Scarlet fever is an acute pediatric infection, accompanied by intoxication syndrome, a rash on the body, hyperemia of the pharynx and a symptom of a “crimson” tongue. The most common pathology occurs in children aged 2 to 10 years. In adulthood, the disease can also occur with the parallel course of a number of certain conditions.
The main etiological cause of infection is the penetration of pathogenic streptococci into the body, namely, Streptococcus pyogenic, which is a member of serogroup A. Scarlet fever infection occurs most often by airborne droplets, the remaining pathways of infection are much less common. However, the development of the disease streptococcus may not be in the presence of immunity, a strong immune system. It is the weakening of the immune system that is important for the onset of scarlet fever.
Thus, getting into the human body by airborne, medical, contact-domestic, sexually or by traumatizing the skin, the streptococcus bacteria against the weakened body begin to infect it, provoking not only scarlet fever, but also other streptococcal infectious processes - tonsillitis, bronchitis, laryngitis, tracheitis, pharyngitis, meningitis, endocarditis. Hypothermia, vitamin deficiency, improper work and rest, chronic infectious diseases (tonsillitis, pneumonia, tuberculosis, diabetes), sedentary lifestyle, exposure to stress, bad habits can be identified among the factors that make an adult or child’s body more susceptible to the development of infections. drug abuse. In children aged 5-7 years, the immune system is not yet fully formed, which is the reason for the high probability of occurrence of infectious processes.
After a person recover from scarlet fever, he develops immunity to scarlet fever. However, due to mutations in modern bacterial infections, it becomes possible to get sick with scarlet fever the second time. That is why it is necessary to always remember the rules of prevention of the disease and not to neglect them.
Symptoms and forms of manifestation
Typical scarlet fever
Under the typical form of scarlet fever means the classic course of the disease with characteristic symptoms, which includes a rash, sore throat, raspberry tongue, fever. In terms of severity, typical scarlet fever is divided into light, moderate and severe, with toxic, septic and toxic-septic signs.
Typical scarlet fever can also occur without toxic-allergic reactions, and with them in the form of synovitis, nephritis, reactive lymphadenitis. Pathology can have toxic-allergic processes, be complicated by purulent processes and septicopyemia, and proceed abortally.
Atypical form and its main manifestations
Under atypical forms or erased forms of scarlet fever are meant those pathologies that occur without the characteristic signs characteristic of the disease. Blurred forms most often occur in adult patients, they are characterized by easy and fast flow, without a long clinic. In this case, the rash, if there is, then for a short time, the patients throat slightly reddens, sometimes patients notice a slight nausea and low-grade fever. Erased forms can sometimes have hypertoxic or hemorrhagic aggravated symptoms.
However, with the toxic-septic form of atypical scarlet fever, the symptoms can be very severe. This is a rare medical phenomenon that occurs in adult patients with scarlet fever, and is accompanied by rapid development with very high body temperature, development of cardiovascular insufficiency in the form of deaf heart sounds, thread-like pulses, a sharp decrease in blood pressure, hemorrhages on the skin. During the next 24 hours, infectious-allergic complications can join these symptoms - lesions of the heart, kidneys or joints, as well as septic complications in the form of otitis, necrotic tonsillitis, lymphadenitis, and others.
There is also the concept of extrabukkalnaya scarlet fever, when the disease proceeds without a special clinic and appears only in the rash in the place of violation of the integrity of the skin from a cut or burn, where the infection could penetrate.
Stages of infection
The incubation period for scarlet fever lasts from 24 hours to 10-12 days. When a streptococcal infection enters the body, clinical signs do not immediately appear, but a person may already be infectious to others. After the disappearance of clinical symptoms for several days, the patient may still remain infectious, but the most dangerous patient for scarlet fever is for others in the first days of the onset of active symptoms.
If we talk about the most common picture of the disease, the incubation period for scarlet fever occurs 2 days after infection and lasts 7 days.
The beginning of the development of the disease
At the initial stage of the disease, the patient is the most infectious for other people. At this time, the main symptoms of pathology develop and their clinical picture actively progresses. The body temperature at this point may rise sharply to 40 degrees, the function of swallowing becomes very difficult, the patient may feel sick, a rash on his body only appears 12 hours after the development of the disease, and before that time it is actively progressing on the mucous membrane of the pharynx. The initial stage of scarlet fever usually lasts 24 hours.
