Scarlet fever is an acute infectious disease. Periodically, approximately every 5-7 years, doctors notice a natural increase in the incidence of scarlet fever.
Children between 3 and 8 years old are most susceptible to this infection.
The causative agent of scarlet fever is group A beta-hemolytic streptococcus (Streptococcus pyogenes). One of the pathogenic characteristics of this microorganism is the capacity of formation of toxins (production of specific exotoxins).
Therefore, the development of scarlet fever in children depends on the level of antitoxic immunity. If it is not present at the time of infection with beta-hemolytic streptococci, the infection proceeds as scarlet fever.
With sufficient intensity of anti-toxic immunity, but in the absence of antimicrobial immunity (to streptococci), the development of scarlet fever does not occur, but the disease progresses like any other form of streptococcal infection (angina, skin disease) , otitis, sinusitis, glomerulonephritis and others).
Scarlet fever is only for sick people, it is an anthroponotic infection. The source of infection is only a person with scarlet fever, as well as any other form of streptococcal infection.
This infection is transmitted, mainly through droplets in the air, in preschool institutions for children it is also possible to have a contact route and domestic use, through care items, toys.
When scarlet fever, most often, the entry doors of the pathogen are the tonsils, which determines the main clinical manifestations. From the site of introduction, the pathogen spreads through the lymphatic channels to the lymph nodes, through the superficial vessels to nearby tissues. Microbial toxins appear in the blood, affecting the cardiovascular, nervous and endocrine systems.
The symptoms of scarlet fever in children depend on the severity of the infectious process, which is represented by toxic, septic and allergic components.
The clinical symptoms of scarlet fever
The clinical symptoms of the disease depend on the period of infection. Then, when scarlet fever assigns the following periods: incubation, the initial period (the period of clinical manifestations), the period of eruption, the period of convalescence.
The duration of the incubation period for scarlet fever can be from several hours to 7 days (up to a maximum of 12 days). During this period, there are no clinical manifestations of the disease.
The initial period is from the appearance of the first symptoms of intoxication until the appearance of a rash. The duration of this period is from several hours to 2 days.
The initial period is characterized by:
- Symptoms of intoxication (fever, headache, nausea, vomiting, refusal to eat, weakness)
- Angina (catarrhal, follicular, lacunar or necrotic) with limited hyperemia in the oropharynx. The type of sore throat correlates with the severity of the disease
- Enlarged regional anterior lymph nodes.
The period of eruption begins with the appearance in the body of a characteristic eruption. For this period it is characteristic:
- Pungent eruption with maximum thickening in natural skin folds. The rash is located mainly on the lateral surfaces of the body, the flexor surfaces of the extremities at the bottom of the reddened (reddened) skin.
- Petechiae can appear on the skin (petechial hemorrhages), which can be arranged in strips, are formed in the places of greatest saturation of the eruption during the mechanical effect on the vessels of the skin.
- A characteristic feature of scarlet fever is that the nasolabial triangle remains free of rash and has a pale color.
- Peculiar changes in the language with scarlet fever. Then, the first day is covered with white flowers, from the second day it begins to clear up and on the fourth day of the disease it turns bright crimson, with the papilla completely exposed.
- For 3-4 days (with typical forms of the disease), the rash fades slightly to pink and the extinction phase begins. At 4-5 days, a persistent red dermographism and bradycardia appear, a decrease in blood pressure can be observed (vague phase).
To better understand and present the manifestations of scarlet fever it is better to see them. Well, you will not meet a patient with scarlet fever every day, but in a picture of scarlet fever in children you can easily find it on the Internet.
With 2 weeks of the disease begins the period of convalescence (recovery). This period is characterized by specific changes in the skin in the form of laminar exfoliation on the palms and soles, and instead of the localized eruption there appears an abundant and scaly exfoliation.
The duration of the period of about 2 weeks.
