Epidemiological features of scarlet fever. Scarlet fever clinic. At the same time, other drugs are prescribed

Scarlet fever is an acute infectious disease characterized by symptoms of general intoxication, tonsillitis and a small punctate skin rash.

Etiology. The causative agent of the disease is group A β-hemolytic streptococcus. Its feature is the ability to produce exotoxin. The decisive role in the occurrence of the disease belongs to the level of antitoxic immunity. If it is low or absent, the introduction of streptococcus causes the development of scarlet fever. With intense antitoxic immunity, streptococcal infection occurs in the form of tonsillitis or pharyngitis. The causative agent is quite stable in the external environment, can be stored in food products for a long time.

Epidemiology. The source of infection is a patient with scarlet fever or other streptococcal disease, a carrier (β-hemolytic streptococcus.

The main mechanism of infection transmission is airborne. A contact-household transmission mechanism or a food route is possible, realized mainly through milk, dairy products, creams.

Most often, scarlet fever affects children of preschool and primary school age. In the 1st year of life, the disease is rare due to the high titer of antitoxic immunity received from the mother.

The contagious index is about 40%. After the infection, a strong antitoxic immunity remains.

Pathogenesis. The entrance gate for the pathogen is the palatine tonsils, in young children due to their underdevelopment of the pharyngeal tonsil or mucous membrane of the upper respiratory tract. In rare cases, streptococcus can enter the body through the wound or burn surface of the skin. The development of the disease is associated with toxic, septic (inflammatory) and allergic effects of the pathogen. At the site of the introduction of streptococcus, an inflammatory focus is formed. Through the lymphatic and blood vessels, the pathogen penetrates into the regional lymph nodes and causes their damage. The entry of exotoxin into the blood leads to the development of symptoms of intoxication. Characteristic of the pathogen is a selective lesion of the smallest peripheral vessels of the skin, autonomic nervous and cardiovascular systems.

clinical picture. The incubation period lasts from 2 to 12 days. The disease begins acutely: body temperature rises, there are general weakness, malaise, sore throat, often vomiting. During the first day, less often at the beginning of the second, a rash appears on the skin, which quickly spreads to the face, neck, trunk and limbs (Fig. 71 on color inc.). Scarlatinal rash has the appearance of small dotted elements, close to each other on a hyperemic background of the skin. The rash is more intense on the lateral surface of the body, in the lower abdomen, on the flexion surfaces of the limbs, in the natural folds of the skin. The skin is dry, rough to the touch, with light pressure, persistent white dermographism appears. The patient's cheeks are hyperemic, against the background of the bright color of the cheeks, a pale, not covered with a rash nasolabial triangle, described by Filatov, clearly stands out.

A constant symptom of scarlet fever is angina - catarrhal, follicular, lacunar. Typical bright hyperemia of the tonsils, uvula, arches ("flaming pharynx"). Regional lymph nodes are involved in the process. They enlarge and become painful on palpation. In the first days of the disease, the tongue is densely covered with a white coating, from the 2-3rd day it begins to clear, becomes bright red, granular, resembling ripe raspberries ("raspberry tongue"). The severity of general intoxication corresponds to the severity of the disease.

Often there are symptoms "scarlet heart" tachycardia, followed by bradycardia, muffled heart sounds, systolic murmur, sometimes expanding the boundaries of the heart.

The acute period of the disease lasts 4-5 days, then the condition of the patients improves. Along with the disappearance of the rash and a decrease in temperature, angina gradually disappears. On the 2nd week of the disease, lamellar peeling appears on the palms, fingers and toes, and pityriasis on the trunk. In infants, peeling is not expressed.

On the part of the blood, leukocytosis, neutrophilia, eosinophilia, increased ESR are noted.

In addition to typical forms, one can observe atypical forms diseases. Erased form proceeds without temperature, sore throat is catarrhal, soft, the rash is mild, scanty, often located only on the folds.

At extrapharyngeal form(burn, wound and postpartum scarlet fever), the rash appears in the primary focus and is most pronounced in these places. There is no angina, there may be mild hyperemia of the oropharynx. Regional lymphadenitis occurs in the region of the entrance gate, but is less pronounced than with typical scarlet fever.

Hypertoxic And hemorrhagic form are practically non-existent at the present time.

Complications. Allocate early (bacterial) and late (allergic) complications. The first group includes purulent cervical lymphadenitis, otitis, sinusitis, mastoiditis, osteomyelitis. Allergic complications occur on the 2nd week of the disease and are accompanied by damage to the joints (synovitis), kidneys (diffuse glomerulonephritis), heart (myocarditis).

Laboratory diagnostics. For laboratory confirmation of the diagnosis, the isolation of β-hemolytic streptococcus in cultures of mucus from the oropharynx, the determination of the titer of antistreptolysin-O, other enzymes and streptococcus antitoxins, and a blood test for TPHA with yersinia diagnosticum (paired serum) are important. The blood is taken V the beginning of the disease - no later than the 3rd day of the rash, then again after 7-9 days. The diagnosis is confirmed by an increase in the titer of specific antibodies by the 10-14th day of illness by 4 times or more. In the general analysis of blood, neutrophilic leukocytosis with a shift to the left, increased ESR is noted.

