on scarlet fever cases and population were obtained from the China Information System for Disease Control and Prevention in Liaoning Province between 2010 and 2019. We examined the spatial and spatiotemporal clusters of scarlet fever across Liaoning Province using the Moran's I, local indicators of spatial association, local Gi* hotspot statistics, and Kulldorff's retrospective space-time scan statistical analysis. RESULTS Between 1st January 2010 and 31st December 2019, 46,652 cases of scarlet fever were reported in Liaoning Province, with an annual average incidence of 10.67 per 100,000. The incidence of scarlet fever had obvious seasonality with high incidence in early summer June and early winter December. The male-to-female ratio was 1.53:1. The highest incidence of cases occurred in 3-9 year old children. The most likely spatiotemporal cluster and the secondary clusters were detected in urban regions of Shenyang and Dalian, Liaoning Province. CONCLUSIONS The incidence of scarlet fever has obvious spatiotemporal clustering, with the high-risk areas mainly concentrated in urban area of Shenyang and Dalian, Liaoning Province. Control strategies need to focus on high-risk season, high-risk areas and high-risk populations in order to reduce the incidence of scarlet fever.
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Affiliation(s)
- Weijun Yu
- Institute for Prevention and Control of Infection and Infectious Diseases, Liaoning Provincial Center for Disease Control and Prevention, No.168, Jin Feng Street, Shenyang, Liaoning 110172, China
| | - Lining Guo
- Hunnan District Center for Disease Control and Prevention, Shenyang, Liaoning 110015, China
| | - Xiulian Shen
- Epidemic Surveillance/Public Health Emergency Response Center, Yunnan Provincial Center for Disease Control and Prevention, Kunming, Yunnan 650022, China
| | - Zijiang Wang
- Institute for Prevention and Control of Infection and Infectious Diseases, Liaoning Provincial Center for Disease Control and Prevention, No.168, Jin Feng Street, Shenyang, Liaoning 110172, China; Department of Emergency Management, Liaoning Provincial Center for Disease Control and Prevention, No.168, Jin Feng Street, Shenyang, Liaoning 110172, China.
| | - Jian Cai
- Department of Communicable Disease Control, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang 310051, China
| | - Huihui Liu
- Chinese Field Epidemiology Training Program, Chinese Center for Disease Control and Prevention, Beijing 100050, China
| | - Lingling Mao
- Institute for Prevention and Control of Infection and Infectious Diseases, Liaoning Provincial Center for Disease Control and Prevention, No.168, Jin Feng Street, Shenyang, Liaoning 110172, China
| | - Wenqing Yao
- Institute for Prevention and Control of Infection and Infectious Diseases, Liaoning Provincial Center for Disease Control and Prevention, No.168, Jin Feng Street, Shenyang, Liaoning 110172, China
| | - Yingwei Sun
- Institute for Prevention and Control of Infection and Infectious Diseases, Liaoning Provincial Center for Disease Control and Prevention, No.168, Jin Feng Street, Shenyang, Liaoning 110172, China.
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Matsubara VH, Christoforou J, Samaranayake L. Recrudescence of Scarlet Fever and Its Implications for Dental Professionals. Int Dent J 2023; 73:331-336. [PMID: 37062653 DOI: 10.1016/j.identj.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
A significant increase in the incidence of scarlet fever, mainly in Europe, has been noted during the COVID-19 postpandemic period. Scarlet fever is caused by a pyrogenic exotoxin-producing streptococcus-Streptococcus pyogenes-responsible for more than 500,000 deaths annually worldwide. Superantigens (SAgs) secreted by this Group A streptococcus (GAS) usually overstimulate the human immune system, causing an amplified hypersensitivity reaction leading to initial symptoms such as sore throat, high fever, and a sandpaper-like skin rash. There could be concurrent oral manifestations known as "strawberry tongue" or "raspberry tongue," which may be first noted by oral health professionals. The early diagnosis and treatment of this disease is critical to obviate the development of local and systemic sequelae such as acute rheumatic fever, endocarditis, and glomerulonephritis. Antibiotics should be prescribed early to mitigate its duration, sequelae, and community spread. Dental practitioners should be aware of the early symptoms of scarlet fever for infection detection, emergency patient management, and appropriate referral. This concise review outlines the prevalence, pathogenicity, oral and systemic manifestations, as well as the dental implications of scarlet fever.
