Scarlet fever symptoms are a combination of symptoms present in a patient that indicate the occurrence of this infectious disease in the body. Most often scarlet fever get sick in childhood. For this reason, it is very important to be aware of the symptoms of scarlet fever so as not to miss the onset of the disease in a child and prevent the development of severe late complications in his body. The goal of the treatment of the infection will not be the elimination of the symptoms, but the directed struggle against active bacteria - streptococci of the A group.
At the beginning of the incubation period after infection, the disease does not manifest itself. The activity of streptococcus that has entered the body usually begins to be felt only for 5-7 days from the moment of infection, which in most cases occurs through airborne droplets.
The first characteristic symptom of scarlet fever is a sharp pain in the throat, coupled with a sharp rise in body temperature to the levels of 38.5-41 degrees. At the same time, a sick person can completely refuse food (the pain in the throat is so severe that food ingestion is much more difficult), becomes irritable, drowsy and passive.
Thus, the first and main symptoms of scarlet fever include swelling and inflammation of the oropharynx, headaches, weakness, hyperthermia.
Characteristics of the main manifestations
Intoxication as a symptom
With a slight course of scarlet fever, intoxication can be expressed only by an increase in body temperature of up to 38.5 degrees. At the same time, appetite is somewhat reduced, the general condition is disturbed, vomiting rarely occurs, and the tone of the sympathetic nervous system may increase. With moderate and severe scarlet fever, the above symptoms that characterize intoxication can increase many times. At the same time, it is complemented by marked cardiovascular and CNS disorders.
The degree of fever largely determines the severity of intoxication. An increase in temperature to significant elevations indicates the severity of the pathology. Vomiting is also a frequent symptom of intoxication, since toxins actively attack the emetic centers of the body. If intoxication is very pronounced, then vomiting can be repeated.
Scarlatinal intoxication is also characterized by phenomena that indicate disturbances in the functioning of the patient’s central nervous system. Such phenomena will always be present in severe forms of the disease. At the same time, depending on the type of nervous system, in some patients anxiety, irritation, insomnia, convulsions, delirium will prevail, while in others, on the contrary, apathy, lethargy, drowsiness, and conditions bordering on a stupor.
Symptoms of disruption of the autonomic nervous system are quite common with intoxication in the case of scarlet fever. Most often, in the first 5 days of the disease, patients develop tachycardia, blood pressure rises, a negative Ashner phenomenon is observed, and so on. In the case of a severe form of scarlet fever, such violations are expressed in severe pallor, adynamia, cyanosis, a sluggish vasomotor reaction, a pupil reacting poorly to light, a filamentous pulse, low arterial pressure.
Under the influence of intoxication on the 4-5 day from the onset of the disease, the tone of the sympathetic nervous system decreases, and instead the parasympathetic tone increases. The patient begins to feel bradycardia, a sharply positive and long symptom of Ashner, low pressure, active white dermographism. Only at the stage of recovery of the balance of the autonomic nervous system begins to recover.
Hyperthermia may occur in the very first hours of the disease. Sometimes the temperature can immediately reach an indicator of 40-41 degrees. In the process of raising the temperature of the patient pronounced chills of varying degrees. At the same time, during the first days of the disease, the temperature tends to increase, after 3-6 days its fluctuations can be observed in both directions, and after 10 days it always returns to normal marks.
If complications develop during scarlet fever, then the temperature can be high for a much longer period. At the end of the first period of the disease, hyperthermia may be within the framework of subfebrile indicators. At the beginning of the second period of the disease, if the temperature re-arises, then it can be concluded that the complications have been added, which will largely affect the degree of rise and the nature of the temperature bar oscillations.
State of the oropharynx
Scarlet fever is always characterized by intense hyperemia of the soft palate and pharynx, which is sharply limited along the edge of the hard palate. Very often in the first days of the disease the hyperemia of the pharynx is expressed by small-point exanthema or punctate hemorrhages. On the tonsils visible bloom, their structure is loosened. The raid is similar to that which occurs with lacunar quinsy with a easily removable yellowish or off-white bloom in the lacunae.
The language becomes overlaid with the onset of the disease. Already by 2-3 days from the onset of the disease, the taxation begins to disappear and by 4-5 days its color becomes bright crimson, and the nipples hypertrophy and give the raspberry berry itself to the tongue even more. Changes in the tongue with scarlet fever are a consequence of desquamative catarrh of the mucous membranes.