Treatment. With scarlet fever, patients can be treated at home. Hospitalization is carried out in case of a severe course of the disease, with the development of complications or By epidemiological evidence.

Treatment at home requires careful medical supervision with obligatory laboratory analysis of blood and urine on the 10th and 21st day of illness. An electrocardiogram is done 2-3 weeks after clinical recovery.

In the acute period of the disease, bed rest is prescribed. The diet should correspond to the age of the child, it should be dominated by dairy and vegetable products. A plentiful fortified drink is shown.

Regardless of the severity of the course of the disease, antibiotics are prescribed, mainly of the penicillin series ( amoxicillin, ampicillin, phenoxymethylpenicillin) at an age dose of 5-7 days.

In case of intolerance to penicillins, macrolide antibiotics are used ( erythromycin, roxithromycin, midecamycin, sumamed) or 1st generation cephalosporins ( cephalexin, cefazolin, cefadroxil) in age doses. After the end of antibiotic therapy, it is administered once intramuscularly bicillin-5 at a dose of 20 OOO U/kg.

Has a specific bactericidal effect against gram-positive cocci tomicid. It is used externally to rinse or irrigate the throat. For one rinse, 10-15 ml of solution is used or 5-10 ml for irrigation. Rinses are carried out after meals 5-6 times a day. Can be used for rinsing furatsilina solution(1:5000) or other disinfectant solutions.

To improve the effectiveness of antibiotic therapy, it is recommended to prescribe Wobenzym - polyenzymatic drug with immunomodulatory and detoxifying effects. A good effect is observed when using bacterial lysates, especially imudon.

Care. When leaving, much attention should be paid to regular ventilation of the room, systematic wet cleaning. The care of the oral mucosa is important. Due to the fact that peeling can cause itching of the skin, the child should cut their nails short to avoid scratching. Given the possibility of developing nephritis, the sister needs to control the volume of urination and the nature of the patient's urine.

In severe form of the disease resort to detoxification and symptomatic therapy. Treatment of complications is carried out according to generally accepted schemes.

Prevention. Immunoprophylaxis of the disease has not been developed. For the specific prevention of scarlet fever among contact persons, the use of tomicide in the form of gargles or irrigation of the throat 4-5 times a day for 5-7 days.

To prevent the spread of infection, patients are isolated for 10 days from the moment of illness. Convalescents attending preschool institutions and the first two grades of the school due to the possibility of complications during the recovery period are allowed to the children's team after additional isolation for 12 days (not earlier than the 22nd day from the onset of the disease).

Activities in the hearth. Children who have been in contact with a patient with scarlet fever, attending preschool institutions and the first two grades of school, are subject to separation for 7 days. They are under medical supervision with daily thermometry, examination of the skin and mucous membranes. Older children are subject to medical supervision for 7 days after the isolation of the patient. If the child is being treated at home, contact children and adults (working in the dairy industry, DU, surgical and obstetric hospitals) are subject to medical supervision for 17 days. In the hearth, airing is carried out, wet cleaning is carried out using a soap-soda solution.

The clinic of scarlet fever has an infectious course, the disease is characterized by an acute form and is transmitted by airborne droplets. As a source of the disease, infected people pose the greatest danger in the first days of the incubation period of the pathology.

It is noteworthy that scarlet fever, the clinic of which manifests itself in the form of tonsillitis, intoxication, small-point rash, fever, occurs not only in young children, contrary to erroneous opinion, but also in adults.

Description

This disease is very insidious and often masquerades as other, more common pathologies. And in order to distinguish the disease from other defects, you should find out the detailed clinic of scarlet fever: etiology, diagnosis, prevention, treatment and symptoms. This is the only way to identify the disease in a timely manner and take up therapy in order to prevent possible complications.

It provokes the pathology of category A streptococcus, which also leads to the development of concomitant infections: chronic tonsillitis, streptoderma, tonsillitis, erysipelas, rheumatism. The causative agent of scarlet fever settles in the nasopharynx, sometimes even covering the skin, which causes local inflammatory processes. Usually, in parallel with this pathology, the first thing to do is tonsillitis and regional lymphadenitis.

The exotoxin produced in infectious foci, in turn, provokes the appearance of signs characteristic of exanthema and general intoxication. Factors predisposing to bacterial invasion lead to the occurrence of a septic ingredient, which manifests itself as lymphadenitis, otitis and septicemia.

Peculiarities

An important place in the development of the clinic of scarlet fever, etiology and pathogenesis is occupied by allergic reactions that are involved in the appearance and subsequent course of the final stage of pathology. Quite often, all kinds of complications of the disease arise due to reinfection or streptococcal superinfection.

The source of infection is a person infected with scarlet fever, tonsillitis, or any other type of respiratory streptococcal disease. As already mentioned, the most dangerous interval for the people around the patient are the first days after the acquisition of the virus. However, its ability to infect continues for up to three weeks from the time of infection.

At-risk groups

Regarding sensitivity to scarlet fever, it is quite high. A disease appears in people who do not have it. Infection is carried out with the help of strains of microbes that secrete erythrogenic toxins. The disease is ubiquitous, with scarlet fever most often diagnosed in cold regions.

According to the general level of morbidity and the dynamics of the pathology, it was noted that children are most often infected, especially preschoolers attending special children's institutions. But babies raised at home are much less likely to become infected with scarlet fever.