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Affiliation(s)
| | - Janina Christoforou
- Dental School, University of Western Australia, Perth, Western Australia, Australia
| | - Lakshman Samaranayake
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, Special Administrative Region, China; Hamdan Bin Mohammed College of Dental Medicine, Dubai, United Arab Emirates.
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Muacevic A, Adler JR, Mutlaq MR, Khojah AA, Khojah SA, Mohamed HA. Atypical Presentation of Scarlet Fever. Cureus 2022; 14:e33142. [PMID: 36721591 PMCID: PMC9884498 DOI: 10.7759/cureus.33142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2022] [Indexed: 12/31/2022] Open
Abstract
Scarlet fever is an infectious illness, which is caused by Streptococcus pyogenes. It causes exanthema and a characteristic tonsillopharyngitis. Its diagnosis is typically straightforward. However, due to the diverse clinical presentation of scarlet fever, one has to be cautious about atypical rash distribution that might go unrecognized or be misdiagnosed. Despite the fact that scarlet fever is primarily a pediatric illness, it can affect people of any age group. The case presented describes the clinical difficulty in the diagnosis of scarlet fever in an adult patient with atypical rash distribution involving dorsum of the hand and feet only till the level of wrists and ankles joints. A high degree of suspicion is required to diagnose this rare presentation and early treatment is essential to limit the spread of the disease.
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Sun L, Xiao Y, Huang W, Lai J, Lyu J, Ye B, Chen H, Gu B. Prevalence and identification of antibiotic-resistant scarlet fever group A Streptococcus strains in some pediatric cases at Shenzhen, China. J Glob Antimicrob Resist 2022; 30:199-204. [PMID: 35618209 DOI: 10.1016/j.jgar.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the annual incidence, molecular epidemiological characteristics, and antimicrobial resistance of group A Streptococcus (GAS) clinical isolates from pediatric patients at Shenzhen Children's Hospital during 2016-2020. METHODS Clinical samples were collected from pediatric patients with a suspected diagnosis of GAS infections. We studied the annual incidence and characteristics of GAS infections using the GAS antigen detection method. Additionally, 250 GAS isolates were randomly selected for genotyping of the emm gene, and antimicrobial susceptibility assay was performed using the Kirby-Bauer paper dispersion strategy. RESULTS Among 43,593 collected samples, 9,313 were positive for the GAS antigen. The main emm type was emm12, followed by emm1, emm6, and emm 4, which were used for distinguishing 90% of the scarlet fever isolated strains. The percentage of emm1 increased from 36% in 2016 to 44% in 2019, whereas the percentage of emm12 decreased from 62% to 50%. Several unusual emm types isolated from scarlet fever patients showed an increase in proportions from 2016 to 2020. These GAS isolates were sensitive to penicillin, ceftriaxone, and vancomycin and were highly resistant to erythromycin and clindamycin. CONCLUSION There was a high incidence of GAS infections during 2016-2020 in Shenzhen, China. The GAS isolates had a high resistance rate to erythromycin and clindamycin; penicillin was the antibiotic of choice for GAS infections. The common emm types were emm12 and emm1. Future studies should investigate the clonal structure and superantigen profiles of the population of GAS isolates associated with scarlet fever.
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Affiliation(s)
- Lifang Sun
- Laboratory of Shenzhen Children's Hospital, Shenzhen, China
| | - Yunju Xiao
- Division of Laboratory Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Weilong Huang
- Laboratory of Shenzhen Children's Hospital, Shenzhen, China
| | - Jianwei Lai
- Laboratory of Shenzhen Children's Hospital, Shenzhen, China
| | - Jingwen Lyu
- Division of Laboratory Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Medical Technology School of Xuzhou Medical University, Xuzhou Key Laboratory of Laboratory Diagnostics, Xuzhou, China
| | - Bingjun Ye
- Laboratory of Shenzhen Children's Hospital, Shenzhen, China
| | - Hongyu Chen
- Laboratory of Shenzhen Children's Hospital, Shenzhen, China.
| | - Bing Gu
- Division of Laboratory Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Medical Technology School of Xuzhou Medical University, Xuzhou Key Laboratory of Laboratory Diagnostics, Xuzhou, China.