Changes in the language can last up to 9-10 days of illness, and then gradually recede. Severe septic forms of pathology lead to extensive necrosis, the tongue may remain coated for a long period.
A characteristic symptom of scarlet fever is a rash all over the body, with the exception of the nasolabial triangle, which, on the contrary, becomes pronounced pallor in this pathology. First, the rash begins on the neck and upper half of the body, but quickly spreads to the rest of the body, limbs, and face. The rash looks like a fused red, but with a close look you can see small dotted closely spaced spots across the entire surface of the body. The spots have a bright scarlet or pink color, which is more pronounced in the center and a little paler at the edges of each rash. The rash is located on a hyperemic background, in places it is abundant (internal folds of the extremities, groin, buttocks) and its elements merge, creating a feeling of continuous erythema. If you press on the rash with your finger, then they disappear for a short time, forming a white spot, and then they take on their color again. This vascular response indicates a favorable prognosis of the disease. With a severe course of scarlet fever, it is very sluggish and slowly recovers.
To the touch, the skin with rashes is dry, in some places it is too smooth (the rash does not protrude above the surface), but most of them have a roughness on the skin due to the small maculopapular character. Sometimes papularity is easily noticeable even with a routine examination - at the folds of the limbs, for example.
On the face of the rash looks a special way. At the temples, the forehead of her color more pink, and on the cheeks rash looks like a solid red spot. At the same time, the nose and nasolabial triangle are distinguished by pallor and purity from rashes.
On articular folds with strong rashes, skin folds become dark red or even bluish. With the development of the disease folds become brown. At the same time on the skin in such areas you can notice petechial hemorrhages, especially if the rash throughout the body is very bright. This symptom has no negative prognostic value, but it perfectly characterizes scarlet fever in the diagnosis of the disease.
As already mentioned, skin dermographism is characteristic of the scarlet rash, resulting in the appearance of white spots or streaks on the skin with a rash when pressed with a finger on it. A white stripe occurs 10 seconds after pressing and sometimes can last for so long that you can write on the patient's skin. An abundant scarlet fever is almost always accompanied by itching, so traces of scratches are often visible on the patient's skin.
In very rare cases, a rash with scarlet fever does not occur immediately, but only 3-4 days after the development of pathology. Sometimes a rash may not be at all, there are also cases of miliary rash in scarlet fever, when small bubbles appear on the patient’s body, filled with clear (sometimes cloudy) contents. Even less often rash can occur with scarlet fever, which is a compound of an ordinary small-dotted rash and spotty elements of irregular shape of various sizes. Such spots on the intensity of color can be brighter than the rest of the rash, they are able to protrude above the surface of the skin, take a maculopapular appearance. Rarely and hemorrhagic rash with extensive skin hemorrhages, indicating a very severe form of scarlet fever.
In cases of mild infection, the rash lasts on the body for hours, one day, maximum 2-4 days, and for severe forms - 6-8 days. The rash fades out gradually, losing its brightness, becoming brown. After the disappearance of lesions on the skin remains pigment, causing the effect of dirty skin. In the articular folds, pigment strips remain for several days. After the rash completely disappears, the skin begins to actively peel off.
Heavy for scarlet fever
A very common symptom of severe scarlet fever is a classic sore throat with typical necrosis that occurs after 3-4 days of illness.
Necrotic tonsillitis constantly accompanies septic scarlet fever. When it on the surface of the tonsils are formed off-white necrosis, spreading over the entire surface of the pharynx - on the tonsils, palatine arches, pharyngeal walls, soft palate, tongue. At the initial stage, the necrosis has an uneven surface protruding above the surface of the mucous membrane. Then, after purulent fusion, they become, as it were, deep, with a smooth surface. The surrounding mucosa has swelling and hyperemia. Extensive necrosis causes unpleasant breath, dryness and thin tongue. The spread of necrosis in the region of the nasopharynx causes symptoms of necrotizing nasopharyngitis - difficulty in nasal breathing, mucopurulent nasal discharge, skin cracks around the nostrils, excoriation.
At the initial stages of necrotic angina, the patient has a pronounced painful effect when swallowing. In the future, even with the preservation of necrosis, pain decreases. Necrosis disappears gradually and slowly, the speed of cleansing the mucous membranes depends on the depth and extent of infection. Necrotic angina lasts for scarlet fever for about 2-3 weeks, which can cause prolonged hyperthermia. Recently, due to the easier course of scarlet fever in most patients, the frequency of necrotic angina in this pathology has decreased.
