英格兰 A 族链球菌的高感染率
英国卫生安全局（UK Health Security Agency, UKHSA）报告，英格兰的猩红热和侵袭性 A 族链球菌（invasive group A streptococcus, iGAS）感染病例数高于每年同时期的预期。
建议对猩红热儿童及时使用抗生素进行治疗，以降低潜在并发症的风险并限制继续传播。如果诊断不确定，在开始抗生素治疗前采集咽拭子。猩红热儿童在完成 24 小时抗生素治疗前应待在家。
猩红热：
约 90% 的病例发生于 10 岁以下的儿童中
通常为轻症，但具有高度传染性
表现为全身性红斑疹，摸起来像砂纸
通常先有咽痛（咽炎、扁桃体炎）
咽部红斑伴渗出物、腭部瘀点，且舌头红肿（“草莓舌”）是具有提示性的特征。
侵袭性 A 族链球菌感染：
这一流行季的儿童 iGAS 感染率相对较高，这可能反映了先前病毒（包括呼吸道病毒和水痘）感染率增加。
建议临床医师保持高度怀疑，因为对 iGAS 感染患者的早期识别和及时启动特定的支持性治疗可挽救生命。
来自 UKHSA 的更多信息：
Summary
Definition
History and exam
Key diagnostic factors
- 存在的危险因素
- 发热或体温低
- 呼吸急促
- 心动过速
- 心动过缓（新生儿和婴儿）
- 精神状态或行为改变
- 外周灌注下降
- 新生儿中活动或喂养模式变化
- 尿片干/尿排出量减少
- 皮肤斑驳、面色苍白、发绀
- 低血氧饱和度
- 血管麻痹
- 按压不退色的紫癜样皮疹
Other diagnostic factors
- 低血压
- 反映基础病变特定的局灶性体征和症状
Risk factors
- 免疫缺陷
- 合并症
- 男性
- 较小的年龄（尤其是新生儿）
- 围产期感染危险因素（新生儿）
- 保健相关因素（新生儿）
- 近期手术或其他侵入性操作
- 皮肤完整性破坏
Diagnostic tests
1st tests to order
- FBC 和分类计数
- 血清葡萄糖
- 血培养
- 尿液分析
- 尿液培养
- 血气
- 血清乳酸
- 血清电解质
- 血清肌酐
- 肝功能检查 (LFT)
- 凝血功能检查
- C 反应蛋白 (CRP)
- 胸部 X 线检查
Tests to consider
- 腰椎穿刺：
- 脑膜炎球菌聚合酶链反应分析
- 支气管肺泡灌洗培养
- 单纯疱疹病毒（herpes simplex virus, HSV）聚合酶链反应（血液和脑脊液）
Emerging tests
- 血清原降钙素
- 新出现的生物标志物
- PhenoTest™ BC 试剂盒
Treatment algorithm
推测或确诊患有脓毒症
Contributors
Authors
Akash Deep, MD, FRCPCH
Director and Professor of Paediatric Critical Care
Paediatric Intensive Care Unit
King’s College Hospital
London
UK
Disclosures
AD declares that he has no competing interests.
Chris Duncan, BMBS, BMedSci, MRCP, FFICM, FEWM, PGCert
Professorial Fellow
Intensive Care Medicine
Nepean Hospital
Sydney
Australia
Disclosures
CD declares that he has no competing interests.
Acknowledgements
Dr Akash Deep and Dr Chris Duncan would like to gratefully acknowledge Dr Jeremy Tong and Dr Adrian Plunkett, previous contributors to this topic.
Disclosures
JT and AP are authors involved in the Paediatric Sepsis Six initiative, cited in this topic.
Peer reviewers
Saul N. Faust, MA, MBBS, FRCPCH, PhD, FHEA
Professor of Paediatric Immunology & Infectious Diseases
Director, NIHR Wellcome Trust Clinical Research Facility
University of Southampton
Southampton
UK
Disclosures
SNF declares that he has no competing interests.
Mohan Pammi, MBBS, MD, MRCPCH
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine
Houston
TX
Disclosures
MP declares that he has no competing interests.
Jerry J. Zimmerman, MD, PhD
Faculty, Pediatric Critical Care Medicine
Seattle Children's Hospital
University of Washington School of Medicine
Seattle
WA
Disclosures
JJZ receives research grant support from NIH/NICHD and ImmuneXpress; travel reimbursement from the Society of Critical Care Medicine to attend board meetings; and royalties from Elsevier for action as a co-editor for the textbook Pediatric Critical Care.
Differentials
- 2019 冠状病毒病（COVID-19）
- 小儿炎性多系统综合征
- 先天性心脏病
More DifferentialsGuidelines
- 脓毒症初始抗菌治疗声明
- 新生儿感染：用于预防和治疗的抗生素
More GuidelinesPatient information
儿童脓毒症
婴儿和儿童的肺炎球菌疫苗
More Patient information
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