Stage of height
The most difficult is the height of scarlet fever. This stage lasts up to 5 days, during which symptomatology is very pronounced - sore throat, profuse small-point rash all over the body, with the exception of the nasolabial triangle, various manifestations of intoxication, which are caused by the reproduction of streptococcal infection in the patient's body.
The patient's throat is very painful, bright red (flaming throat), many patients and especially children at this time completely refuse to eat because of the inability to swallow.
The tongue clearly appears on the papillae, it itself is colored crimson.
It was during the height of the disease that various complications could join — sinusitis, pharyngitis, purulent lesions of the liver and kidneys, and cardiovascular pathologies. As soon as the symptoms become less pronounced, we can say that scarlet fever has passed into the stage of recovery.
Stage of recovery
At the stage of recovery, all symptoms of the disease disappear completely. This period can last from 7 to 22 days. At this time, the patient's body temperature normalizes, a sore throat disappears, and a rash disappears, at the site of which, due to the influence of erythrotoxin, peeling occurs. The skin is peeling off very strongly, it can begin to flake off, especially in the area of the extremities, auricles, armpits. In children, a characteristic symptom of the fact that the patient has had been ill with scarlet fever is the exfoliation of the skin on the hands in the shape of a glove. Finally, the skin ceases to peel only by the end of the third week after the symptoms disappear.
The stage of recovery of scarlet fever in the absence of the necessary treatment of the disease with the use of antibiotics may be complicated by rheumatism and vascular inflammation, since streptococci have a highly allergenic factor that negatively affects the internal organs of a person. Also, the occurrence of remote complications in the form of inflammation in the kidneys (glomerulonephritis), cardiac muscle (myocardial inflammation), heart valves (endocardial inflammation), brain (Sideren's chorea), and joints is not excluded.
In the modern world, scarlet fever often proceeds easily. This is due to the use of antibacterial drugs for treatment in the early stages and improving the quality of life of people, expressed in a stable diet and strengthening of protective functions.
Mild scarlet fever occurs with mild symptoms. Body temperature usually rises no more than up to 38.5 degrees, nausea, vomiting, headaches, or not at all, or they are expressed in a very weak form, catarrhal manifestations such as sore throat and pharyngitis occur without pustular plaque on the tonsils. Only the hypertrophy of the lingual papillae and its bright crimson hue are preserved in the light form of pathology.
The skin rash in this form of the disease is either completely absent, or manifested by a small number of dull eruptions. Following the rash comes peeling of the skin, which, due to the non-aggressiveness of the inflammatory elements, is also weakly expressed.
Acute symptoms of mild scarlet fever disappear in 5 days. After 3 days, intoxication, fever disappears, then the rash and sore throat begins to disappear. Only the tongue takes on a healthy appearance after 10 days. At the same time, there are no late complications of the infection.
The moderate form of scarlet fever is characterized by an increase in temperature to 39-40 degrees, the onset of general weakness, nausea and headaches. Sometimes a high temperature provokes hallucinations and delusions. Increased toxicity of the body can cause multiple vomiting. The patient has increased heartbeat, there may be symptoms of "scarlet heart" - shortness of breath, pain in the chest. Symptoms of sore throat are complemented by purulent bloom in the throat, skin rashes are very pronounced, and desquamation after them at the recovery stage gives a lot of unpleasant sensations.
The primary symptoms of scarlet fever of moderate form disappear only after 5-7 days of illness. During this period, body temperature also stabilizes. With this form of pathology, the development of early complications of scarlet fever associated with the spread of infection in organs and tissues is possible.
Late complications in this case also sometimes arise. They can be expressed in myocarditis, nephritis, articular rheumatism. To avoid their occurrence, after the main symptoms of the disease have passed, it is necessary to pass blood and urine tests, an ECG.
With a moderate form of scarlet fever in children, often the treatment must become stationary. If the pediatrician treating the child insists on hospitalization, in no case can one resist this, since the risk of complications can be extremely high.