Quite often with scarlet-like sore throat and cervical lymphadenitis occurs. The upper cervical lymph nodes are enlarged from the first day of illness, thickened, cause pain during palpation. If the inflammatory phenomena of lymphadenitis are pronounced, then the disease refers to the complication of scarlet fever.
Improper keratinization impregnated with exudate epidermis (parakeratosis) leads to scarlet skin peeling. Peeling occurs at the end of the first week of the disease or at the beginning of the second. The brighter the rash of scarlet fever was expressed and colored, the more actively the skin will begin to peel off. With a mild and pale rash, peeling occurs later, may not occur at all or almost not felt.
First, peeling occurs in the neck, chest, ears, then spreads down through the entire body. On the hands, peeling usually develops from the fingertips of the nails or from the back of the side surfaces of the palms. The face and neck are flaky in small fractions, and larger scales are separated on the body, while on the extremities the epidermis can fall off in large layers in the area of the feet and palms. On average, skin after scarlet fever can peel up to 2-3, and sometimes up to 5-6 weeks.
Atypical course of scarlet fever
In adults, scarlet fever can occur in an atypical form. Among the atypical forms of infection are:
- The erased form of scarlet fever, when the pathology is characterized exclusively by sore throat, and a rash can occur only at the point of infection;
- extrabukkalnuyu form in which streptococcus into the body of the sick penetrated through the wound surface (sometimes during childbirth bacteria penetrate into the mucous membrane of the female genital organs), and only in the area of penetration of infection is possible the appearance of punctate rash;
- aggravated form, which is the most severe, which can develop toxic-septic shock or DIC.
The first signs of toxic-septic shock can be dizziness, general deterioration of health, a drop in blood pressure, nausea. In the event of such symptoms, an ambulance should be urgently called.
Dermographism of the skin can also be a clear sign of scarlet fever when an atypical course occurs, when a white trail forms on pressing on the eruption site and does not immediately disappear.
Symptoms for varying degrees of severity of scarlet fever
Most recently, scarlet fever occurs in patients in mild form. The symptomatology of the mild form of the disease is moderate, it is expressed by hyperthermia up to 38.5 degrees, moderate headache. Catarrhal symptoms in mild pathology in the form of sore throat or pharyngitis occur without complications in the form of purulent plaque on the tonsils. The main bright symptom of scarlet fever in mild form is hypertrophy of the lingual papillae and its crimson color. Skin rash may not be, or it is expressed by small and faded rashes. Peel skin at the stage of recovery is also not much. Acute symptoms must stop during the first 5 days of the disease - for 3 days intoxication and fever disappear, then the rash disappears, and the last is angina. The state of the language is normalized 10 days after the onset of the disease. Late complications in the mild form of scarlet fever, as a rule, does not happen.
The moderate form of scarlet fever is characterized by an increase in body temperature up to 39-40 degrees, weakness, headache, nausea. An increase in body temperature to significant levels may cause delirium or hallucinations. Severe intoxication will provoke vomiting, palpitations, symptoms of "scarlet heart" (shortness of breath, pain behind the sternum). Emerging sore throat is often accompanied by purulent patches in the throat. The rash is very abundant, pronounced, causing subsequently significant peeling of the skin. The initial symptomatology of scarlet fever of the moderate form disappears only a week after the moment of illness, and the temperature should be normalized in the same period.
Moderate scarlet fever may be accompanied by early complications of the disease associated with the spread of infection in tissues and organs. Rarely, but there are, and late complications of the infection process in the form of articular rheumatism, myocarditis, nephritis.To prevent their occurrence and timely detection of symptoms, it is recommended that after recovery, an electrocardiogram should be performed, and general blood and urine tests should be taken. With moderate scarlet fever in children with vivid symptomatology, it is worthwhile to consider the option of treating pathology in stationary conditions. This decision is usually made by a pediatrician.
Very rarely in modern medicine there are cases of severely scarlet fever. This fact is explained by the improvement of the living standards of the population and the timely taking of antibiotics, which do not allow for the global development of infection. However, sometimes a severe course of scarlet fever can still occur. In this case, the patient's hyperthermia reaches a level of 41 degrees, which often leads to hallucinations and delirium, mental disorders. Intoxication is very pronounced, it manifests itself in severe nausea, frequent vomiting, increased pulsation, headaches. Angina can spread from the throat area to the mouth, the sky, to the middle ear. The rash on the patient's skin is very abundant and bright.