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Modeling the effects of air pollution and meteorological factors on scarlet fever in five provinces, Northwest China, 2013-2018. J Theor Biol 2022; 544:111134. [DOI: 10.1016/j.jtbi.2022.111134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022]
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Ferreira LCM, Oliveira A, Pereira C, Guedes A, Assunção JP. Scarlet fever in an adult patient: A challenging diagnosis in an airway emergency. SAGE Open Med Case Rep 2021; 9:2050313X211049908. [PMID: 34659770 PMCID: PMC8511905 DOI: 10.1177/2050313x211049908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 09/13/2021] [Indexed: 11/22/2022] Open
Abstract
Scarlet fever is essentially a childhood disease, although it may occur in all ages. Early diagnosis and treatment are essential in preventing the spread of infection and progression to life-threatening complications. The case presented describes the clinical difficulty in the diagnosis of scarlet fever in an adult patient with acute involvement of the airway (oedematous laryngitis) and the need for emergent orotracheal intubation and eventually tracheotomy. A high degree of suspicion related to the airway involvement is of utmost importance in an emergency room setting.
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Affiliation(s)
| | - Ana Oliveira
- Hospital Center Tondela-Viseu, Anesthesiology Service,
Viseu, Portugal
| | - Cláudia Pereira
- Hospital Center Tondela-Viseu, Anesthesiology Service,
Viseu, Portugal
| | - Alexandra Guedes
- Hospital Center Tondela-Viseu, Anesthesiology Service,
Viseu, Portugal
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Jiang F, Wei T, Hu X, Han Y, Jia J, Pan B, Ni W. The association between ambient air pollution and scarlet fever in Qingdao, China, 2014-2018: a quantitative analysis. BMC Infect Dis 2021; 21:987. [PMID: 34548016 PMCID: PMC8456591 DOI: 10.1186/s12879-021-06674-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 09/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background We conducted a distributed lag non-linear time series analysis to quantify the association between air pollution and scarlet fever in Qingdao city during 2014–2018. Methods A distributed lag non-linear model (DLNM) combined with a generalized additive mixed model (GAMM) was applied to quantify the distributed lag effects of air pollutions on scarlet fever, with daily incidence of scarlet fever as the dependent variable and air pollutions as the independent variable adjusted for potential confounders. Results A total of 6316 cases of scarlet fever were notified, and there were 376 days occurring air pollution during the study period. Scarlet fever was significantly associated with air pollutions at a lag of 7 days with different relative risk (RR) of air pollution degrees [1.172, 95% confidence interval (CI): 1.038–1.323 in mild air pollution; 1.374, 95% CI 1.078–1.749 in moderate air pollution; 1.610, 95% CI 1.163–2.314 in severe air pollution; 1.887, 95% CI 1.163–3.061 in most severe air pollution]. Conclusions Our findings show that air pollution is positively associated with scarlet fever in Qingdao, and the risk of scarlet fever could be increased along with the degrees of air pollution. It contributes to developing strategies to prevent and reduce health impact from scarlet fever and other non-vaccine-preventable respiratory infectious diseases in air polluted areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06674-8.
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Affiliation(s)
- Fachun Jiang
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Tao Wei
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao City, 266000, Shandong Province, People's Republic of China
| | - Xiaowen Hu
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Yalin Han
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Jing Jia
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Bei Pan
- Department of Acute Infectious Diseases, Qingdao Municipal Center for Disease Control and Prevention, Qingdao Institute of Prevention Medicine, Qingdao City, Shandong Province, People's Republic of China
| | - Wei Ni
- Qingdao Women and Children's Hospital, Qingdao University, No.6 Tongfu Road, Qingdao City, 266000, Shandong Province, People's Republic of China.