Due to the presence of antibiotics among modern doctors, severe forms of scarlet fever today are rare. In this case, the hyperthermia of the body can reach 41 degrees and cause mental disorders, delusional states and hallucinations. Intoxication processes can also be pronounced - the patient may be constantly nauseous, he will experience an increase in pulse rate and severe headache. Regarding the manifestations of angina, it is worth noting that, in the case of a severe form of pathology, in addition to the pharynx, the entire oral cavity, the sky, and the middle ear can affect. The rash in this case is pronounced and abundant.
Severe scarlet fever can occur in several forms. Toxic scarlet fever is caused by exposure to erythrotoxin, secreted by streptococcus during reproduction. The result of this type of disease is pronounced poisoning of the body, intoxication up to the development of toxic toxic shock, high body temperature.
In septic varieties of scarlet fever, an extensive purulent-necrotic lesion of the nasopharynx develops along with the surrounding tissues. The most dangerous is the toxic-septic form of the disease, since it combines the symptoms of the two types of pathology described above with a severe course and may pose a threat to the patient's life. In the presence of signs of severe scarlet fever in patients of any age, urgent hospitalization and therapy under medical supervision is necessary.
Complications and consequences of scarlet fever
The development of complications of scarlet fever in children does not depend on the sex of the child. Dependence in this case can be observed only on the basis of the age of the patient. In young patients, the risk of complications is much higher.
Previously, it was believed that scarlet fever can provoke infertility in the future in boys who have suffered it, but today there is no scientifically based relationship between male infertility and this infection.
The following concomitant factors can lead to complications of scarlet fever in boys and girls:
- recent postponed colds;
- the occurrence of infection in the background of another chronic disease;
- improper and late treatment of the disease;
- reducing the protective immune forces of the patient.
All complications of scarlet fever can be divided into early and late. Among the early complications are otitis with inflammatory purulent processes in the middle ear, pharyngitis, characterized by redness of the posterior pharyngeal wall, sinusitis with purulent inflammation in any nasal sinus, decreased blood pressure, bradycardia, paratonsillar abscesses.
The trigger for the occurrence of late complications of scarlet fever are toxic-allergic reactions to streptococcal pathogen. Among them, inflammatory processes in the heart valves are especially common, which can only be treated surgically, joint inflammation - synovitis with swelling of the joints, severe pain during their movements, brain damage with marked uncontrolled motor activity of the glomerular renal apparatus, which subsequently leads to chronic renal failure. Late complications are very serious, they lead to permanent violations of the functionality of vital organs.
In adult patients
Most often, scarlet fever in an adult is easy. The ease of flow does not depend on the time the patient suffers from the disease. In rare cases, without the use of adequate therapy, the disease can turn into extremely severe forms. Symptoms of the disease in adulthood does not vary by gender.
Among the main symptoms of scarlet fever adult doctors distinguish:
- acute tonsillitis;
- hyperthermia and intoxication;
- rashes with subsequent peeling of the skin.
The main early complications of scarlet fever in adults are changes in cardiac and vascular work, the spread of infection to the liver and kidneys, and the nasopharynx. Among the late complications, doctors identify articular rheumatism, inflammation of the heart muscle, pathological renal lesions.
Among the most common complications of this infection are:
- purulent lymphadenitis;
- purulent otitis media;
- severe allergic reactions;
Opinion about the negative impact of scarlet fever on the reproductive system of men is not supported by scientific data. Streptococcal infection does not affect the genitourinary system, and therefore can not lead to atrophy of the testicles. However, while a man is undergoing treatment for scarlet fever, the conception of a child should be postponed until antibiotic therapy is stopped.
Scarlet fever is a great danger in the first trimester of pregnancy, because in this period all the organs and systems of the unborn child are laid, and the treatment of pathology requires urgent medical effects. Sometimes the use of antibiotics for scarlet fever in pregnant women leads to a forced abortion.
In the second and third trimesters of pregnancy, scarlet fever is not able to affect the embryo so strongly, since the placenta has a protective function and does not allow drugs and infections to penetrate into the child’s body. However, sometimes as a complication of scarlet fever during pregnancy, intrauterine hypoxia, a pathological course of labor or even premature labor can occur.