Classification

Scarlet fever, the clinic of which serves to determine the types of pathology, is divided into several main types, depending on the form of the course:

• typical;
• atypical.

The last type could be:

• erased - rashes on the skin do not occur;
• engraved - in this case, hypertoxic and hemorrhagic signs appear;
• extrabuccal, abortive.

Given the severity of the scarlet fever clinic, there is:

• light variety;
• moderate form;
• severe type leading to complications.

Depending on the course of the disease, they are divided into:

• sharp form;
• lingering variety;
• pathology, passing without any complications and allergic reactions of the body;
• an allergic disease.

Given the nature of the emerging complications, the disease can be:

• purulent;
• septic;
• allergic;
• mixed infection.

In short, the clinic of scarlet fever initially manifests itself in the form of fever, symptoms of intoxication, sore throat, rash and local lymphadenitis. This disease is characterized by an acute onset. That is why it is so important to know all the signs of the scarlet fever clinic, etiology, diagnosis, treatment and prevention of pathology - these details will help to identify the defect in time and deal with its elimination.

Symptoms in children

The duration of the incubation period of the pathology is approximately a week, but in some cases the duration increases to 12 days. The disease always begins in an acute form. The clinic of scarlet fever in children is characterized by an increase in body temperature up to 40-42 degrees, general malaise, and severe headaches. Often the child has pain when swallowing, as well as a burning sensation in the throat.

Regularly, the clinic of scarlet fever in children manifests itself in the form of nausea and vomiting, fever, delirium, and even convulsions. It becomes difficult for the child to open his mouth, the lymph nodes become inflamed and noticeably enlarge.

A typical and constant companion of any form of scarlet fever is angina, which is characterized by staining the sky in a bright scarlet color, an increase in tonsils and the appearance of plaque on their surface. Sometimes the etiology, the clinic of scarlet fever manifests itself as severe pain in the abdomen, which resembles the sensations of appendicitis.

Usually already on the first day, much less often on the second day, a bright pink or red rash appears on the skin, the spots of which hardly reach two millimeters and only slightly protrude above the integument. The rash spreads all over the body, resembling red goose bumps. Most spots occur in the armpits and elbows. Itching is likely.

It is noteworthy that the face of the baby is significantly different from the body. The pink rash is concentrated in the area of ​​the forehead and temples, a very bright blush appears on the cheeks. At the same time, the nose, upper lip and chin remain pale. The sky, tonsils, tongue, arches acquire a rich red color - this is a characteristic feature of the scarlet fever clinic. Diagnosis and treatment of pathology begins precisely with this phenomenon: only on this basis, a specialist can already suspect a disease, and during therapy, this symptomatology is first eliminated. And given the pallor of the nasolabial triangle, this sign of scarlet fever is very striking.

The duration of the rash can reach about five days, and then it becomes less noticeable, which is additionally accompanied by a decrease in the body temperature of a small patient. In the second week of the disease, the skin begins to peel off strongly. This process can take up to three weeks. Sometimes complications of the scarlet fever clinic develop, the treatment of which is required immediately. We are talking about purulent inflammation, covering various organs. Often, the transferred pathology provokes the onset of rheumatism.

As already mentioned, the clinical picture and signs of scarlet fever are very similar to tonsillitis, due to which it is not always possible to make a specific, correct diagnosis. As a result, an infected child remains a distributor of a dangerous disease.

Symptoms of the defect in adults

Timely treatment and prevention of the scarlet fever clinic play a significant role in the patient's later life. After all, not taking care of proper therapy and preventing severe forms of the disease in time, the patient may face very unpleasant and even deplorable consequences. That is why it is so important to know in detail the signs of scarlet fever, especially the initial ones, for the fastest possible detection of the pathology and its elimination.

Today, the most common forms of the disease are extrabuccal, erased and septic varieties. As for adult patients, they are most often subject to the last two variants of the disease.

Erased scarlet fever is characterized by the appearance of a light rash, as well as minimal changes in the nasopharynx and oral cavity. The symptoms of this form of the disease are usually subdued, which, in turn, often leads the infected person to ignore their condition. And the rashes that accompany such scarlet fever disappear rather quickly, so that they do not cause much anxiety in patients.

Regarding the septic type of the disease, it is not so common, but it is for her that most of the severe signs and complications are characteristic. In children, this kind of scarlet fever, as a rule, does not occur at all, being an exclusively "adult" type.

The symptoms of this disease are extremely dangerous and have a pronounced severity. Among the main signs of septic scarlet fever, it is worth highlighting: cooling of the extremities, lowering blood pressure, weak pulse, and heart rhythm disturbance.

As complications, disorders in the work of the kidneys, heart, joint damage, the development of necrotic tonsillitis, otitis media and other defects are often manifested.

Diagnostics

Knowing about the methods of treatment, prevention, epidemiology, etiology and clinic of scarlet fever, it will not be difficult to detect the disease in time even for a simple layman. Having such awareness of the details of the course of the disease, it is quite easy to determine the disease even by the visual components of the symptoms and the general sensations of the patient.

However, the differential diagnosis of scarlet fever with such pathologies as all kinds of dermatitis, measles, pseudotuberculosis, rubella is very important. In some cases, fibrous plaques characteristic of an infectious disease, with an increase in the tonsils, require an additional difference between the disease and diphtheria. After all, the symptoms of all these diseases are very similar to each other, and only a specialist can distinguish the clinical pictures of different diseases.

