Scarlet fever definition etiology clinical picture. Scarlet fever (scarlatina). Epidemiology. clinical picture. Treatment. Symptoms in children

Most often, children 2-10 years old get sick.

The causative agent of scarlet fever is group A streptococcus, which can also cause kidney damage (glomerulunophritis), tonsillitis, chronic tonsillitis, rheumatism and other diseases. Scarlet fever occurs if at the time of infection with streptococcus there is no immunity to it.

Source of infection- a patient with scarlet fever, tonsillitis or a "healthy" carrier of stereptococci. The incubation period usually lasts from 1 to 10 days. The child is considered contagious the day before the onset of the first symptoms and for the next 2-3 weeks.

The infection is transmitted by airborne droplets (when sneezing, kissing, etc.). In addition, you can get infected with scarlet fever through food, shared utensils, clothes, or simply by holding on to the door handle, which was previously opened by a completely healthy-looking carrier of the infection.

What's happening?

Getting on the mucous membrane, streptococcus causes inflammatory changes in the nasopharynx. The microbe produces a large amount of a toxic substance - erythrotoxin. Once in the blood, this toxin destroys red blood cells and causes intoxication (poisoning of the whole organism). Under its action in all organs, including the skin and mucous membranes, small vessels expand, which leads to the appearance of a characteristic rash. Erythrotoxin causes the death of the outer layer of the skin - the epidermis, which leads to severe flaking of the skin.

By the end of the first week of illness, immunity to streptococcus begins to develop. The synthesis and accumulation of antibodies, their binding of toxins leads to a decrease and elimination of the manifestations of toxicosis and the gradual disappearance of the rash.

How is it manifested?

Scarlet fever begins acutely: with a sharp rise in temperature to 39º C. The child complains of headache, nausea, severe malaise, severe pain when swallowing.

At the end of the first beginning of the second day, a small, itchy rash appears, which covers almost the entire body in a few hours. An important sign of scarlet fever is a thickening of the rash in the form of dark red stripes on the skin folds in places of natural folds - in the inguinal folds, armpits, elbows. The skin feels very dry and feels like sandpaper.

If you look into the patient's mouth, you can see a bright red inflamed mucosa, purulent deposits on the palatine tonsils and a crimson tongue with sharply enlarged papillae. Doctors characterize this condition of the throat with the expression "flaming pharynx."

On the face, the rash is located on the cheeks, to a lesser extent on the forehead and temples, while the nasolabial triangle remains pale and free from rash elements (a characteristic sign of scarlet fever).

After 3-5 days, the skin turns pale and severe peeling begins, especially pronounced on the palms of the child: the skin is removed from them like gloves.

Complications :

• lymphadenitis (damage to the lymph nodes);
• purulent otitis media (inflammation of the ear);
• allergic kidney disease - glomerulonephritis,
• joint inflammation - arthritis, synovitis;
• heart damage - allergic myocarditis;
• pneumonia (inflammation of the lungs).

The chance of complications is greatly reduced by taking a full course of antibiotics.

After suffering scarlet fever, as a rule, lifelong immunity is preserved. However, re-infection with scarlet fever does occur. Doctors are convinced that this is the fault of too active therapy - the disease is neutralized so quickly that the immune system does not have time to form.

Diagnosis and treatment

The diagnosis is made on the basis of data on contact with a patient with scarlet fever, tonsillitis, in the presence of a characteristic rash and sore throat.

Treatment is usually done at home. Children with severe and complicated forms of scarlet fever are hospitalized.

Bed rest must be observed for 7-10 days. To suppress the growth of streptococcus, antibiotics are used for a 10-day course. In addition, gargling with a solution of furacillin, infusions of chamomile, calendula, and eucalyptus are prescribed. Antiallergic drugs, vitamins are also used.

The prognosis is favorable.

After recovery, it is necessary to carefully monitor the well-being of the child, the color of urine (with glomerulonephritis, urine becomes the color of "meat slops", which is associated with the release of blood), pay attention to the appearance of pain in the joints. This will allow timely identification and treatment of complications of scarlet fever.

Prevention

Children who have been in contact with a sick person and have not previously suffered from scarlet fever are admitted to preschool or the first two grades of school after a seven-day isolation at home. In the apartment where the patient is located, regular wet cleaning and ventilation of the premises are carried out.

There is no vaccine for scarlet fever.

Scarlet fever (lat. Scarlatina) is an acute infectious disease characterized by general intoxication, tonsillitis (see Angina), punctate rash and a tendency to complications.

Scarlet fever - causes (etiology)

The causative agents of scarlet fever are toxigenic β-hemolytic group A streptococci. Epidemics of scarlet fever are characterized by an undulating course. Periodic rises in incidence occur after 5-7 years. This disease occurs in children of all ages, but children between the ages of 3 and 10 are most susceptible to scarlet fever.

When cultured on blood agar, it causes hemolysis. Serological classification is carried out according to the antigenic properties of the C-polysaccharide. Group A streptococci, which include the causative agent of scarlet fever, includes more than 80 serotypes, group A β-hemolytic streptococcus is resistant in the external environment. Withstands boiling for 15 minutes, resistant to many disinfectants (mercuric chloride, chloramine, carbolic acid).

Despite the exceptional interest in the problem of streptococcal infections and the huge number of solid works in this area, it is still not possible to get a clear answer to the question of the specific properties of the types of streptococci A that can cause scarlet fever.

It is known that the pathogen produces erythrogenic (scarlet fever) toxin.

Scarlet fever - the mechanism of occurrence and development (pathogenesis)

The main source of infection in scarlet fever is the patient. Infection can occur throughout the course of the disease, but in the acute period the contagiousness is highest. From an epidemiological point of view, mild and atypical cases are of great danger, the number of which has now greatly increased. The causative agent of scarlet fever is found mainly in the mucus of the pharynx and nasopharynx and is transmitted by droplets, as well as by direct contact. Transmission of the pathogen through healthy carriers is of limited importance. They also do not attach much importance to the spread of scarlet fever through objects, since the pathogen does not remain on them for very long.

The pathogenesis of scarlet fever is a sequential development of three stages (lines) associated with the toxic, septic and allergic effects of streptococcus. These lines of pathogenesis are interrelated.

At the site of introduction on the mucous membrane of the oropharynx, respiratory, genital tract or on damaged skin (with burns, wounds), streptococcus causes inflammatory changes. With scarlet fever, the palatine tonsils are the most common portal of entry. From the site of introduction, it can spread through the lymphatic pathways to regional lymph nodes, but through superficial vessels, intracanalicularly, or upon contact, to nearby tissues. At the same time, toxic substances of β-hemolytic streptococcus appear in the blood, which affect the cardiovascular, nervous and endocrine systems. A complex pathological process develops in the body, which is represented by toxic, septic and allergic syndromes.