Diagnosis of the disease
What tests to take
Despite the abundance of obvious external manifestations of scarlet fever, in rare cases, the results of some laboratory tests may be needed to make a diagnosis. If the patient suspects scarlet fever, the doctor sends him for a general blood test, the results of which will show shifts characteristic of a bacterial infection - an increase in leukocytes and ESR. It is also often necessary to conduct bacteriological seeding from the nasopharynx and pharynx to determine the sensitivity of microorganisms to a particular antibiotic and to identify streptococcus. Additional swabbing helps identify streptococcus antigens. Also the result of a blood test for antistreptolysin-O can tell about the presence of streptococcal infection. Conducting all of the above laboratory tests helps to detect the presence of infection even before the first symptoms develop.
As already noted, scarlet fever is often diagnosed during a routine physical examination, because it has specific symptoms. Confirm the assumption will help information about contacts with a sick infection and the transfer of pathology in childhood. However, the presence of some related symptoms with measles, rubella, pseudotuberculosis and diphtheria requires differential diagnosis.
A specific symptom of scarlet fever is a flaming mouth with a clear restriction of the transition of the mucous membrane to the hard palate. Also, only with this infection, changes in the tongue appear - it becomes a bright crimson color, and the papillae on its surface substantially hypertrophy. The rash in scarlet fever is punctate, it usually thickens in places of articular folds. The only place on the patient's body that is clear of rashes is a pale nasolabial triangle. When pressed on the skin with a rash, the latter then disappears for a while. When the rash is completely gone, the patient's skin is very flaky, while in the area of the feet and palms, it can go huge layers.
The moment of development of all the main symptoms of scarlet fever is always accompanied by hyperthermia, which can vary from 38.5 degrees in mild disease to 41 degrees in severe form.
Mild and moderate forms of the considered infection are treated at home, and only in case of a severe course do you need inpatient treatment. Antibiotics (medium and severe forms of infection) and antihistamines are necessary for the treatment of scarlet fever, which can neutralize erythrotoxin, which has a powerful allergenic effect on the human body. If the body temperature in case of illness is very high, then the use of antipyretic drugs is advisable. To relieve sore throat, apply local antiseptics in the form of sprays, rinse solutions, lozenges. To eliminate severe intoxication, the patient may be prescribed intravenous administration of detoxification drugs.
However, in addition to symptomatic treatment and antibiotic therapy for scarlet fever, it is very important to use medicines to increase the body's defenses. To this end, doctors prescribe vitamins of groups B and C, multivitamin and immunomodulatory complexes to patients.
Also, the system of treatment of scarlet fever, in addition to drug therapy, necessarily includes bed rest, a special diet with a high content of vitamins in food, and abundant drinking.
To prevent infection of other family members from a patient with scarlet fever, it is important to regularly ventilate the room, carry out frequent wet cleaning with the use of various disinfectors, boil the patient's bed linen and his dishes. 2 weeks after the patient recovers, it is important for him to conduct a routine examination in order to avoid the development of late complications.
Can I get sick again
Medical professionals know cases of scarlet fever twice and even three times in life. The weakened immune system of the patient together with a number of provoking factors is to blame for this pathology. These factors include the late treatment of scarlet fever, which in children begin too forcefully, which can lead to a halt in the mechanisms of formation of immunity against infection in the future. With early antibiotic therapy, the antibodies produced in the body can be completely leveled by drugs, which will lead in the future to a lack of immunity and the possibility of re-infection.
The second factor that provokes recurrent illness may be infection at an early age. It is known that a child’s own immunity occurs in the child’s body only by the age of 2, which means that with all the infections that he has had before he will be able to get infected again. However, there are not so many precedents about the infection of such young children in medical practice, since babies usually are protected by maternal antibodies from breast milk.
Another factor that provokes repeated infection with scarlet fever may be the simultaneous infection of several types of infection, which is also quite rare. At the same time, if rubella and scarlet fever viruses enter the body at the same time, the immune response arises only in relation to the main, stronger one, and the second disease can be tolerated in the future again.
Bacterial infections in modern conditions tend to develop resistance, therefore, cases of reinfection with any infections, to which a strong immunity should form in the human body, are not excluded, therefore, the methods of preventing such diseases should never be neglected.
Scarlet fever can only be prevented by complying with hygienic rules when caring for a patient and timely quarantine against infected people. There is no vaccination against scarlet fever in medicine, therefore it is only by such means that it is possible to carry out prevention of the disease.