For the diagnosis of scarlet fever, laboratory methods are necessarily used. Express detection of pathology involves the use of a coagglutination reaction, with the help of which it becomes possible to identify streptococcal antigens.

The clinic of the disease is so acute that it requires constant medical supervision even at the stage of therapy. True, it is necessary to start treatment only after confirming the diagnosis and establishing the causes, as well as the causative agent of the pathology. However, the main therapy consists of several unchanging components and rules.

• It is very important to adhere to bed rest for the first two weeks after infection. In the case of a mild and moderate form of pathology, the patient can be at home. If we are talking about the severe stage of scarlet fever, then staying in a hospital is a prerequisite for effective treatment.
• It is necessary to completely isolate the infected person from others in order to prevent the spread of pathogenic microorganisms.
• Drug therapy necessarily includes taking antibiotics of the penicillin group, which are aimed at destroying the bacteria that provoked the disease. The drugs are prescribed exclusively by a specialist, the optimal course of therapy is at least 10 days - usually, this period is quite enough for recovery. It is very important not to stop treatment and complete the entire regimen, even if the symptoms have already subsided. Otherwise, the risk of developing a recurrence of the pathology is extremely high. Usually, doctors prescribe such antibiotics: Ampiox, Amoxicillin, Cefalexin, Sumamed.

• If an intolerance to penicillin components or an allergy to this substance is found in a child or adult patient, erythromycin can be used for treatment.
• During therapy, painkillers are also used to eliminate pain, which can significantly alleviate the general condition of the patient. Of these funds, doctors most often recommend: "Septolete", "Lizak", "Strepsils". However, very young children should not be given such drugs, as babies can choke on lollipops. In addition, as an anesthetic, you can use a solution of "Dioxidin" or "Furacilin" for gargling. In this case, decoctions of sage, calendula and chamomile will be effective.
• It is equally important to review the patient's diet, deleting spicy, pickled, salty dishes from the menu, which can further irritate the throat. The patient may not even realize that it is precisely because of malnutrition that the pain and discomfort in the affected area increases. It is best for the patient to give preference to frayed, liquid dishes that will be easy to swallow.
• Another stage of treatment is the elimination of unbearable itching on the body. To do this, you can use antihistamines, like Suprastin, Dimedrol, Diazolin, Tavegil and Loratadin. If we are talking about an infected child, then it is desirable to use topical creams and ointments from the group of corticosteroids.
• You can stabilize body temperature and eliminate general malaise with the help of a special drinking regimen, as well as medicines: Nurofen, Panadol and Ibuprofen. Parents should remember that it is strictly forbidden for children to shoot down a high thermometer with acetylsalicylic acid. After all, this drug is capable of provoking the occurrence of a deadly pathology - Reye's disease.

Prevention of scarlet fever

Complications and a severe clinic can await those patients who do not engage in timely treatment or neglect the rules of therapy. But, probably, everyone is well aware that it is much better to prevent the onset of the disease than to deal with its elimination later. Knowing about the rules for the prevention of scarlet fever, the clinic of which is extremely difficult for both children and adults, you can prevent the onset of the disease in advance.

You can protect yourself and your child from such an insidious pathology only by limiting contact with an infected person. In fact, there is no vaccine against scarlet fever. Particular care should be taken by women during pregnancy, because this disease is extremely dangerous and can affect the fetus in an unpredictable way.

The main preventive measures to avoid infection:

• frequent washing of hands with various antiseptics after visiting crowded places - this must be done very carefully;
• the use of individual hygiene items and cutlery - it is very important to teach this to the child;
• limiting contact with people who have clear clinical signs of scarlet fever.

If one of the family members has contracted the infection, it should be prevented from spreading. To do this, it is necessary to carefully wash all the dishes and other items that the sick person used. In addition, as far as possible, communication between the patient and other people should be minimized.

In the event of the appearance of signs characteristic of scarlet fever, you should immediately consult a therapist. In addition to him, you may also need to consult a specialist such as an infectious disease specialist.

Forecast

Modern medicine makes it possible to quickly and effectively suppress streptococcal infection, which includes scarlet fever, through the use of antibiotics in the early stages of the disease. As a rule, pathology has a favorable outcome. Only in rare cases, with a severe course of the septic variety of scarlet fever, various complications can occur. Relapses of the disease appear only in 2-3% of all cases of infection.

Among infectious diseases, scarlet fever in children occupies a special place. An adult can also get sick with it, but children are more susceptible due to undeveloped immunity and poor resistance.

Just 10 years ago, this disease terrified parents and instilled fear in children, because mortality from it was high. Today, this disease can be successfully treated and the consequences can be avoided. However, for any disease there is nothing better than quality prevention.

Scarlet fever refers to acute infectious diseases caused by excessive susceptibility of the body's defense systems to the immune complexes of streptococcus. The skin is predominantly affected, but internal organs are also often affected.

The human body is very susceptible to streptococci - bacterial pathogens of most diseases. Immunity to them is developed weak and not for everyone, damage to internal organs can lead to its insufficiency, and the bacterium itself develops resistance to new antibiotics.