The toxic syndrome (toxic line of pathogenesis) develops under the influence of the thermolabile fraction of exotoxin and is characterized by the development of fever, intoxication (headache, vomiting), sympathetic manifestation of vascular changes (in the sympathetic phase) in the form of increased blood pressure (see Blood pressure), muffled heart sounds , tachycardia, persistent white dermographism and the appearance of a small punctate rash.

In more severe cases, it is possible to develop hemodynamic disorders, hemorrhagic syndrome up to hemorrhage in the adrenal cortex, cerebral edema, degenerative changes in the myocardium, autonomic disorders up to sympathicoparesis.

The septic line of pathogenesis is due to the influence of microbial GABHS factors and is manifested by purulent and necrotic changes in the inflammatory reaction at the site of the entrance gate and complications of a similar nature. The septic component may be leading in the clinical picture from the first days of the disease or manifest as complications in the later period of infection. More frequent complications are sinusitis, otitis, lymphadenitis, adenophlegmon, osteomyelitis. With necrotic otitis, the process can move to bone tissue, dura mater, venous sinuses.

The allergic line of pathogenesis develops as a result of sensitization by a thermostable fraction of exotoxin and antigens of damaged tissues. Allergic syndrome can manifest already in the first days of the disease and reaches its greatest severity at 2-3 weeks of the infectious process in the form of allergic complications (various rashes, unmotivated low-grade fever, glomerulonephritis, myocarditis (see Myocarditis), synovitis, lymphadenitis, arthritis, etc.).

In the pathogenesis of scarlet fever, the phases of autonomic nervous activity change: at the beginning of the disease, there is an increase in the tone of the sympathetic division of the autonomic nervous system (“sympatheticus phase”), which is replaced by a predominance of the tone of the parasympathetic division of the nervous system (“vagus phase”) in the 2nd week.

Antitoxic immunity after scarlet fever is persistent, repeated cases of the disease are observed in 4-6% of children. Early use of penicillin prevents the formation of intense antitoxic immunity.

Scarlet fever - pathological anatomy

According to the severity of the course, scarlet fever is classified as mild, moderate and severe. The mild form can be characterized by only the most minor changes in the pharynx, such as catarrhal sore throat. Medium to severe scarlet fever is divided into toxic, tocoseptic and septic.

These forms differ from each other in the intensity of intoxication and the depth of purulent-necrotic processes in the pharynx, tonsils and lymph nodes of the neck. Of course, the duration of the evolution of all these processes will be the longer, the more widespread they are. But in general, they end by the end of the 3rd week of illness.

The second period of scarlet fever is not an obligatory expression of the disease and cannot be foreseen. The onset of the second period does not depend on the severity of the first. In this regard, people who have had the disease for 3 weeks, despite the absence of clinical manifestations, are observed for another 2 weeks and, if everything goes well, they talk about a complete recovery from scarlet fever.

The second period of scarlet fever is expressed by the occurrence of minor catarrhal phenomena in the pharynx. However, the most significant should be considered changes in the kidneys, where acute diffuse glomerulonephritis develops with a pronounced hemorrhagic component. Clinically appear hematuria and hypertension. Nephritis in rare cases takes a chronic course and ends with secondary wrinkling of the kidneys. In addition, in the second period, vasculitis, warty endocarditis, serous arthritis can be observed.

Scarlet fever - symptoms (clinical picture)

The incubation period in most cases ranges from 3 to 7 days, rarely up to 11 days. A shorter incubation (1-3 days) is observed with extrabuccal scarlet fever.

When determining the form of scarlet fever, the classification of A. A. Koltypin is most often used, which is based on the differentiation of the disease by type, severity and course. With typical forms, all the main signs of scarlet fever are clearly expressed; with atypical, one of the cardinal signs is absent (rash or sore throat) or all symptoms are mild (erased form). Atypical include hypertoxic forms and extrabuccal scarlet fever. When assessing the severity, the degree of severity of general intoxication and the intensity of the local process in the pharynx, nasopharynx and regional lymph nodes are taken into account. Forms in which manifestations of general severe intoxication predominate are classified as toxic, and in the case of a predominance of a severe local process, they are classified as septic. When determining the course, the presence or absence of complications or undulating outbreaks of the process and their nature are taken into account.

A typical mild form is characterized by slight intoxication, there may be a slight and short-term increase in temperature, vomiting is absent or happens once. Angina is catarrhal, with limited hyperemia and a brighter coloration of the small tongue, the tonsils are slightly enlarged and somewhat painful. Small-pointed rash on the background of erythema can be quite common, while the middle of the face, lips, nose and chin are free from rash (Filatov's white triangle), but often the rash can only be in the skin folds, on the inner surfaces of the thighs, in the lower abdomen.

All symptoms quickly regress, and by the 5-6th day of illness, a period of convalescence begins.

Currently, the mild form is predominant, accounting for 80-85% of all cases. It must be remembered that with this form, late complications are possible, including nephritis.

In the moderate form of scarlet fever, high fever, moderate intoxication, repeated vomiting, profuse, uniform rash with distinct white dermographism, sore throat with necrosis, crimson tongue, regional lymph nodes are observed. Complications in this form are more common than in mild, and are more diverse.

Severe forms of scarlet fever in modern conditions are rare (less than 1%), among them there are toxic, septic and toxic-septic.

With toxic scarlet fever, a violent onset, high fever, uncontrollable vomiting, frequent loose stools, anxiety, delirium, convulsions, adynamia, injection of scleral vessels, acrocyanosis, cold extremities, frequent weak pulse, weakened heart sounds are noted. The rash is scanty, uneven, cyanotic, sometimes there may be hemorrhages. Changes in the pharynx and regional lymph nodes are minor. These forms are found mainly in children older than 3 years.

The septic form of scarlet fever is now extremely rare. It is characterized by deep and extensive necrotic changes in the pharynx and nasopharynx, inflammation of the lymph nodes of the neck with rapid involvement of the surrounding tissue in the process.

Atypical forms include erased scarlet fever, in which all symptoms are very mild or one of the main symptoms, most often a rash, falls out. A mild rash lasts for several hours and can easily go unnoticed.

Extrabuccal scarlet fever in children is most often observed after a burn. The incubation period in this case is short (1-2 days), the rash begins at the site of the burn. Angina in the first days of the disease does not happen or it is mild. The course of this form of scarlet fever is mostly mild.

From the 4-5th day, with uncomplicated scarlet fever, the reverse development of all symptoms begins. Manifestations of general intoxication subside, the temperature becomes normal, mild sore throats pass in 5-7 days, necrotic ones last 9-10 days, the rash disappears without leaving pigmentation behind.

