Ye Zhenzhen thought for a while and replied: "Measles, rubella, scarlet fever, and urticaria with allergic reactions, however, judging from the characteristics of the rash on the baby boy just now, urticaria can be ruled out." Pen, fun, pavilion www. biquge。 info”

Nan Zhiqiao nodded slightly, agreeing with Ye Zhenzhen's statement.

Seeing that Nan Dashen had no objections, Ye Zhenzhen asked, "You checked just now, what did you find?"

Nan Zhiqiao: "The overall development and nutrition of this baby boy is slightly poor, the response is low, the skin is pale, the sclera is mildly yellowed, the ends of the toes and heels are scattered in 0.6~1 cm brownish-yellow-red maculopapular rash, the center is flat and light yellow, there are thin layers of scales on the surface, and the pressure is slightly fluctuating, and the lower abdomen, back and buttocks are scattered in 0.3~1.2 cm of pink maculopapular rash and macules. ”

When Ye Zhenzhen heard Nan Zhiqiao's description of the rash, she suddenly remembered something, and interjected: "In this case, you can also rule out scarlet fever." ”

Nan Zhiqiao: "Why?"

Ye Zhenzhen: "Because I remember that the rash of scarlet fever is a bleeding point the size of a pin, after pressing, the rash will disappear, after the pressure is lifted, the rash will appear again, if the scarlet fever is severe, there will be a bloody rash. ”

"Well, that's a difference. Nan Zhiqiao rarely refuted.

Ye Zhenzhen: "Just now I saw that you also checked the baby boy's armpits and groin, did you find anything?"

Nan Zhiqiao: "The armpit and inguinal area touch two to five soybean-sized lymph nodes respectively, the range of motion is OK, the abdomen is flat and soft, four centimeters below the cost, tough, and three centimeters below the spleen, tough. Non-pitting edema on the back of both feet. ”

Ye Zhenzhen thought for a while and said, "Swollen lymph nodes? This means that there is an infection, what could it be? Measles? Or rubella?"

"Measles, one of the most common acute respiratory infections in children, is caused by the measles virus, and after a child is infected with the measles virus, there is an incubation period of about 10 days, after which symptoms similar to upper respiratory tract infection appear.

One to two days before the rash, measles mucosal plaques appear, occasionally cutaneous urticaria, vaguely macules, or scarlet fever-like rashes, which disappear after the typical rash appears.

The rash period generally appears after 3~4 days of fever, the rash is a sparse and irregular red maculopapular rash, the skin between the rashes is normal, and the order of rash is also characteristic: it begins to appear behind the ears, on the neck, along the hairline edge, and develops downward within 24 hours, covering the face, trunk and upper limbs, and on the third day, the rash involves the lower limbs and feet. In severe cases, the rash often fuses, the skin is edema, and the face is edematous and deformed. Most of the rashes fade away, but there are also petechiae. Swollen lymph nodes and splenomegaly throughout the body and persist for several weeks. ”

After Nan Zhiqiao finished speaking, he looked at the baby boy who had just fallen asleep on the bed and said, "Judging from the sporadic rash that appears on the baby's body at present, it is not measles. ”

Ye Zhenzhen nodded, agreeing with Nan Zhiqiao's statement, while adding: "The baby's red rash is scattered on the back and abdomen, buttocks and feet, which is different from the order of measles. ”

"Rubella ......" Nan Zhiqiao was thinking about the possibility of rubella again.

Ye Zhenzhen suddenly interjected: "Rubella, as I know, is an acute exanthematous infectious disease caused by rubella virus, which is clinically characterized by a short prodromal period, low-grade fever, rash and swollen lymph nodes behind the ears and occipital region.

The rash usually appears after 1~2 days of fever, the rash first appears on the face and neck, rapidly expands the trunk and limbs, and covers the whole body within 1 day, but there is no rash on the palms and soles of the feet. The rash initially appears as a fine punctate pale red macule, maculopapular rash or papule, with a diameter of 2~3 mm. The rash on the face and distal extremities is sparse and partially confluent to resemble measles. The trunk, especially on the back, has a dense rash that coalesces into patches that resemble scarlet fever. The rash usually lasts about three days to subside, so some people call rubella "three-day measles".

A rash on the face is characteristic of rubella, and in some patients the rash is hemorrhagic with systemic hemorrhage, mainly due to thrombocytopenia and elevated capillaries.

In the eruption stage, there is often low-grade fever, mild upper respiratory tract inflammation, splenomegaly, and generalized superficial lymphadenopathy, especially behind the ear, occipital region, and posterior cervical lymphadenopathy. Enlarged lymph nodes are mildly tender, non-confluent, and non-suppurating. Sometimes the spleen and lymphadenopathy of rubella patients can be enlarged 4~10 days before the rash, and the regression is slow, often lasting 3~4 weeks.

The rash recedes without pigment and without desquamation. Only a small number of severely ill patients may have fine bran desquamation, and large peeling is rare. When the rash resides, the body temperature drops, the upper respiratory tract symptoms subside, and the swollen lymph nodes gradually recover, but it takes several weeks for them to fully return to normal. ”

After hearing this, Nan Zhiqiao nodded slightly, and then asked, "So what?"

Ye Zhenzhen continued: "Therefore, comparing the symptoms of measles and rubella with the baby's current symptoms, there are some differences, and it is difficult to determine the cause from the symptoms alone. ”

Nan Zhiqiao: "To determine the cause, it is necessary to have the results of the laboratory pathogen examination, and before that, it is all speculation to judge only from the symptoms. ”

After Nan Zhiqiao finished speaking, he was still frowning, and Ye Zhenzhen asked, "Senior Nan, what are you thinking?"

"I'm thinking, what you just said about rubella symptoms. ”

"Are there any problems with rubella symptoms?" Ye Zhenzhen asked rhetorically, thinking at the same time, what I just said was from books, and there must be no problem.

Nan Zhiqiao: "The symptoms you just mentioned are all symptoms of acquired rubella, and there is another condition of rubella, congenital rubella. ”

"Congenital rubella?!" Ye Zhenzhen was surprised: "You mean that the baby may have congenital rubella?"

"Well, I just doubt it's possible. Nan Zhiqiao continued, "This little baby looks very small, and it should be born only a few months old. ”

Ye Zhenzhen added in time: "It's been more than three months, and there is a note in the carton containing the baby, and the note has a date on it, which should be the baby's birth time. ”

Nan Zhiqiao: "Such a small baby, the rash on the body, and the lymph nodes the size of soybeans are likely to be caused by congenital diseases.

Congenital rubella is a pregnant woman infected with rubella virus during pregnancy, and the rubella virus infects the fetus through the placenta, causing the newborn to suffer from congenital heart disease, cataracts, deafness, developmental disorders and other symptoms.

The appearance of a red rash in newborns is also one of the symptoms of congenital rubella. ”

Ye Zhenzhen: "Congenital rubella?

Nan Zhiqiao shook his head, "Although it can be treated, the prognosis is very poor. ”

Ye Zhenzhen sighed, "I hope it's not congenital rubella." ”

Nan Zhiqiao followed Ye Zhenzhen's words and said: "Among the congenital diseases that can cause baby rashes and swollen lymph nodes, there is another possibility. ”

"What is possible?" Ye Zhenzhen felt from Nan Zhiqiao's tone that the illness that the great god was going to say next must be more serious.

"Congenital syphilis. ”

"Congenital syphilis?!" Ye Zhenzhen should have been shocked at this time, "No, syphilis is a venereal disease, and the child is still so young......"