It is the characteristics of the pathogen that explains the danger of the disease. Streptococcus can affect the throat, but the “tail” of complications will render the kidneys, heart, and liver unusable. Scarlet fever in children is dangerous because an infection that has not been completely cured can lead to damage to these organs in a matter of hours. Treatment of complications lasts for years, and far from always ends with success. Fortunately, antibacterial agents such as flemoxin or azithromycin are available and effective today, to which the bacterium does not yet have immunity.

As mentioned earlier, children are more susceptible, but immunocompromised adults and pregnant women are also at risk. For the latter, scarlet fever is extremely dangerous and often serves as a reason for termination of pregnancy or a contraindication to natural delivery.

Causes

Various causes and contributing factors are called etiologies. What caused the disease determines how it manifests itself - in the form of inflammation, allergies, or asymptomatic.

Scarlet fever is an infection caused by group A streptococcus. This is a particularly resistant and strong bacterium that produces a toxin that spreads throughout the body with the blood.

What you need to know about the pathogen:

• streptococcus does not die at a temperature of 70 ° C, so the body cannot fight the infection on its own (whether it is a sore throat or scarlet fever);
• the danger is not so much the bacterium itself, but the product of its vital activity - erythrotoxin, which is carried with the bloodstream to all organs and tissues (hence the rash);
• the bacterium is sensitive to antiseptics;
• the child's body reacts sharply to streptococcus, producing an extremely aggressive immune response, which can affect organs that are not involved in the disease, such as the heart;
• it is very difficult to kill streptococcus; due to undertreatment, it often becomes a chronic inhabitant of the body, and a person becomes a carrier of the bacterium.

This is the direct cause of the disease.

In addition to it, there are also predisposing factors:

• chronic tonsillitis (frequent diseases of the throat and tonsils in particular);
• atopic dermatitis - an autoimmune disease that increases the body's reactivity to streptococcus;
• diathesis and other immune skin pathologies - for the same reason;
• malnutrition, undernourishment, low body weight, relative to the age norm and, as a result, poor resistance;
• any immunodeficiency states - AIDS, HIV, pregnancy, acclimatization;
• diabetes mellitus, other endocrine pathologies;
• pathology of the adrenal glands, hormonal instability;
• chronic pathological changes in the nasopharynx - pharyngitis, nasopharyngitis;
• regular intake of immunosuppressants, such as steroid hormones, which are often prescribed for allergies, stenosis, obstruction in children.

Each factor individually is predisposing, but if more than two converge in one child's body, this is a 90% probability of the disease. Despite so many factors contributing to the disease, prevention and immune support can reduce the risk many times over.

Development mechanism

How a disease develops, is transmitted, and causes symptoms is pathogenesis. It is worth knowing his parents only in general terms in order to have an understanding of the staging of the onset of symptoms.

The source of infection is a sick person or carrier. This is important, because most of the inhabitants of cities are carriers of streptococcus - everyone who suffers from cough and runny nose. But not everyone gets sick. In the presence of the above risk factors, contact with the carrier will cause the development of the disease. Without them, the child will get off with a mild cold.

Scarlet fever is transmitted by airborne droplets. Through the upper respiratory tract (there is the most accessible mucous membrane), streptococcus enters the child's body. On their moist and warm surface, the bacterium multiplies, creating colonies and damaging the vulnerable mucosa. Among other things, it feeds and excretes metabolic products, which are absorbed into the blood and gradually spread throughout the body.

Our blood, as a perfect environment, quickly reacts to enemy agents and activates specific cells - lymphocytes. This is called antibody function.

That is, the streptococcus bacterium and its toxin is an antigen, and lymphocytes produce antibodies. Together, this creates an antigen-antibody immune complex, the circulation of which causes dysfunction of the internal organs and all the accompanying symptoms of scarlet fever in children.

While immune complexes are located in the upper respiratory tract, inflammation is localized in the throat. Later, a rash appears as a more systemic reaction. If the bacterium is killed, and the immune complexes are still wandering through the blood of the child, there will be consequences.

That's all parents need to understand so as not to stop the course of antibiotics halfway through.

Clinical picture

Typical shapes

Alas, sometimes even good prevention is not able to prevent infection. Depending on the internal forces of the child's body, the disease can have different forms and periods of flow.

The forms are as follows:

• mild, in which the signs are mild, the course is moderate, and complications often do not occur;
• moderate - the signs of the disease are more than moderately expressed, but the course is uncomplicated and the prognosis is conditionally favorable, provided that treatment is timely;
• severe - manifested by complications, the symptoms are pronounced, difficult to correct, the prognosis is unfavorable (complications on the internal organs, their insufficiency).

The severe form can also proceed in different ways:

• toxic;
• septic;
• toxic-septic.

You need to know the stages of scarlet fever in order not to mistake the stage of the disease for recovery.

In total, 4 periods of the disease are distinguished:

1. Incubation.
2. Elementary.
3. Eruption period.
4. convalescence period.

Incubation, or latent period , is characterized by the fact that the pathogen already exists in the body, but there are no open manifestations yet. During this period, the parents of a sick child may notice a slight increase in temperature and fatigue, take it for SARS. From the moment of contact with the "culprit" to the beginning of this period, about a week passes. And the incubation period itself can vary from a few days to a week.