If in a children's team, a person who is sick with scarlet fever is detected, then a seven-day quarantine is established. After the child has contacted the carrier of this infection, it can be sent to the team only after 17-22 days. If the child was sick with scarlet fever at home, he can begin to visit the team only 22 days from the date of the onset of the illness, and those who were treated for infection in the hospital - only 12 days after discharge from the hospital.
Prevention of scarlet fever necessarily implies certain hygienic rules. When returning home from crowded places, wash your hands thoroughly with soap and water. If a person is in a public place, you should try to stay away from those who have cold symptoms (coughing, sneezing, runny nose). In the house where there is a child who is sick with scarlet fever, all surfaces and toys are regularly washed with a solution of chloramine, and the dishes and bedding are boiled.
Contacting the patient with an adult is advised not to neglect the rinsing of the pharynx using antiseptics, especially in the case of chronic pathologies of the upper respiratory tract in history.
To stop the spread of infection, patients need to be isolated from others. However, such isolation will be effective if it is started from the first hours of the onset of symptoms, since the disease is already contagious from the beginning of the infection. Patients with severe forms of pathology can be isolated to the hospital if there are children who have not been ill at the age of 10 years in the family of the sick person, those patients who have healthy relatives in the family who work in preschool and primary school institutions, and hospitals.
When scarlet fever is detected in children's institutions, collectives are quarantined for a week after isolating the last person infected. Isolated healthy members of such a team are examined twice a day by a doctor. If even banal symptoms of ARVI are detected, they are also isolated from the rest of the staff, and the quarantine is prolonged for another 7 days.
In the case of scarlet fever, diet food is an important component of the whole treatment. At the same time it is impossible to abuse fat and fried, spicy and smoked, because the organism is already weakened from the infection. It is required to exclude soda, coffee, chocolate and other irritating pharynx products from the diet.
It is necessary to eat light soups and broths, liquid cereals, fresh fruits and vegetables that provide the body with the necessary vitamins and trace elements. In general, in the case of scarlet fever, doctors most often recommend a dietary menu according to the established rations "Table number 2" or "Table number 13" in the early stages of the disease, and "Table number 7" after 14 days from the onset of the disease. The most useful is the fractional meal up to 7 times a day with cooked steamed dishes. Radish, cabbage, pumpkin, beets with their anti-inflammatory effects, berries, fruits, tea with lemon, black currant to cleanse the body of toxins and slags and enhance its protective functions stand out among the most useful products from which the patient’s diet with scarlet fever should be made up rosehip decoction, juices and compotes to eliminate the symptoms of dehydration of the body, steam dishes from fish and meat, dairy products, preventing the occurrence of dysbacteriosis when taking antibiotics, honey, fish oil and so on.
Contraindications for scarlet fever
When transferring scarlet fever to the patient must comply with bed rest, because it helps to accumulate the body's strength for a speedy recovery. In this way, the isolation of the sick from society also occurs. At the same time to comply with bed rest when the infection takes from 8 to 10 days. To air the room where the patient is located, you need several times a day.
Walking with a child in the event of his illness scarlet fever is allowed only if he feels normal, and he does not oppose such walks. An important factor for the possibility of walking is the presence of antibiotic therapy in the treatment regimen. In this case, the first walk can be carried out only a day after the first taking of an antibacterial drug, because only after such a quantity of time does the sick child cease to be contagious to others. In the absence of antibiotic therapy in the treatment regimen, it is possible to walk with a sick child only 10 days after the development of the infection.
But even observing the above rules, walking with a sick child is possible only where there are no people at all, because the patient needs to be protected from external meetings with the very minimum concentration of streptococcus, which is capable of causing severe complications with scarlet fever. And since each person is a carrier of streptococcus (certain types of such bacteria form the microflora of the human body), it is necessary to completely exclude any contact until complete quarantine is removed.
Since scarlet fever is an infectious process, it is better to avoid bathing in the early days of the disease in order to avoid complications.
It is possible to begin hygienic procedures from the time when the body temperature completely normalizes. At the same time, it is necessary to carefully monitor the temperature of the water (it should not be hot or cold), do not use washcloths and not rub the skin. After bathing the body can not be wiped, it is recommended to slightly blot the skin to remove moisture.
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 of the Higher Attestation Commission.