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8
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Scarlet Fever After Streptococcus pyogenes Skin Infection Associated With FreeStyle Libre Glucose Monitoring. Can J Diabetes 2021; 45:689-691. [PMID: 33582045 DOI: 10.1016/j.jcjd.2020.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/08/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022]
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9
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Gajdács M, Ábrók M, Lázár A, Burián K. Beta-Haemolytic Group A, C and G Streptococcal Infections in Southern Hungary: A 10-Year Population-Based Retrospective Survey (2008-2017) and a Review of the Literature. Infect Drug Resist 2021; 13:4739-4749. [PMID: 33408489 PMCID: PMC7781025 DOI: 10.2147/idr.s279157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/18/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Pyogenic β-hemolytic streptococci (including Group A, C and G Streptococcus) are some of the most important Gram-positive bacterial pathogens in human medicine. Although effective therapy is available, invasive streptococcal infections are associated with a significant disease burden. Methods In this retrospective study, the epidemiological characteristics of invasive Group A (iGAS) and Group C and G (iGCGS) streptococci, along with tonsillo-pharyngitis-causing pGAS and pGCGS infections, were assessed in Southern Hungary. A total of 1554 cases of streptococcal tonsillo-pharyngitis infections (26.5–44.1/100,000 persons, pGAS: 95.5%; n=1484) and 1104 cases of invasive streptococcal infections were detected (12.5–31.4/100,000 persons, iGAS: 77.9%; n=861). Results The average age of the affected patients in the various groups were the following: pGAS: 13.2±13.1 years, pGCGS: 21.0±15.0 years (p=0.039), iGAS: 49.1±12.8 years, iGCGS: 58.7±18.5 years (p>0.05). iGAS isolates originated from abscesses (47.1%), blood culture samples (24.1%), surgical samples (16.7%), biopsies (4.6%), pleural fluid (3.5%), pus (2.0%), synovial fluid (1.3%) and cerebrospinal fluid samples (0.7%). In contrast, iGCGS isolates mainly originated from blood culture samples (53.8%), abscesses (22.9%), surgical samples (12.3%), synovial fluid (5.1%), pleural fluid (3.7%), pus (1.8%) and cerebrospinal fluid samples (0.4%). All respective isolates were susceptible to benzyl-penicillin; overall resistance levels for erythromycin (10.5% for GAS, 21.4% for GCGS) and clindamycin (9.2% for GAS, 17.2% for GCGS) were significantly higher in GCGS isolates, while resistance levels for norfloxacin were higher in GAS isolates (13.5% for GAS, 6.9% for GCGS). Conclusion The rates of resistance to macrolides and clindamycin are a cause for concern (especially among GCGS isolates); however, resistance levels are still relatively low, compared to Southern European countries.
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Affiliation(s)
- Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged 6720, Hungary
| | - Marianna Ábrók
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Lázár
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Department of Medical Microbiology, Faculty of Medicine, University of Szeged, Szeged 6720, Hungary
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10
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Sachdeva M, Gianotti R, Shah M, Bradanini L, Tosi D, Veraldi S, Ziv M, Leshem E, Dodiuk-Gad RP. Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. J Dermatol Sci 2020; 98:75-81. [PMID: 32381430 PMCID: PMC7189855 DOI: 10.1016/j.jdermsci.2020.04.011] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Various cutaneous manifestations have been observed in patients with COVID-19 infection. However, overall similarities in the clinical presentation of these dermatological manifestations have not yet been summarized. OBJECTIVE This review aims to provide an overview of various cutaneous manifestations in patients with COVID-19 through three case reports and a literature review. METHODS A literature search was conducted using PubMed, OVID, and Google search engines for original and review articles. Studies written in the English language that mentioned cutaneous symptoms and COVID-19 were included. RESULTS Eighteen articles and three additional cases reported in this paper were included in this review. Of these studies, 6 are case series and 12 are case report studies. The most common cutaneous manifestation of COVID-19 was found to be maculopapular exanthem (morbilliform), presenting in 36.1% (26/72) patients. The other cutaneous manifestations included: a papulovesicular rash (34.7%, 25/72), urticaria (9.7%, 7/72), painful acral red purple papules (15.3%, 11/72) of patients, livedo reticularis lesions (2.8%, 2/72) and petechiae (1.4%, 1/72). Majority of lesions were localized on the trunk (66.7%, 50/72), however, 19.4% (14/72) of patients experienced cutaneous manifestations in the hands and feet. Skin lesion development occurred before the onset of respiratory symptoms or COVID-19 diagnosis in 12.5% (9/72) of the patients, and lesions spontaneously healed in all patients within 10 days. Majority of the studies reported no correlation between COVID-19 severity and skin lesions. CONCLUSION Infection with COVID-19 may result in dermatological manifestations with various clinical presentations, which may aid in the timely diagnosis of this infection.