Peeling usually begins at the end of the 2nd week. First of all, pityriasis peeling appears on the neck, ear lobes, in the axillary, pubic areas; larger scales form on the trunk, and large layers separate on the fingers and toes, on the palms and soles. In infants, peeling is usually mild.

It must be emphasized that in recent years there has been an increase in the number of erased forms of scarlet fever and a softening of its main initial signs. The temperature does not reach high numbers, the febrile period has become shorter, the rash is low-intensity and does not last long, angina is almost always catarrhal, the reaction from the regional lymph nodes is moderate. Complications are less common and less varied.

The second period of scarlet fever is characterized by peculiar changes in the cardiovascular system. The pulse becomes slow, arrhythmic, the heart sounds are weakened, a functional systolic murmur may appear, a bifurcation of the II tone on the pulmonary artery, the borders of the heart expand somewhat, and blood pressure drops. This is the so-called scarlatinal heart, its manifestations last an average of 2-4 weeks. These disorders are changeable, unstable and almost do not burden the general condition of the patient, they are due to a violation of the nervous regulation of the cardiovascular system.

There are septic and allergic complications, according to the time of occurrence - early and late.

Septic complications include lymphadenitis, otitis, sinusitis. The most common complication is lymphadenitis, the group of anterior cervical lymph nodes is more often affected with reverse development after 2-5-9 days. At present, purulent lymphadenitis is extremely rare, the frequency of inflammation of the middle ear has noticeably decreased, and in the vast majority of cases, otitis media are catarrhal, sinusitis (ethmoiditis, frontal sinusitis) is less common, which proceed easily, with less severe symptoms and are not always recognized.

Allergic complications include synovitis and nephritis. Synovitis is a benign short-term inflammation of predominantly small joints, most often appearing on the 4-7th day of illness in children over 5 years old.

Kidney damage in scarlet fever can be varied - from toxic nephrosis to diffuse glomerulonephritis. In recent years, pronounced nephritis has been observed very rarely. Given the possibility of asymptomatic forms of nephritis, it is necessary to conduct urine tests for 3-4 weeks.

Scarlet fever - treatment

Patients with scarlet fever are hospitalized in a hospital according to clinical and epidemiological indications. It is necessary to simultaneously (within 1-3 days) fill the wards or department. Communication between patients from different wards should not be allowed. Children who develop complications should be isolated from other patients. The department should not be overloaded with patients. It is necessary to strictly ensure that the compartment is systematically ventilated. It is very important to achieve compliance with the correct regimen and especially long sleep of sick children in the acute period of the disease.

When treating a sick child at home, it is necessary to isolate in a separate room and take measures against the transfer of infection by the person caring for the patient.

Since objects that patients come into contact with can be a source of infection for others, the current disinfection of dishes, towels, handkerchiefs, toys and other personal items of the patient should be carefully carried out.

In the acute period of the disease, even with a mild form of scarlet fever, the child should be on bed rest. At the end of the acute period (from the 6-7th day), at normal temperature, a satisfactory condition of the child and the absence of pronounced changes in the cardiovascular system, you can allow him to get out of bed. Care must be taken to increase the emotional tone of the child (toys, books, drawing, etc.).

It is necessary to measure body temperature 2 times a day and systematically do urine tests.

Food should be complete and rich in vitamins. In the presence of necrosis and sore throat, food should be mechanically and chemically gentle. Care must be taken to ensure that in the acute period the child receives a sufficient amount of fluid (at least 1 liter).

Antibiotics are prescribed for scarlet fever. The most widely used penicillin (within 6-8 days). In case of intolerance or resistance to penicillin, drugs of the tetracycline group are prescribed. According to most authors, antibiotics should be administered even in the mildest cases of scarlet fever.

Attention should be paid to symptomatic therapy, heavy drinking, desensitizing agents. In the treatment of septic complications, the leading place is occupied by antibiotic therapy for 6-8-10 days. With scarlatinal nephritis, treatment is carried out according to the principle of therapy for acute glomerulonephritis.

Synovitis proceeds favorably and passes without special treatment. With scarlatinal heart, no other therapeutic measures are required, except for rest.

Scarlet fever - prevention

Anti-epidemic measures in the fight against scarlet fever are currently reduced to timely diagnosis, early isolation of patients, compliance with quarantine deadlines and the fight against infection in children's groups.

They are discharged from the hospital after the 10th day of illness, provided that the patient feels well, has a normal temperature for 5 days, in the absence of complications, a calm state of the pharynx and nasopharynx, normalization of blood composition and ESR. When treating at home, communication with the patient is allowed no earlier than the 10th day from the onset of the disease. For children attending preschool institutions and the first 2 grades of school, additional separation from the team is established within 12 days after discharge from the hospital or isolation at home.

When a patient is hospitalized, quarantine is imposed only on children who have not had scarlet fever, who live in the same room with the patient and attend preschool institutions and the first 2 classes of the school. The quarantine period is 7 days from the moment of isolation of the patient. If the patient remains at home, then quarantine for children who have been in contact with him is imposed for 7 days from the end of the acute period, that is, after the 10th day.

Adults serving children's institutions, surgical departments, maternity hospitals, food and dairy industries are subject to medical supervision for 7 days.

Scarlet fever is a common, mainly childhood infection, transmitted by airborne droplets. Lack of a scarlet fever vaccine results in a high incidence of scarlet fever in the 2 to 8 year old age group. The prevalence of the causative agent of scarlet fever, streptococcus, is very high. Given that a sufficiently large group of people of different ages is an asymptomatic carrier of the infection, the reason for the frequent incidence of scarlet fever becomes clear.
The child's body is most susceptible to the influence of the pathogen bacteria, and after the illness, a strong immunity is formed. This allows us to classify scarlet fever as an infectious disease of childhood. In extremely rare cases, people who have had scarlet fever have a turn of infection in adulthood. Scarlet fever is a dangerous disease, every parent needs to know about its features, clinical picture and prevention of complications.

Scarlet fever: etiology and symptoms of the disease

The disease has long been known as dangerous for children aged 1 to 9 years with a significant number of deaths. Before the advent of modern medicines in most countries of the world, during the epidemics of scarlet fever, a huge number of children died. The reason for limiting the age period is the presence of protection of the child with maternal antibodies in the first period of life up to 1-2 years, depending on the type of feeding and immunity of the mother, and the formation of the body's own immune defense in children 8-9 years old.