Severe scarlet fever has several varieties. Toxic scarlet fever is associated with the release and exposure to streptococcal erythrotoxin. He actively poisons the patient, causing extreme hyperthermia. The form of intoxication can be expressed in very severe infectious-toxic shock. In septic scarlet fever, extensive purulent-necrotic lesions of the nasopharynx and surrounding tissues may develop. The most dangerous is the toxic-septic form of the disease, combining the signs of the two above-mentioned varieties of severe forms of scarlet fever.
A severe form of scarlet fever represents a danger to the health and life of the patient, so its course cannot be allowed to take its course, and at the first sign of such a pathology the patient should be urgently hospitalized.
Features of manifestation in children
At the age of one year, scarlet fever in babies is almost never found. This is associated with obtaining maternal immune protection from breast milk, limiting contact with other children in babies up to the age of one. But in this case, the development of the disease is possible. The source of infection may be an infected family member or an unauthorized person with whom the child was in contact. With the disease before the age of 1 year, the signs of scarlet fever do not practically differ from the well-known. The baby has a sore throat, the temperature rises, skin rashes appear, the tongue becomes crimson. After the disease enters the stage of recovery, the child begins to torment the skin flakings. The difficulty lies in the fact that the baby can express any changes in well-being only with a cry, and mothers can not always track, the child responds in this way to the existing symptoms or he has symptoms of early complications of the disease, which is very important to differentiate. Early complications in young children are usually expressed in the occurrence of a "scarlet heart", inflammation of the internal organs, hemorrhages. Late complications in young children can be expressed in articular rheumatism, glomerulonephritis, myocarditis.
The symptomatology and the course of the disease are well known to pediatricians, so only they must fully control scarlet fever in young children. It is also important to remember that many antipyretic drugs and antibiotics cannot be taken by infants without a doctor’s supervision, since the development of the disease before the age of 1 year can take on a swift pace, and to avoid this, it is important to constantly monitor any changes in the child’s clinical picture.
The symptoms of scarlet fever in older children are also not much different from the typical picture of this disease. Sore throat, high fever, signs of intoxication, raspberry tongue and rash are a standard set of scarlet fever patient at any age. Skin rashes in this case may be similar to a similar eruption with rubella and measles. The pallor of the nasolabial triangle, which is characteristic only of this disease, as well as the accumulation of lesions in the area of the articular folds and in the inguinal zone will help distinguish the rash in scarlet fever. The rash disappears after 7 days of illness, and the skin beneath them begins to actively peel off. At the stage of recovery, it is important to monitor the condition of the child in order to prevent the development of late severe complications characteristic of this infection.
Scarlet fever during pregnancy
On the occurrence of scarlet fever in pregnant can say tiny-dotted rash in the first or second day after the deterioration of general well-being. At the same time, when pressing with a finger on the rash, it disappears, and after a while it appears again. The abundance of rash prevails in the facial area, where only the nasolabial triangle remains clean and pale, as well as in the areas of the articular folds. After 4-5 days the rash fades and disappears, peeling of the skin begins in its place. In addition to the rash of scarlet fever, a pregnant woman will have all the typical symptoms of scarlet fever - sore throat, fever, raspberry tongue. Cervical lymph nodes may also increase.
Often, when scarlet fever occurs in pregnant women, severe and frequent vomiting occurs.
This symptom in the period after the end of the first trimester of pregnancy always speaks of global pathologies. After scarlet fever, purulent otitis or necrotic lymphadenitis may occur in a pregnant woman. Also, there may be infectious-allergic complications of the disease, develop rheumatism, hypertension, tachycardia.
Scarlet fever during pregnancy can not threaten only a woman who had previously endured this infection and is immune to it. In other cases, if contact is detected with scarlet fever, a pregnant woman should be urgently hospitalized.
Specialty: pediatrician, infectious diseases specialist, allergist-immunologist.
Total experience: 7 years.
Education: 2010, SSMU, pediatric, pediatrics.
Experience infectious diseases more than 3 years.
He has a patent on the topic “A method for predicting a high risk of the formation of a chronic pathology of the adeno-tonsillar system in frequently ill children”. As well as the author of publications in the journals VAK.