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Affiliation(s)
- Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raffaele Gianotti
- Institute of Dermatological Sciences, University of Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Shah
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lucia Bradanini
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
| | - Diego Tosi
- Division of Infectious Diseases, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, Milan, Italy
| | - Stefano Veraldi
- Department of Pathophysiology and Transplantation, Università degli Studi, Foundation IRCCS, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michael Ziv
- Dermatology Department, Emek Medical Center, Israel
| | - Eyal Leshem
- Institute for Travel and Tropical Medicine, Sheba Medical Centre, Israel; School of Medicine, Tel Aviv University, Israel
| | - Roni P Dodiuk-Gad
- Dermatology Department, Emek Medical Center, Israel; Bruce Rappaport Faculty of Medicine, Technion - Institute of Technology, Israel; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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11
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Elias M, Patel S, Schwartz RA, Lambert WC. The color of skin: red diseases of the skin, nails, and mucosa. Clin Dermatol 2019; 37:548-560. [PMID: 31896409 DOI: 10.1016/j.clindermatol.2019.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Red color is pervasive in local and systemic skin conditions. It is a color that often reflects variations of dermal blood flow and extends beyond the rubor and calor of inflammation. The pathophysiology of red skin involves remote and local chemical mediators that dilate arteriolar smooth muscle and increase blood flow to superficial vessels and capillary beds. Incident light hits hemoglobin, which preferentially absorbs light of shorter wavelengths, such as blue, and reflects warmer colors. Due to its pervasiveness and consistency, red color is a useful descriptive factor in helping narrow a differential diagnosis. Red skin disorders include a variety of conditions involving endocrine mediators, cardiovascular responses, and the disruption of the skin barrier. An understanding of the blood's role in these disorders equips clinicians to generate differential diagnoses through the lens of pathophysiology. Dermatologists can improve management by considering red skin as part of systemic disease rather than as an isolated incident.
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Affiliation(s)
- Marcus Elias
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Shreya Patel
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Robert A Schwartz
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - W Clark Lambert
- Department of Dermatology, Rutgers New Jersey Medical School, Newark, New Jersey, USA; Department of Pathology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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12
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Kim J, Kim JE, Bae JM. Incidence of Scarlet Fever in Children in Jeju Province, Korea, 2002-2016: An Age-period-cohort Analysis. J Prev Med Public Health 2019; 52:188-194. [PMID: 31163954 PMCID: PMC6549015 DOI: 10.3961/jpmph.18.299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/02/2019] [Indexed: 11/09/2022] Open
Abstract
Objectives: Outbreaks of scarlet fever in Mexico in 1999, Hong Kong and mainland China in 2011, and England in 2014-2016 have received global attention, and the number of notified cases in Korean children, including in Jeju Province, has also increased since 2010. To identify relevant hypotheses regarding this emerging outbreak, an age-period-cohort (APC) analysis of scarlet fever incidence was conducted among children in Jeju Province, Korea. Methods: This study analyzed data from the nationwide insurance claims database administered by the Korean National Health Insurance Service. The inclusion criteria were children aged ≤14 years residing in Jeju Province, Korea who received any form of healthcare for scarlet fever from 2002 to 2016. The age and year variables were categorized into 5 groups, respectively. After calculating the crude incidence rate (CIR) for age and calendar year groups, the intrinsic estimator (IE) method was applied to conduct the APC analysis. Results: In total, 2345 cases were identified from 2002 to 2016. Scarlet fever was most common in the 0-2 age group, and boys presented more cases than girls. Since the CIR decreased with age between 2002 and 2016, the age and period effect decreased in all observed years. The IE coefficients suggesting a cohort effect shifted from negative to positive in 2009. Conclusions: The results suggest that the recent outbreak of scarlet fever among children in Jeju Province might be explained through the cohort effect. As children born after 2009 showed a higher risk of scarlet fever, further descriptive epidemiological studies are needed.