History of scarlet fever

Scarlet fever as a separate disease was isolated in 1675 by Zinedgam (Sidengam). In the years 1789-1824, Bretonneau was engaged in compiling a complete clinical picture. Loffler (Loffler) was the first doctor who expressed in 1882 the idea of ​​streptococcus as the causative agent of scarlet fever on the basis of its isolation from the pharynx, blood and organs of the dead. Then the infectious disease specialists Pirquet and Mooser (Pirquet, Mooser) in 1903, in support of this hypothesis, reported that scarlatinal streptococcus, unlike other types of bacteria in this group, is agglutinated by the serum of convalescents (recovering) after scarlet fever.
I. G. Savchenko (1905) was the first to isolate streptococcal toxin, with which he successfully immunized horses during experiments, which made it possible to create an antitoxic serum that has a therapeutic effect in this disease.
Later, G.N. Gabrichevsky in 1906 proposed an anti-streptococcal vaccine for the prevention of the disease. G. F. Dick, G. H. Dick (1923 - 1925) proposed an intradermal test with scarlatinal streptococcus toxin to determine susceptibility to this infection.

Etiology and types of spread of infection

The name is based on the description of the symptoms of the disease. The Latin word scarlatum, meaning "bright red", "scarlet", describes one of the characteristic symptoms of scarlet fever - skin rashes of bright red color. A characteristic scarlet fever exanthema, a rash of a certain shape, size and localization, is the main clinical sign that allows the doctor to diagnose streptococcal infection.
A streptococcal bacterium, group A beta-hemolytic streptococcus, is the causative agent of infection and the cause of scarlet fever. Infection occurs through contact with sick people or hidden carriers, as well as without direct contact, when using some hygiene items, dishes, toys, other items and food products. Also, the disease is transmitted through a third person who has been in contact with a sick person or a carrier of a streptococcal infection of this type.

Manifestations of the disease

The characteristic scarlet rash that occurs with scarlet fever is the body's reaction to erythrotoxin, which, from the first day of the development of the disease, is produced by streptococcus when it reproduces on mucous surfaces. Under the influence of this toxin, small blood vessels dilate, forming spots of red color and rounded shape.
This clinical symptom clearly points to scarlet fever. The combination of tonsillitis and a red rash, gradually capturing the surface of the body, starting from the head and going down, allows you to confidently diagnose this disease during an external examination.
Specific symptoms also include the absence of a rash in the area of ​​the nasolabial triangle, which, together with severe hyperthermia, redness of the cheeks and puffiness of the neck due to an increase in the cervical lymph nodes, is a characteristic picture of the appearance of a sick child. Filatov's symptom, a pale nasolabial triangle, is not pantognomic only for scarlet fever, it also manifests itself in other diseases.
Exanthema manifests itself several hours after the acute manifestation of the disease. The incubation period from the moment of infection to the appearance of obvious symptoms averages 5-7 days, but there are cases when the latent stage lasted from several hours to 12 days. At the same time, a child with scarlet fever is contagious from the first day until clinical recovery, that is, for about three weeks.

Stages of manifestation of the rash and its variations depending on the form and severity of the disease

First of all, pink dotted rashes appear on the face, lateral surfaces of the body, in the skin folds of the armpits, in the groin area, neck, etc. In places of increased friction of the skin on clothing and bedding (for example, on the back), the rash has a confluent character and can cover significant areas of the skin almost entirely. Polymorphism of scarlatinal exanthema, uneven manifestations are characteristic of severe, septic forms and early layering of allergic reactions. In case of severe intoxication, uneven, scanty cyapotic exanthema with hemorrhagic phenomena is possible.
The most pronounced rashes are 3-5 days after the onset of scarlet fever, after which the rash turns pale, disappearing without a trace, and significant peeling of the skin begins, which is also a consequence of the impact of a specific toxin on the body.
A pronounced exfoliation of epidermal particles is noticeable on the hands and soles of the feet: the so-called “palm symptom” describes the exfoliation of the skin in the form of a kind of “glove”, in whole layers, spreading from the area around the nail plates to the entire surface.
Scarlatinal rash, especially in children diagnosed with exudative diathesis, may be accompanied by moderate itching. In some cases, most often with a mild and moderate course of the disease, groups of whitish small vesicles with initially transparent and then cloudy contents are added to the classic type of rash at the places of folds and natural folds. According to N. F. Filatov, such a rash - miliaria crystalline - has a favorable prognostic value. By the end of the disease, the vesicles dry up, leaving a slight peeling of the skin.

Angina and other symptoms of the disease

With insufficient severity of the clinical picture, scarlet fever can be diagnosed as a sore throat, since the disease is accompanied by inflammation of the larynx, also provoked by streptococci. The primary localization of the introduction and reproduction of streptococci in most cases is the nasopharynx, and first of all, when infection and development of scarlet fever in a child, an inflammatory process begins in this area, tonsillitis develops with reddening of the soft palate, enlarged tonsils, grayish purulent plaque, accompanied by an increase and soreness of local lymph nodes due to an allergic reaction to toxins. The characteristic "scarlet fever" tongue of bright crimson color with protruding taste buds is noted on the fourth day from the onset of the disease. Purulent-septic foci of inflammation on the mucous membrane and skin can also develop, especially with primary infection with streptococcus through the surface of wounds and abrasions.
Thus, the symptoms of scarlet fever include:

• a sharp onset of the disease with a feverish state, high fever, a significant deterioration in well-being, signs of intoxication of the body (nausea, vomiting, signs of an increase in the tone of the sympathetic nervous system may be noted);
• streptococcal angina, accompanied by an increase in local lymph nodes;
• "flaming pharynx", hyperemia, redness of the mucous membranes of the throat, limited by the line of the hard palate;
• rash of a characteristic type and localization;
• "crimson" language.

Depending on the severity of the course of the disease and the degree of intoxication of the body, the clinical picture may be supplemented by symptoms of septic complications, allergic reactions, and damage to internal organs.

Varieties of the course and complications of scarlet fever in children

Scarlet fever in recent decades is most often mild. This is connected both with the invention of effective medicines and the possibility of antibiotic treatment, as well as with the improvement of lifestyle, a variety of nutrition, and medical care, which allow children to form a higher body resistance compared to previous centuries.

Symptoms of a mild form of the disease

The mild form of the disease is quite moderate, manifesting the following symptoms:

• hyperthermia not higher than 38.5 ° C;
• vomiting, nausea, headache are absent or mild;
• catarrhal manifestations (pharyngitis, tonsillitis) proceed without complications;
• purulent-necrotic plaque on the tonsils and soft palate is absent;
• the rash is not bright, not abundant or absent;
• peeling of the skin is mild.

The course of the disease is moderate, the acute febrile stage ends in 3-4 days, angina and skin rashes disappear by 5-6 days. Complications develop in rare cases.
Their characteristic signs of scarlet fever, which make it possible to distinguish an erased form from a sore throat, are distinguished by a scarlet tongue of crimson color with pronounced papillae, this symptom is also present in the mild stage of the disease.