Types of scarlet fever
According to the classification proposed by A.A. Koltypin distinguishes the following types of scarlet fever:
According to the type of issue:
one. Typical forms – They occur with the typical symptoms of scarlet fever, have a clear cyclical nature of the entire period of the disease (incubation, onset, rash, convalescence).
The typical forms, according to the severity of the clinical manifestations, are divided into:
– moderate severity
two Atypical forms
There are several types of atypical forms:
- erased, rudimentary (the lightest): characterized by a weak severity and short-term clinical manifestations, the rash may be completely absent. These forms can only be diagnosed in scarlet fever.
- Extrabuccal (extrapharyngeal) form. It is a wound, burn, postpartum form of scarlet fever. In these forms there is no sore throat, but there is a typical saturated rash.
- Aggravated (the most serious form). This is a hemorrhagic and hypertonic form (with the development of an infectious-toxic shock).
Depending on the course of scarlet fever, distinguish:
- uncomplicated course
- with complications.
Due to the nature of the complications of scarlet fever in children, purulent and allergic forms are distinguished.
More often, under modern conditions, a typical mild form of scarlet fever occurs. It is characterized by: mild symptoms of intoxication, catarrhal throat pain, a small and slight punctate rash that disappears 3-4 days after the illness.
Heavy forms, lately, are rare. For severe forms it is characteristic: pronounced symptoms of intoxication (toxic form), predominance of septic lesions (septic form), or it may proceed as a toxic-septic form.
Characteristics of scarlet fever in infants.
Children in the first year of scarlet fever get very little sick, as they are protected by a high degree of antitoxin, which they receive transplacentally (through the placenta). In babies with residual transplacental immunity, scarlet fever may occur, but usually presents as a rudimentary form (erased), with minimal poisoning, with a small rash that quickly disappears.
The peeling is mild or may be absent.
The situation is more difficult with young children who lack immunity to scarlet fever. They have a disease in severe forms, most of the time it is a septic form with purulent complications.
Complications of scarlet fever
The complications of scarlet fever are early (they appear in 1-2 weeks of the disease) and late in 3-4 weeks.
Diagnosis of scarlet fever.
The diagnosis of scarlet fever is based on clinical manifestations, epidemiological data (contact with patients with any type of streptococcal infection). Also use laboratory diagnostics.
In the acute period, all patients are prescribed a complete blood count. Scarlet fever is characterized by an increase in the number of leukocytes and neutrophils in the blood, an increase in ESR, which indicates a bacterial cause of the infection. To confirm the diagnosis, a bacteriological method is used, in which the beta-hemolytic streptococcus is isolated in mucus cultures of the oropharynx.
Modern diagnostic methods are the determination of the antistreptolysin-O titer, antibodies against DNase and other enzymes, including Streptococcus antitoxins.
Treatment of scarlet fever
Mild forms of scarlet fever can be treated at home. The indications for hospitalization are: early age of the child, malformations of the heart and blood vessels, encephalopathy, nephropathy, immunodeficiency states, severe forms of the disease.
In addition, patients who can not be isolated in the home and who are provided with the necessary conditions for treatment must be hospitalized.
The treatment for scarlet fever is complex and consists of a regimen, a diet, an antibacterial and symptomatic therapy.
Mode for scarlet fever – bed during the whole period of the disease.
The diet should correspond to the age of the child, preserving mechanically, chemically and thermally (taking into account the manifestations of angina). Vitamin therapy is indicated.
Antibacterial therapy: it is one of the main methods of treatment for scarlet fever. Antibiotic therapy should be prescribed as soon as possible, regardless of the severity of the disease. The drugs of choice for scarlet fever are penicillin antibiotics.
If penicillins can not be used, then antibiotics from the group of cephalosporins or macrolides are used.
When an allergic component is added, the prescription of antihistamines (clemastine, loratadine and others) is indicated.
Antipyretic therapy is prescribed when the body temperature increases above 38 degrees. Apply ibuprofen, paracetamol.
During scarlet fever with antibiotic therapy initiated on time, as a rule, mild complications rarely occur. The prognosis is favorable, in most cases the disease ends with a complete recovery.