Initial period - this is the appearance of the first signs - one of the leading symptoms. It begins with a sore throat and sore throat, in the region of the root of the tongue and tonsils. On examination, the mucous membrane of the tonsils will show bright redness (hyperemia) and a characteristic rash - exanthema.

This rash looks like hives. At first, the rash is only in the throat. In order to detect exactly a scarlatina rash, you need to look at the boundaries - it should not go beyond the tonsils and soft palate.

Already during this period, doctors prescribe an antibacterial drug - Flemoxin, Augmentin, Erythromycin.

The skin of the child at this stage is hard, rough and hot, but clean. This period lasts from several hours to 1-2 days. At the same stage, an altered tongue is observed - with hypertrophied papillae, bright red.

Eruption period begins a day after the defeat of the throat and lasts from the beginning of the first elements to five days after it. The nature of the rash is punctate, roseolous.

The elements of the rash are located close to each other, but do not merge. Within a few hours, the rash spreads to the surface of the neck, the upper body in the chest area, gradually it covers the entire body and flexion surfaces of the limbs.

On the first day, the rash has a bright red color, the skin resembles sandpaper. This is explained by the fact that the hair follicles increase in size. By the third day, the color changes, the rash turns pale and becomes a muted pink. With adequate treatment, the rash may disappear by the fifth day.

It is important to remember that for the entire period of the rash, plus five days after the rash has disappeared, the child is contagious, and therefore must be quarantined. At the same time, it is undesirable to bathe the baby.

In addition to the rash during this acute period, the child will develop signs of intoxication. The temperature can rise to 39 degrees, it is difficult to succumb to antipyretics. All this is naturally accompanied by nausea, vomiting and headache. So the body tries to remove the toxin, but to no avail, because the pathogen remains intact.

convalescence period - this is the time when the symptoms gradually subside, but in no case should you stop treatment. This is the period of active circulation of immune complexes in the blood. It can last 5-7 days.

Atypical forms

In some cases, the clinical picture may look atypical for scarlet fever and cause difficulties in diagnosis.

Atypical scarlet fever can occur in three ways:

1. Extrapharyngeal - intact (not affected) tissues of the oropharynx and pharynx, but against this background, regional lymphadenitis is pronounced.
2. Subclinical (erased) form - with it, typical syndromes are absent or poorly expressed.
3. The rudimentary form lasts only 2-5 days.

Symptoms

Briefly describe what is characteristic of scarlet fever in children, the following symptoms can be distinguished:

• angina;
• hyperthermia;
• red tongue with hypertrophic papillae;
• phenomena of intoxication;
• exanthema on the throat;
• roseola on the body.

Specific symptoms of scarlet fever:

• Filatov's symptom - pallor of the nasolabial triangle, a bright crimson blush on the cheeks, a bright crimson tongue;
• white dermographism - after holding a solid object on the skin, a persistent white mark remains, which does not disappear within a few seconds;
• lamellar peeling and flaking on the plantar surface of the foot and palmar surface of the hands.

Streptococcal symptoms are a group of signs of damage to additional organs in the later stages (during the convalescence period). These include:

• tachycardia;
• violation of the heart rhythm (arrhythmia);
• hypertension (reactive) in the first days;
• hypotension from the fourth day of illness;
• expansion of percussion borders of the heart;
• systolic murmur at the apex of the heart;
• accents for splitting the second tone at the point of auscultation of the pulmonary artery.

In general, the full period of scarlet fever lasts 20-25 days. It is very important not to miss the moment when it begins in order to start treatment on time and avoid complications.

Diagnosis of the disease

The first thing to do when any of the symptoms appear is to see a doctor. To begin with, it is worth calling a pediatrician who will examine, probe and listen to the child to determine whether it is scarlet fever, measles, or a common viral infection.

When the diagnosis of scarlet fever is confirmed, the doctor may advise a trip to the infectious disease hospital. You should not refuse, because there they will take all the necessary tests, and they will be able to provide full-fledged assistance that cannot be provided at home.

For diagnosis, the doctor is obliged to interview the patient or his parents in detail not only about the current disease, but also about all previous infections, about whether he was vaccinated, there were contacts with patients, and the presence of HIV status. Based on this history, a guess can be made.

• clinical, he is a general blood test;
• smear to determine the microflora of the pharynx - determine the pathogen and its number;
• analysis of venous peripheral blood to determine the titer of antibodies to group A streptococcus;
• sensitivity of streptococcus to the main drugs of therapy - Flemoxin, Azithromycin.

Laboratory diagnostics is the most informative during the first days of the disease, while the concentration and activity of bacteria is maximum.

It is not necessary for parents to know the transcript - if they are found, the laboratory and clinic workers will contact them. All these analyzes are monitored in dynamics, that is, during the entire period of the disease.

In addition to laboratory, hardware methods may also be needed - ECG, ultrasound of the kidneys, heart.

Features of the course in children of different ages

The course of the disease and its consequences largely depend on how well the immune system is formed, that is, on age.

In children under one year, scarlet fever is almost never diagnosed. However, in some cases this may be the case. In a baby, scarlet fever will be very difficult, such children are kept under round-the-clock supervision of doctors. The stages are the same as for older children.

In kindergarten age, the incidence of scarlet fever is at its peak. The course is moderate, the prognosis is favorable. The periods of the disease are milder, but last longer.