Moderate form of scarlet fever

Scarlet fever in moderate form is characterized by the following characteristic features:

• a significant increase in body temperature - 39-40 ° C;
• a sharp deterioration in well-being, chills, weakness, headache, nausea, vomiting (sometimes exhausting, repeated);
• delirium, hallucinations are possible as a result of intoxication and excitation of the sympathetic nervous system;
• tachycardia, palpitations, a symptom of "scarlet fever", accompanied by shortness of breath, shallow breathing, pain in the sternum;
• purulent-necrotic plaque on the tonsils, purulent tonsillitis;
• bright, numerous rashes on the skin, profuse peeling of the skin during recovery.

The duration of the manifestation of primary symptoms and the acute period with a moderate form of the disease is 7-8 days, during which hyperthermia also persists. This form is characterized by early and late complications of the course of the disease, which often requires the placement of a sick child in a hospital for timely detection of symptoms.

Scarlet fever in severe form

Due to the timely prescription of antibiotics and immunization of the general population, a severe form is quite rare today. The disease is characterized by the following symptoms:

• an increase in body temperature to critical limits (41 ° C);
• severe nausea, repeated vomiting, headache, tachycardia;
• mental disorders: confusion, delirium, hallucinatory phenomena;
• inflammation of the nasopharynx extends to the soft palate, oral region, local lymphatic system, middle ear;
• the rash is abundant, uneven, confluent, pronounced.

There are three forms of severe scarlet fever:

• toxic, provoked by the abundant release of erytotoxin. This form is accompanied by severe intoxication of the body and can cause infectious-toxic shock and death;
• purulent-necrotic lesion of the nasopharynx and adjacent tissues is characteristic of the septic form in the severe stage;
• toxic-septic, the most dangerous combined form of scarlet fever, combining septic phenomena and severe intoxication.

Scarlet fever in severe form requires mandatory hospitalization of both children and adult patients.

Early and late complications of scarlet fever in children

As a rule, the occurrence of complications of the early and late period is associated with late diagnosis or insufficient treatment of the disease. Treatment of scarlet fever requires strict adherence to all specialist prescriptions, not only for a quick and effective recovery, but also to prevent the development of numerous and rather serious complications of this infection.

Early complications of scarlet fever

When introduced into the body, an infectious agent begins to negatively affect various organs and systems. The most common complications of the early period of scarlet fever in children include such phenomena as:

• , inflammation of the tonsils, sinuses due to the development of infection in the nasopharynx;
• inflammatory processes, purulent foci in the liver, kidneys;
• change, thinning of the heart walls, which leads to an increase in the size of the heart, a decrease in its performance, the level of filling of blood vessels. "Scarlatine" or toxic heart as a syndrome is accompanied by a decrease in blood pressure, a decrease in heart rate, shortness of breath, pain in the chest;
• disturbances in the functioning of the circulatory system due to the effect of streptococci on the walls of blood vessels, which is dangerous for hemorrhages in various parts of the body, including in the brain.

These complications develop when a weakened child develops scarlet fever or when therapy is not started in time, leading to a severe form of scarlet fever.

Late complications of scarlet fever

Most of the late complications of scarlet fever are associated with untimely initiation of treatment and non-compliance with prescriptions in the regimen and limitation of loads during the period of illness and recovery.

Articular rheumatism

Rheumatism affecting the joints is one of the frequent late complications of scarlet fever. The first symptoms are noted on average two weeks after clinical recovery and include the following manifestations:

• pain in the large joints of the limbs;
• asymmetric localization of inflammatory processes;
• redness, swelling over the joint.

Myocarditis

Inflammation of the heart muscle or myocarditis develops as a result of an inflammatory process in the tissues of the myocardium, as a result of which the elasticity of the tissues and their contractility decrease.
Inflammation develops when streptococcus enters the heart muscle. To cure myocarditis, it is necessary to eliminate the cause of the disease, which implies the full treatment of scarlet fever.
To reduce the likelihood of myocarditis during the period of illness and within two weeks after recovery, it is necessary to limit physical activity. Therefore, scarlet fever in children requires exemption from physical education classes for a period of two weeks and bed rest during the treatment of scarlet fever.

Glomerulonephritis

Group A hemolytic streptococcus causes a severe allergic reaction in the body, which provokes the destruction of body tissues by immune cells. If the kidney glomeruli, the main filtering elements of the kidneys, are damaged due to allergies, the child develops glomerulonephritis.
Manifestations of glomerulonephritis can be observed both a few days and a few weeks after the disease with scarlet fever. At the beginning of the disease, the following symptoms appear:

• hyperthermic turn, increased body temperature;
• pain in the lumbar region;
• a decrease in the total volume of urine excreted, a change in its transparency, the presence of sediment;
• edema, especially manifested after sleep.

Treatment of glomerulonephritis after scarlet fever in childhood is carried out in a hospital and requires strict medical supervision after recovery to prevent the transition of the acute form of the disease into a chronic one.

Pneumonia

In 5% of cases, a late complication of scarlet fever is pneumonia or pneumonia. As a rule, streptococcal pneumonia develops in the first week of septic scarlet fever due to streptococci entering the lungs through the respiratory tract.
If inflammation of the lungs is noted later, then usually the causative agent is pneumococcus, which joins against the background of a weakened immune system of the child's body.
Pneumonia is a dangerous disease at any age, requiring long-term therapy and a recovery period. Timely intake of antibiotics for scarlet fever helps prevent the infection from moving from the nasopharynx to the lungs and avoid the development of such a complication.

Principles of treatment of scarlet fever in childhood

When diagnosing scarlet fever, treatment is determined by a specialist. First of all, the choice of therapy is based on the form of the disease, the severity of its course and concomitant diseases, dysfunctions and the individual characteristics of the child.
The mild form does not always require the appointment of antibiotics, the need for antibiotic therapy is determined by the pediatrician. Mandatory maintenance therapy aimed at relieving symptoms and reducing the likelihood of complications includes antihistamines, anti-inflammatory drugs for the nasopharynx, antipyretics, if necessary. A prerequisite is a plentiful drink, as well as compliance with the bed rest of the patient, lack of stress, peace, dietary nutrition.
Moderate and severe forms of scarlet fever are cured with antibiotics of the penicillin group, the most effective against streptococci. If, with an established diagnosis of scarlet fever, treatment with antibiotics of the penicillin series is impossible (for example, in the presence of an allergic reaction to penicillin), drugs of other groups are selected, to which the sensitivity of the infectious agent has been established.
In addition to mandatory antibiotic therapy, antihistamines, antipyretics, drugs for detoxification of the body, and vitamins are prescribed. When complications are attached, an appropriate course of treatment is selected.
Scarlet fever is treated by a pediatrician, self-administration of drugs is unacceptable. In any form of scarlet fever, it is necessary to drink plenty of fluids to remove erytotoxins and alleviate the patient's condition, as well as bed rest and complete rest of the patient. It should be remembered that mild scarlet fever, if the doctor's prescriptions are not followed, can cause serious complications leading to chronic diseases or disability of a person.