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Affiliation(s)
- Jinhee Kim
- Jeju Center for Infection Control, Jeju, Korea
| | - Ji-Eun Kim
- Jeju Center for Infection Control, Jeju, Korea
| | - Jong-Myon Bae
- Jeju Center for Infection Control, Jeju, Korea.,Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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Tang JH, Tseng TJ, Chan TC. Detecting spatio-temporal hotspots of scarlet fever in Taiwan with spatio-temporal Gi* statistic. PLoS One 2019; 14:e0215434. [PMID: 30990838 PMCID: PMC6467404 DOI: 10.1371/journal.pone.0215434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 04/02/2019] [Indexed: 11/18/2022] Open
Abstract
A resurgence of scarlet fever has caused many pediatric infections in East Asia and the United Kingdom. Although scarlet fever in Taiwan has not been a notifiable infectious disease since 2007, the comprehensive national health insurance data can still track its trend. Here, we used data from the open data portal of the Taiwan Centers for Disease Control. The scarlet fever trend was measured by outpatient and hospitalization rates from 2009 to 2017. In order to elucidate the spatio-temporal hotspots, we developed a new method named the spatio-temporal Gi* statistic, and applied Joinpoint regression to compute the annual percentage change (APC). The overall APCs in outpatient and hospitalization were 15.1% (95% CI: 10.3%-20.2%) and 7.7% (95%CI: 4.5% -10.9%). The major two infected groups were children aged 5-9 (outpatient: 0.138 scarlet fever diagnoses per 1,000 visits; inpatient: 2.579 per 1,000 visits) and aged 3-4 (outpatient: 0.084 per 1,000 visits; inpatient: 1.469 per 1,000 visits). We found the counties in eastern Taiwan and offshore counties had the most hotspots in the outpatient setting. In terms of hospitalization, the hotspots mostly occurred in offshore counties close to China. With the help of the spatio-temporal statistic, health workers can set up enhanced laboratory surveillance in those hotspots.
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Affiliation(s)
- Jia-Hong Tang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Tzu-Jung Tseng
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
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Scarlet Fever Epidemic in China Caused by Streptococcus pyogenes Serotype M12: Epidemiologic and Molecular Analysis. EBioMedicine 2018; 28:128-135. [PMID: 29342444 PMCID: PMC5835554 DOI: 10.1016/j.ebiom.2018.01.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 12/31/2022] Open
Abstract
From 2011, Hong Kong and mainland China have witnessed a sharp increase in reported cases, with subsequent reports of epidemic scarlet fever in North Asia and the United Kingdom. Here we examine epidemiological data and investigate the genomic context of the predominantly serotype M12 Streptococcus pyogenes scarlet fever isolates from mainland China. Incident case data was obtained from the Chinese Nationwide Notifiable Infectious Diseases Reporting Information System. The relative risk of scarlet fever in recent outbreak years 2011–2016 was calculated using the median age-standardised incidence rate, compared to years 2003–2010 prior this outbreak. Whole genome sequencing was performed on 32 emm12 scarlet fever isolates and 13 emm12 non-scarlet fever isolates collected from different geographic regions of China, and compared with 203 published emm12 S. pyogenes genomes predominantly from scarlet fever outbreaks in Hong Kong (n = 134) and the United Kingdom (n = 63). We found during the outbreak period (2011–2016), the median age-standardised incidence in China was 4.14/100,000 (95% confidence interval (CI) 4.11-4.18), 2.62-fold higher (95% CI 2.57-2.66) than that of 1.58/100,000 (95% CI 1.56-1.61) during the baseline period prior to the outbreak (2003 − 2010). Highest incidence was reported for children 5 years of age (80.5/100,000). Streptococcal toxin encoding prophage φHKU.vir and φHKU.ssa in addition to the macrolide and tetracycline resistant ICE-emm12 and ICE-HKU397 elements were found amongst mainland China multi-clonal emm12 isolates suggesting a role in selection and expansion of scarlet fever lineages in China. Global dissemination of toxin encoded prophage has played a role in the expansion of scarlet fever emm12 clones. These findings emphasize the role of comprehensive surveillance approaches for monitoring of epidemic human disease. The study used all epidemiological data from 1950 to 2016, and describe increased incidence levels for the current outbreak. Using global emm12 scarlet fever isolate genome sequences, the multiclonal nature of the outbreak was confirmed. Global surveillance of GAS toxin and drug resistance mobile genes in the scarlet fever outbreak is necessary.
Our study provides a detailed report of scarlet fever epidemiology and genomic analysis for mainland China since the 2011 outbreak began. We also provide a comprehensive comparison of the genomic relationship of scarlet fever outbreak emm12 isolates from China, Hong Kong and the United Kingdom, countries experiencing an unparalleled re-emergence of scarlet fever. Our observations implicate an important role for GAS toxin and drug resistance related mobile genes in the outbreak and reveal different evolutionary patterns, and identify common themes relating to the acquisition of toxin carrying prophage elements. This work emphasizes the importance of comprehensive nationwide surveillance to track scarlet fever, GAS emm types, exotoxin-encoding prophage and antibiotic resistance genes in a global context.
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