Case: Hand, Foot and Mouth Disease Herpes Fever Come
Posted on October 13, 2009Filed Under Hand-Foot-Mouth Disease Care | Leave a Comment
Case REVIEW: 4-year-old tiger hand, foot and mouth perianal rash 2 days, and 2 days to subside, he had no rash, while rash gradually increased, while consumption has gradually reduced, which in the end how’s going on?
【Case】
Papular fever eating less
4-year-old tiger was found two days ago by the families seen in a number of oral ulcers, hands, feet, and perianal accompanied by a little red maculopapular rash, initially did not care, does not give treatment. 2 days to children with no obvious rash subsided, while skin rash gradually increased, while eating a decrease than before, hand-test found that children with a fever.
Test results clearly effective treatment of symptomatic fast
Hospital checkup: T37.9 ℃, P88 beats / min, R18 beats / min, clear consciousness, spiritual slightly soft, well nourished, palms, foot, perianal visible red maculopapular rash, herpes surrounded by inflammation Xing Hongyun, oral, under lip mucosa can see multiple ulcers, neck soft, no resistance, no obvious abnormalities in heart and lung auscultation, abdomen soft, liver and spleen less than ribs, limb muscle strength to normal, pathological negative sign.
Laboratory
Routine blood test: WBC12.9 * 10 ^ 9 / L, N70.7%, L21.1%, HGB124g / L, PLT294 * 10 ^ 9 / L (on admission). (Admission day) blood count: WBC12.5 × 10 ^ 9 / l, N72.1%, L20.8%, HGB123g / l, PLT304 * 10 ^ 9 / l; liver and kidney function and myocardial enzymes were normal.
HIV test results: EV71-positive.
Diagnosis of hand, foot and mouth disease, give symptomatic treatment, five days later, the temperature dropped to normal, children with no obvious discomfort complained of, discharged.
The Medical Analysis】
1, hand, foot and mouth disease herpes, and which diseases need to identify?
Chickenpox: from zoster virus infection, mainly in the 5 to 9-year-old children; winter and spring, the main disease; rash showed concentric distribution, particularly prevalent in the trunk and head, while the lower limbs; also visible rash, papules, herpes and scab and other pleomorphic rash rash; rash of old and new exist side by side; rash, itching, thin and break.
Herpes stomatitis: by the herpes simplex virus infection;, mainly in the 3 years of age, Four Seasons may be ill in order to disseminate the main case; lesions often involving the gum; rash is less common; many accompanied by swollen lymph nodes submental or submandibular pain.
Papular urticaria: mainly in the 3 years of age; incidence of the main summer and autumn; rash spindle-shaped, the size like peanuts, hard, wall thickness are not easily broken, skin rashes often appear surrounded by erythema, often transparent to the top of the Central blisters, itching, night rather; common in the limbs stretched face, especially in lower extremities for multiple right and left are not necessarily symmetrical, but generally not involving the scalp and mucous membranes; course is short, generally no lymph nodes. Ruoyin scratching break the secondary infection, may be the formation of local suppuration, nearby lymph nodes may also be significantly enlarged.
Dermatitis herpetiformis: more common in adults, but also occurs in children over the age of 5; rash is polymorphic, may have erythema, papules, wind groups, Qiu herpes, blisters, blood blisters, pustules, etc., in which red plaques, papules, Qiu more common herpes and blisters, rashes, often arranged in circular or irregular shape, and to groups of mainly the distribution of blisters; blister size, maximum diameter of up to l ~ 2 cm, blister tight plump , blisters wall thickness, not easy to break, surrounded by often accompanied by flush; rash often symmetrical distribution, occur in the extensor surfaces of extremities, axillae, shoulders Department, buttocks and other parts susceptible to friction can also be made in the face, trunk, scalp, etc. site, a rare oral mucosal lesions; rash, severe itching; rash dissipated often pigmentation. Recurring illness, the course was chronic after, but the general prognosis is good.
Impetigo: children more common, multi-occur in summer and autumn; contagious, often in nurseries, kindergartens has caused epidemics; rash forms: the beginning when erythema, papules, or blisters quickly become pustules, blisters thin wall easy to break, itching; occur in the facial, neck, limbs and other exposed parts; critically ill patients can be accompanied by high fever, swollen lymph nodes or causing sepsis; Laboratory examination: WBC count and neutrophil increased bacterial culture of pus Staphylococcus aureus or hemolytic streptococci.
2, hand, foot and mouth disease in nursing infants
Disinfection and isolation
If found to have contracted hand-foot-mouth disease, for which she should be timely medical treatment to avoid contact with the outside world, generally requires isolation for 2 weeks.
Baby items used to thoroughly disinfect: Available chlorine disinfectant, not soaking the items can be placed in sunlight exposure.
Baby’s room should be on a regular basis window ventilation to keep the air fresh, flow and temperature appropriate. Conditional household per day fumigation can be used for air disinfection lactic acid. To reduce personnel and out of baby room, no smoking to prevent the air foul, to prevent secondary infection.
If you get sick in the summer, baby easily lead to dehydration and electrolyte imbalance, the need for appropriate replenishment and nutrition.
Babies should stay in bed for 1 week, drink warm water.
Children with fever, oral herpes, appetite poor, unwilling to eat. Baby should eat light, warm, tasty, digestible, soft, liquid or semi-liquid, fasting cold, spicy, salty and spicy food and so on.
Oral Care
Baby would be due to mouth pain antifeedant, salivation, crying does not sleep and so on, to keep baby’s mouth clean, rinse with saline before meals, after meals, the baby will not mouthwash, you can use clean cotton swab dipped in saline solution and gently mouth.
Vitamin B 2 powders can be directly apply on oral erosive parts of, or coated cod liver oil, can also be oral vitamin B 2, vitamin C, supplemented with ultrasonic aerosol inhalation in order to alleviate pain, promote healing of erosion as soon as possible to prevent secondary bacterial infections.
Rash Care
Baby clothing, bedding should be clean, clothing should be comfortable, soft and changed frequently.
Cropped baby’s nails, if necessary, wrap your baby with both hands to prevent the scratch rash.
Buttocks rash baby and be ready to clean up his toilet, keep the buttocks clean and dry.
Hand and foot rash initially calamine lotion can be painted after they have herpes, or herpes ulceration of the formation of 0.5% iodophor when painted.
Pay attention to maintaining the skin clean to prevent infection.
Hand, foot and mouth disease in children is generally low heat or moderate fever, no special treatment, allowing your baby drink plenty of water.
Body temperature at 37.5 ℃ ~ 38.5 ℃ between the baby, to give heat, drink plenty of warm water, wash warm water bath, etc. physical cooling.
First of all, or body care, to give the child the best support.
A child suffering from any disease at the time, if the resistance of the body in a good state, then infected with any disease can be well controlled.
Because the hand, foot and mouth disease virus infection of primary infection for the virus, at present, we are still in support of the therapy-based, there is no specific treatment for any particular, but also promote the use of ribavirin, but the overall results are not very satisfactory .
Because the onset of antiviral drugs in general 24 hours to 48 hours prior to use is the best. We often diagnosed when the hand, foot and mouth disease, have been the most effective treatment phase, and now do not advocate using these anti-viral drugs.
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