At an older age (from the age of 14), scarlet fever can cause complications, since the course is more severe and resistance, oddly enough, falls. The prognosis is favorable with timely therapeutic measures.

As for the difference in the consequences in boys and girls, there is no clinical evidence of the effect of streptococcus on the development of the gonads.

Lifestyle of a child during illness

The infection weakens the baby, so he needs to provide bed rest, in a room without bright lights and loud sounds. Minimize stress levels as much as possible.

Although it is customary in our society to feed sick children, in the case of scarlet fever, it is better not to do this. It is necessary to give little by little, all products should be boiled and ground so that they are easy to swallow. Food should be warm, not hot. The diet at the same time excludes spicy, salty and spicy foods that irritate the throat.

As for the drinking regimen, you need to drink a lot. It is better if it is an alkaline warm drink. The baby should have access to it around the clock. Dehydration must not be allowed. You need to drink fractionally, that is, a sip, but often.

Bathing a baby during scarlet fever is undesirable, at least during the first 5-7 days. Changes in temperature and excessive irritation will only exacerbate the manifestations of the rash. It is also not worth treating the rash with anything.

Treatment

Drug therapy of scarlet fever must necessarily include antibiotics of a number of penicillins. Streptococcus is not sensitive to the rest. Alas, without antibiotic therapy, the bacteria cannot be killed. The course of treatment must be followed exactly as prescribed by the doctor, without unnecessary initiative.

Antibacterial drugs are used for treatment. The most commonly prescribed are Augmentin and Flemoxin. Less commonly prescribed Erythromycin, Amoxiclav. All antibiotics can be given in any form - tablets, injections, suspensions.

Flemoxin is given in tablets, the children's dosage is 0.125 g once a day or 0.25 twice at the age of one to three, from three to six years the dose is 0.25 g. Flemoxin is given for 10 days.

Augmentin has more options - syrups, drops, suspensions, tablets. You can choose the one that is best suited for a particular age. The dosage also depends on the form. The instruction is presented in detail on the Internet, and should also be interpreted by the attending physician.

Along with a course of antibiotics, it is necessary to give a high-quality probiotic that will support the microflora of the baby. Flemoxin is more aggressive towards the intestines, but more effective in terms of treatment. Augmentin is relatively gentle.

Paracetamol can be used to lower the temperature. Ibuprofen is best avoided if possible, as it has strong effects on the liver and kidneys.

Symptomatic therapy involves local anesthesia and sanitation of the throat (rinses, sprays and lozenges), treatment of concomitant pathologies such as otitis media or conjunctivitis.

It is also important to carry out adequate detoxification therapy - to maintain a balance of fluid and salts.

Prevention

Not all children can get sick with scarlet fever. Only three out of ten will become infected after contact with a sick peer. Prevention of scarlet fever infection involves stimulation of the immune system and timely treatment of ENT diseases; a long course of a cold should not be allowed.

Vaccinations already exist for most dangerous infections, but a vaccine against scarlet fever has not yet been developed. Yes, and there is no special need for development, because the immunity of most children is able to cope with the disease.

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Etiology

Pathogenesis

Epidemiology

Clinic

Patients complain of headache, weakness, some experience nausea and vomiting. At the same time, hyperemia of the soft palate, arches, tonsils, posterior pharyngeal wall (“flaming pharynx”) appears, the tonsils increase in size.

Some patients have signs of lacunar or follicular tonsillitis. The tongue is covered with a white coating, however, from the 3-4th day of the disease, it begins to clear itself of plaque and becomes "raspberry".

There is an increase and soreness of regional lymph nodes. The appearance of a patient with scarlet fever is characteristic - against the background of hyperemia of the face, a pale nasolabial triangle is clearly distinguished.

Already by the end of the 1st-2nd day of the disease, on a hyperemic background of the skin, a dotted rash appears with thickening in the axillary and inguinal regions, in the area of ​​\u200b\u200bnatural skin folds. In severe forms of the disease, petechiae can be observed, especially often localized in the area of ​​\u200b\u200bthe elbows.

The disease during this period proceeds with hypertonicity of the sympathetic nervous system. Therefore, the skin of patients is dry and hot to the touch, white dermographism is noted.

The rash lasts 3-5 days, then slowly fades away. Linear thickening of the rash persists somewhat longer in the natural folds of the skin (elbows, popliteal, inguinal, axillary areas) - Pastia's symptom.

On the 2nd week of the disease, there is a pityriasis peeling on the trunk and lamellar (leaf-like) on the palms and feet. Scarlet fever can occur in mild, moderate and severe forms.

The severe form is now rare. The severity of the course is determined by the development of infectious-toxic shock, accompanied by cardiovascular insufficiency, cerebral edema, and hemorrhagic syndrome.

In debilitated patients, scarlet fever can take on a septic course with a severe necrotic process in the pharynx, fibrinous deposits and purulent regional lymphadenitis. Metastatic foci can be localized in the kidneys, brain, lungs and other organs.

The extrafarinaeal (extrabuccal) form of scarlet fever (wound, postpartum, burn) develops when the entrance gate for streptococcus is not the mucous membrane of the oropharynx, but other areas. Around the wound, burn, in the area of ​​female genital organs after childbirth, abortion, there is a bright punctate rash, regional lymphadenitis, accompanied by fever and intoxication.