Scarlet fever: methods of disease prevention

Scarlet fever is a disease that is not yet preventable by vaccination methods. Therefore, in order to avoid scarlet fever, non-specific preventive measures are taken to prevent the spread of infection in children's groups. In the absence of an effective vaccine, quarantine, isolation of the sick and good personal hygiene are the basic ways to prevent the incidence of scarlet fever.
Therefore, when diagnosing scarlet fever in a child attending a preschool or school educational institution in a kindergarten class or group, a week-long quarantine is established. If there is contact with a sick child with scarlet fever, other children are allowed into the team only after 17 days in the absence of symptoms of the onset of the disease.
Those who have had scarlet fever at home are allowed to visit a children's institution 22 days after the first day of illness, and those discharged from the hospital - 12 days after discharge.
Such quarantine measures help reduce the incidence rate and prevent epidemics in kindergartens, schools and other forms of children's groups.
Compliance with personal hygiene is also one of the methods of preventing scarlet fever. Mandatory washing of hands with soap for 30 seconds, careful handling, especially upon returning from crowded places, regular sanitization of toys, objects, surfaces, washing food can effectively destroy most pathogens.
In the house where the patient with scarlet fever is located, special hygiene measures are carried out, including regular surface treatment with chloramine, boiling bed linen, underwear and dishes, and antiseptic treatment of toys.
When in contact with a patient with scarlet fever, regular gargling with an antiseptic is recommended, especially in the presence of chronic diseases of the nasopharynx (pharyngitis, tonsillitis, sinusitis, etc.), washing the nasal passages with saline.

An acute infectious disease characterized by skin lesions with the formation of a sharply limited inflammatory focus, as well as fever and symptoms of general intoxication, recurrence.

Etiology. The causative agent is hemolytic streptococcus. These are facultative anaerobes, they are resistant to environmental factors. But when exposed to heat, antiseptics and antibiotics quickly die.

Epidemiology. The source of infection is a patient with erysipelas, as well as a carrier of β-hemolytic streptococcus. Infection occurs as a result of the penetration of the pathogen through damaged skin or mucous membranes. Immunity after erysipelas does not arise.

Pathogenesis. The causative agent penetrates through small breaks in the skin. Exogenous infection is possible (through contaminated instruments, dressings). In the occurrence of recurrence of erysipelas in the same place, allergic mood and skin sensitization to hemolytic streptococcus matters.

Clinic. The duration of the incubation period lasts from several hours to 5 days (usually 3-4 days). By the nature of local lesions, erythematous, erythematous-bullous, erythematous-hemorrhagic and bullous forms are distinguished, according to the severity of the course - mild, moderate and severe, as well as primary, recurrent and repeated; by the nature of local phenomena - localized, widespread and metastatic. Primary erysipelas begins acutely, with symptoms of general intoxication. Body temperature rises to 39-40 ° C, general weakness, chills, headache and muscle pain appear, in severe cases, convulsions, impaired consciousness, symptoms of irritation of the meninges may appear. After 10-24 hours from the onset of the disease, local symptoms develop: pain, burning and a feeling of tension in the affected area of ​​the skin; on examination, hyperemia and swelling are revealed. Erythema is often uniform, rising above the level of the skin. The severity of edema is mainly observed with the localization of inflammation in the eyelids, lips, fingers, genitals. Sometimes, against the background of erythema, blisters are formed, filled with serous (erythematous-bullous erysipelas) or hemorrhagic (bullous-hemorrhagic erysipelas) contents. Lymphangitis and regional lymphadenitis are also noted. At the site of inflammation in the future, peeling of the skin appears. Local changes persist for 5-15 days, pastosity and pigmentation of the skin can persist for a long time. Recurrences of erysipelas can occur within a few days to 2 years after infection. With a later (over 2 years) appearance of erysipelas, we are talking about repeated erysipelas. It is usually localized in a new area of ​​​​skin. Recurrence is promoted by insufficient treatment of primary erysipelas, residual effects after erysipelas (lymphostasis, etc.). With frequent relapses, fever and symptoms of intoxication are mild. Complications and consequences of erysipelas may be the same as in other streptococcal diseases (rheumatism, nephritis, myocarditis), but may be more specific: ulcers and necrosis of the skin (gangrenous erysipelas), abscesses and phlegmon (abscessing erysipelas), impaired lymph circulation, leading to to elephantiasis of the affected limb. In the case of clinical diagnosis, differentiation with other diseases is necessary, in which local redness and swelling of the skin may occur (vein thrombosis, erysipiloid, phlegmon and abscesses, acute dermatitis, etc.). In the blood, there is a slight leukocytosis with a shift to the left, an acceleration of ESR.

Treatment. The most effective action is provided by antibiotics of the penicillin series. For primary erysipelas and rare recurrences, penicillin is prescribed at a dose of 500,000 IU every 6 hours for 7-10 days; With significant residual effects, to prevent recurrence, bicillin-5 must be administered within 4-6 months (1,500,000 IU every 4 weeks). In case of intolerance to penicillin, erythromycin (0.3 g 5 times a day) or tetracycline (0.3-0.4 g 4 times a day) can be used, the duration of the course is 7-10 days. With persistent and frequent relapses of erysipelas, antibiotics are combined with corticosteroid hormones (prednisolone 30 mg / day).

The prognosis is generally favorable. With often recurrent erysipelas, elephantiasis may occur, partially disrupting the ability to work.

Prevention. Prevention of injuries and scuffs of the legs, treatment of streptococcal diseases. With a pronounced seasonality of relapses, bicillin prophylaxis is carried out, which begins a month before the start of the season and continues for 3-4 months (Bicillin-5 is injected every 4 weeks at 1,500,000 units). With frequent relapses of erysipelas, year-round bicillin prophylaxis is advisable. There are no activities in the outbreak. Specific prophylaxis has not been developed.

Acute airborne anthroponosis, affecting mainly children under the age of 10 years, but there are cases of the disease at a later age. The infection is characterized by fever, general intoxication, sore throat symptoms, characteristic elements on the skin and changes in the pharynx. The incidence increases in the autumn-winter months.

Etiology, pathogenesis. The causative agent is beta-hemolytic toxigenic group A streptococcus, it settles in the nasopharynx, less often in the skin, causing local inflammatory changes (tonsillitis, regional lymphadenitis). The exotoxin produced by it causes symptoms of general intoxication and characteristic local manifestations. Streptococcus, under conditions favorable to microbial invasion, causes the development of a septic component, manifested by lymphadenitis, otitis media, and septicemia. In the development of the pathological process, the sensitizing mechanisms involved in the occurrence and pathogenesis of complications in the late period of the disease play an important role. The development of complications is often associated with streptococcal superinfection or reinfection.

Clinic. The incubation period lasts 5-7 days. The disease begins acutely. The body temperature rises, there is a pronounced deterioration in the child's condition, headache, sore throat when swallowing. A typical and constant symptom is tonsillitis, characterized by a bright delimited hyperemia of the soft palate, an increase in tonsils, in lacunae or on the surface of which plaque is often found. Upper cervical lymph nodes are enlarged, painful. Vomiting often occurs as a symptom of intoxication. On the 1st (less often on the 2nd) day, a bright pink or red punctate rash appears on the skin of the whole body with a predominant localization on the chest, in the region of the extensor surfaces of the forearms. The nasolabial triangle remains pale (Filatov's symptom), white dermographism is determined, petechial hemorrhages are not uncommon in the folds of the limbs. The rash lasts from 2 to 5 days, and then turns pale, while the body temperature drops. In the second week of the disease, peeling of the skin appears - lamellar on the palms and soles, finely and coarsely scaly - on the trunk. The tongue is initially lined, from the 2nd-3rd day it is cleared and by the 4th day it takes on a characteristic appearance: bright red color, sharply protruding papillae (crimson tongue). In the presence of severe intoxication, damage to the central nervous system is observed (excitation, delirium, blackout of consciousness). At the beginning of the disease, symptoms of an increase in the tone of the sympathetic, and from the 4-5th day - of the parasympathetic nervous system are noted. With a mild form of scarlet fever, the symptoms of intoxication are slightly expressed, fever and all other manifestations of the disease disappear by the 4-5th day; this is the most common variant of the modern course of scarlet fever. The moderate form of scarlet fever is characterized by a greater severity of symptoms, including intoxication phenomena, the febrile period lasts 5-7 days. The severe form, currently very rare, occurs in two main variants: in the form of toxic scarlet fever with pronounced symptoms of intoxication (with high fever, symptoms of CNS damage - blackout, delirium, and in young children with convulsions, meningeal signs), all symptoms from the pharynx and skin are pronounced; in the form of severe septic scarlet fever with necrotizing angina, violent reaction of regional lymph nodes and frequent complications of a septic order; necrosis in the throat can be located not only on the tonsils, but also on the mucous membrane of the soft palate and pharynx. The toxic-septic course of scarlet fever is characterized by a combination of the symptoms of these two severe forms. Atypical forms of the disease include erased scarlet fever, in which all symptoms are rudimentary, and some are completely absent. If the skin is the entrance gate of infection (burns, wounds), then the development of an extrapharyngeal, or extrabuccal, form of scarlet fever occurs, in which such an important symptom as tonsillitis is absent. With mild and erased forms of scarlet fever, changes in peripheral blood are insignificant or absent. In moderate and severe forms, leukocytosis, neutrophilia with a shift to the left, and a significant increase in ESR are observed. From the 3rd day of the disease, the content of eosinophils increases, however, in severe septic form, their decrease or complete disappearance is possible. Complications: glomerulonephritis (mainly in the third week), synovitis, the so-called infectious heart, less often myocarditis, which is a formidable manifestation of the disease in children. In the presence of a septic component of the disease, purulent complications may occur (lymphadenitis, adeno-phlegmon, otitis media, mastoiditis, sinusitis, septicopyemia). Pneumonia may develop. Relapses of scarlet fever and tonsillitis are associated with streptococcal reinfection. In recent decades, the incidence of complications has declined sharply. After suffering scarlet fever, as a rule, lifelong immunity is preserved. However, in recent years, the incidence of recurrence has increased slightly. Difficulties in diagnosis arise in atypical forms of the disease.

Differential diagnosis is carried out with measles, rubella, drug rash, scarlet fever-like form of pseudotuberculosis. Cases of staphylococcal infection with scarlatiniform syndrome are observed.

Treatment. In the presence of appropriate conditions, therapy is carried out at home. Patients are hospitalized with severe and complicated forms of scarlet fever, as well as according to epidemiological indications. Bed rest is always observed for 5-6 days (in severe cases or more). Antibiotic therapy is carried out: benzylpenicillin is prescribed at the rate of 15,000-20,000 IU / kg per day. in / m for 5-7 days. At home, with a mild form of scarlet fever, phenoxymethylpenicillin can be used orally, doubling the indicated daily dose. In the toxic form in a hospital, intravenous infusions of neocompensan, gemodez, 20% glucose solution with vitamin therapy are used. With a septic form, intensive antibiotic therapy is indicated. Treatment of complications (lymphadenitis, otitis, nephritis) is carried out according to the usual rules.

The prognosis is favorable.

Prevention. The patient is isolated at home or (according to indications) is hospitalized. The wards in the hospital are filled simultaneously for 1-2 days, contacts of convalescents with patients in the acute period of the disease are excluded. Convalescents are discharged from the hospital in the absence of complications on the 10th day of illness. Children who have been in contact with a sick person and have not previously had scarlet fever are allowed to preschool or the first two grades of school after 7 days of isolation at home. In the apartment where the patient is kept, regular current disinfection is carried out; under these conditions, the final disinfection is unnecessary. It must be remembered that scarlet fever is transmitted through clothing, underwear, toys and other things, that is, through third parties.

Infection occurs from patients by airborne droplets (when coughing, sneezing, talking), as well as through household items (dishes, toys, linen). Patients are especially dangerous as sources of infection in the first days of illness.

The pathogenesis of scarlet fever:

Toxinemia leads to a generalized expansion of small vessels in all organs, including the skin and mucous membranes, and the appearance of a characteristic rash. The synthesis and accumulation of antitoxic antibodies in the dynamics of the infectious process, the binding of toxins by them subsequently cause a decrease and elimination of the manifestations of toxicosis and the gradual disappearance of the rash. At the same time, moderate phenomena of perivascular infiltration and edema of the dermis develop. The epidermis is saturated with exudate, its cells undergo keratinization, which further leads to peeling of the skin after the scarlatina rash fades. The preservation of a strong connection between keratinized cells in the thick layers of the epidermis on the palms and soles explains the large-lamellar nature of peeling in these places.

The components of the cell wall of streptococcus (group A-polysaccharide, peptidoglycan, protein M) and extracellular products (streptolysins, hyaluronidase, DNase, etc.) cause the development of delayed-type hypersensitivity reactions, autoimmune reactions, the formation and fixation of immune complexes, disorders of the hemostasis system. In many cases, they can be considered the cause of the development of glomerulonephritis, arteritis, endocarditis and other immunopathological complications.