The rash often spreads throughout the body. With this form, only the changes in the oropharynx and regional lymph nodes characteristic of scarlet fever are absent.

Complications of scarlet fever can be otitis, sinusitis, mastoiditis, adenophlegmon. Immunopathological complications include: myocarditis, endocarditis, glomerulonephritis, vasculitis, etc.

Differential Diagnosis

Rubella is not characterized by a significant rise in temperature, vomiting, neutrophilic leukocytosis, an increase in ESR, eosinophilia; as a rule, there is no angina, there is no "raspberry" tongue; moist skin, pink dermographism; the rash quickly disappears, there is no subsequent peeling; peripheral, more often posterior and occipital lymph nodes increase; in the blood - leukopenia, lymphocytosis, Turk's plasma cells. A scarlet-like rash can be observed in pseudotuberculosis, which also begins acutely, with a rise in temperature, nausea and vomiting. The rash appears early. Possible petechiae in the folds of the skin, a positive pinch symptom.

After the rash fades, large-lamellar peeling is observed, neutrophilic leukocytosis is detected in the blood, high ESR values. However, pseudotuberculosis is characterized by symptoms that are not characteristic of scarlet fever: nasopharyngitis and abdominal pain at the onset of the disease; the rash is often polymorphic on the arms and legs, sparing the face and neck; hyperemia and swelling of the palms, feet, lymphadenitis, bright hyperemia of the oral mucosa, enterocolitis, mesadenitis, arthritis, hepatitis, increased ESR up to 60-70 mm/h. The disease proceeds for a long time, in waves. With pseudotuberculosis, there is no angina, which always manifests itself in the initial stage of scarlet fever.

For the diagnosis of pseudotuberculosis, a carefully collected epidemiological history is important: contact with rodents or eating contaminated with rodent excrement is detected. Decisive in establishing the diagnosis of pseudotuberculosis are bacteriological studies of feces, blood, mucus from the throat and the agglutination reaction or RIGA, which reveal an increase in the titer of antibodies to the pathogen. Staphylococcal infection can be accompanied by a scarlatiniform exanthema, and therefore such children are often hospitalized in the wards for patients with scarlet fever, which contributes to cross-infection. This disease, like scarlet fever, begins acutely, with a significant rise in temperature, vomiting and sore throat.

The skin is covered with a small punctate rash on a hyperemic background, mainly in the same places as in scarlet fever, thickening in natural folds. The rash appears on a pale background, elements of its various sizes. There is angina. The tongue is coated, "raspberry".

After the rash fades, on the 4-5th day, lamellar peeling may be noted. Unlike scarlet fever, staphylococcal infection has a purulent primary focus: barley, osteomyelitis, felon, abscess, phlegmon, impetigo, otitis media, purulent lymphadenitis, sinusitis, infected wounds and burn surfaces, less often staphylococcal tonsillitis. In this case, the rash begins around the primary focus in the form of extrabuccal scarlet fever, appears later - on the 3rd-4th, less often - on the 6-8th day of the disease (with scarlet fever on the 1st-2nd day), the rash is usually less bright, in places there is no hyperemic background, lasts less long (1-2 days). The low effectiveness of treatment with penicillin is noted.

Pathogenic staphylococcus is sown from the primary focus and often from the blood, an increase in the titer of anti-staphylococcal antibodies is noted. Recurrent scarlatiniform toxic erythema develops as a result of the use of certain toxic drugs (antibiotics, sulfonamides, mercury ointments) and the use of foods such as chocolate, honey, eggs, etc. The disease may be accompanied by a rise in temperature, a scarlatiniform rash appears, but there is no sore throat and "raspberry" tongue, dry skin, white dermographism, positive pinch sign. The rash is only in some areas, quickly disappears after the appointment of antihistamines.

An important sign is the reappearance of the rash after taking the same allergens. A scarlatiniform rash may occur during the prodromal period of natural and chicken pox, measles, and meningococcal infection. In such cases, after the initial rise in temperature, a small punctate rash appears on the skin of the trunk and extremities on a hyperemic background. More often it is limited, mainly located on the trunk, less often - on the limbs, dim, there are no sore throats characteristic of scarlet fever, "crimson" tongue, dry skin, white dermographism.

The rash is ephemeral, disappears after 1-4 hours, after which symptoms of the disease appear. Sweating in infants may resemble scarlet fever. In such cases, take into account the appearance of a rash on limited areas of the skin when the child overheats. There is no angina.

There is increased skin moisture, pink dermographism. The rash after cooling the child quickly turns pale and disappears, there is no subsequent peeling.

Prevention

Diagnostics

Treatment

Patients are prescribed penicillin at a dose of 15,000-20,000 U / kg to 50,000 U / kg of body weight per day intramuscularly, depending on the severity of the course of scarlet fever, or methicillin. Usually, antibiotics are administered for 3 days, on the 4th day, bicillin-3 or bicillin-5 is prescribed once at a dose of 20,000 IU / kg intramuscularly.

In case of intolerance to penicillin, macrolides are prescribed. Bed rest should be observed for 5-6 days.

An extract is made on the 10th day of illness after a control analysis of blood and urine.

Attention! The described treatment does not guarantee a positive result. For more reliable information, ALWAYS consult a specialist.

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 the 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, such as the 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 preceding 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.