From the lymphatic formations of the mucous membrane of the oropharynx, pathogens enter the regional lymph nodes through the lymphatic vessels, where they accumulate, accompanied by the development of inflammatory reactions with foci of necrosis and leukocyte infiltration. Subsequent bacteremia in some cases can lead to the penetration of microorganisms into various organs and systems, the formation of purulent-necrotic processes in them (purulent lymphadenitis, otitis media, lesions of the bone tissue of the temporal region, dura mater, temporal sinuses, etc.).

Scarlet fever symptoms:

There are pains in the throat when swallowing. When examining patients, a bright diffuse hyperemia of the tonsils, arches, uvula, soft palate and posterior pharyngeal wall (“flaming pharynx”) is observed. Hyperemia is much more intense than with ordinary catarrhal angina, it is sharply limited at the point of transition of the mucous membrane to the hard palate. It is possible to form a sore throat of a follicular-lacunar nature: on enlarged, highly hyperemic and loosened tonsils, mucopurulent, sometimes fibrinous and even necrotic plaques appear in the form of separate small or (less often) deeper and more widespread foci. At the same time, regional lymphadenitis develops, the anterior cervical lymph nodes are dense and painful on palpation. The tongue, at first covered with a grayish-white coating, clears up by the 4-5th day of the disease and becomes bright red with a raspberry tint and hypertrophied papillae (“crimson tongue”). In severe cases of scarlet fever, a similar "crimson" color is also noted on the lips. By the same time, the signs of angina begin to regress, necrotic raids disappear much more slowly. From the side of the cardiovascular system, tachycardia is determined against the background of a moderate increase in blood pressure.

Scarlatinal exanthema appears on the 1st-2nd day of the disease, located on a general hyperemic background, which is its feature. Rash is an important diagnostic sign of the disease. First, punctate elements appear on the skin of the face, neck and upper body, then the rash quickly spreads to the flexor surfaces of the limbs, the sides of the chest and abdomen, and the inner surface of the thighs. In many cases, white dermographism is clearly expressed. A very important sign of scarlet fever is a thickening of the rash in the form of dark red stripes on the skin folds in places of natural folds, for example, elbows, inguinal (Pastia's symptom), and also in the armpits. In places, abundant punctate elements can completely merge, which creates a picture of continuous erythema. On the face, the rash is located on the cheeks, to a lesser extent - on the forehead and temples, while the nasolabial triangle is free from elements of the rash and is pale (Filatov's symptom). When pressing on the skin with the palm of the hand, the rash in this place temporarily disappears (“palm symptom”).
Due to the increased fragility of blood vessels, small pinpoint hemorrhages can be detected in the area of ​​the articular folds, as well as in places where the skin is subjected to friction or compression by clothing. Endothelial symptoms become positive: symptoms of a tourniquet (Konchalovsky-Rumpel-Leede) and gum.

In some cases, small vesicles and maculo-papular elements may appear along with the typical scarlatinal rash. The rash may appear late, only on the 3-4th day of illness, or even be absent.

By the 3-5th day of the disease, the patient's state of health improves, the body temperature begins to gradually decrease. The rash turns pale, gradually disappears, and by the end of the first or beginning of the 2nd week is replaced by finely scaly peeling of the skin (on the palms and soles it has a large-lamellar character).

The intensity of the exanthema and the timing of its disappearance may be different. Sometimes, in mild scarlet fever, a scanty rash may disappear within a few hours of onset. The severity of skin peeling and its duration are directly proportional to the abundance of the previous rash.

Extrabuccal scarlet fever. The sites of skin lesions - burns, wounds, foci of streptoderma, etc. become the gates of infection. The rash tends to spread from the site of introduction of the pathogen. In this currently rare form of the disease, there are no inflammatory changes in the oropharynx and cervical lymph nodes.

Erased forms of scarlet fever. Often seen in adults. They occur with mild general toxic symptoms, changes in the oropharynx of a catarrhal nature, a scanty, pale and quickly disappearing rash. However, in adults, the disease can sometimes take place in a severe, so-called toxic-septic form.

The toxic-septic form develops rarely and, as a rule, in adults. Characterized by a rapid onset with hyperthermia, the rapid development of vascular insufficiency (muffled heart sounds, a drop in blood pressure, a thready pulse, cold extremities), often there are hemorrhages on the skin. In the following days, complications of an infectious-allergic genesis (damage to the heart, joints, kidneys) or septic nature (lymphadenitis, necrotic tonsillitis, otitis media, etc.) join.

Complications.
The most common complications of scarlet fever include purulent and necrotic lymphadenitis, purulent otitis media, as well as complications of an infectious-allergic genesis, more often occurring in adult patients - diffuse glomerulonephritis, myocarditis.

Diagnosis of Scarlet Fever:

Scarlet fever is distinguished by a bright diffuse hyperemia of the oropharynx (“flaming pharynx”), sharply limited at the point of transition of the mucous membrane to the hard palate, a bright red tongue with a raspberry tint and hypertrophied papillae (“raspberry tongue”), punctate elements of the rash against a general hyperemic background, thickening rashes in the form of dark red stripes on the skin folds in places of natural folds, a distinct white dermographism, a pale nasolabial triangle (Filatov's symptom). When pressing on the skin with the palm of the hand, the rash in this place temporarily disappears (“palm symptom”), endothelial symptoms are positive. After the disappearance of the exanthema, finely scaly peeling of the skin is noted (large-lamellar on the palms and soles).

Laboratory diagnostics.
Changes in the hemogram typical of a bacterial infection are noted: leukocytosis, neutrophilia with a shift of the leukocyte formula to the left, an increase in ESR. Isolation of the pathogen is practically not carried out due to the characteristic clinical picture of the disease and the wide spread of bacteria in healthy individuals and patients with other forms of streptococcal infection. For express diagnostics, RCA is used, which detects streptococcal antigens.

Scarlet fever treatment:

The diet should be sparing - all dishes are given in a pureed and boiled form, liquid or semi-liquid, thermal irritation is excluded (neither hot nor cold, all food is served only warm). The child needs to drink more to remove toxins from the body. After the subsidence of acute phenomena, the transition to normal nutrition is gradually carried out.

Antibiotics play a leading role in the treatment of scarlet fever. Until now, streptococci remain sensitive to drugs of the penicillin group, which are prescribed at home in tablet form, and in the hospital - in the form of injections according to age dosages. If the child has intolerance to penicillin antibiotics, erythromycin is the drug of choice.

In addition to antibiotics, antiallergic drugs are prescribed (diphenhydramine, fencarol, tavegil, etc.), calcium preparations (gluconate), vitamin C in appropriate doses. Locally, for the treatment of angina, rinsing with warm solutions of furacilin (1: 5000), dioxidine (72%), infusions of chamomile, calendula, and sage is used.