Epidemiological features of scarlet fever. Scarlet fever (scarlatina). Epidemiology. clinical picture. Treatment. Video: Rash in a child. How to recognize the disease

All parents know that there are contagious childhood diseases. But not everyone knows how to recognize them, why they are dangerous and whether infection can be avoided. Vaccination helps against contracting certain infections, but for scarlet fever, for example, vaccinations are not given. Scarlet fever can be mild, but the complications are very serious. It is important to accurately establish the diagnosis of the disease, to conduct a full course of treatment.

Content:

How does scarlet fever occur?

The causative agent of scarlet fever is group A streptococcus, one of the most dangerous infections of this type. Once in the human blood, the bacterium begins to secrete erythrotoxin, a toxic substance that spreads throughout the body. Poisoning is accompanied by the appearance of specific painful symptoms. In the early days, scarlet fever can be confused with a common sore throat.

The infection is transmitted mainly by airborne droplets (when coughing, sneezing), less often - by household means (when the patient's saliva gets on clothes, toys, furniture, dishes). Streptococcal infection can be contracted from a sick or already recovering person. Sometimes scarlet fever proceeds with little to no symptoms, and parents take the baby to a children's institution, unwittingly contributing to the spread of infection. Very rarely, but there are cases when the infection enters the body through wounds on the skin.

Most often occurs in children under 10 years old, actively communicating with each other, attending kindergarten, school, playgrounds. Babies under the age of 6-7 months rarely get sick, as their body is protected from infection by maternal immunity transmitted through breast milk. After suffering from scarlet fever, a person develops stable immunity. The second time scarlet fever is extremely rare.

Video: Causes and symptoms of scarlet fever in children

Forms of scarlet fever and their symptoms

The characteristic symptoms of scarlet fever are high body temperature, sore throat (tonsillitis), skin rash and subsequent severe peeling of the affected areas. Perhaps the typical and atypical course of this disease.

Typical scarlet fever

Depending on the severity of the symptoms of typical scarlet fever, several forms of the disease are distinguished.

Light. The temperature of the child does not rise above 38 ° C. There is no nausea, vomiting and headache. Angina does not pass into a purulent form. The tongue turns red, papillae appear on it. But there are few spots of rash on the skin, they are pale. In some cases, the rash does not appear at all, the skin almost does not peel off. Temperature and sore throat exist in the first 5 days. Reddening of the tongue is noticeable for about 10 days. This form of the disease occurs most often, since treatment usually begins immediately when the first symptoms appear. Contributes to the easy flow of scarlet fever strengthening immunity, healthy nutrition and good physical development of children.

Medium severity. The temperature rises to 39-40 ° C, hallucinations and delusions may occur. There is a headache, nausea, vomiting. The heartbeat becomes more frequent, a state of the so-called "scarlet heart" occurs: shortness of breath and pain behind the sternum appear. A bright red rash develops on the skin, merging into spots.

Especially extensive spots are formed in the armpits, inguinal folds, on the bends of the elbow. Redness covers the neck and face, with the area around the mouth and nose (nasolabial triangle) remaining white. The tonsils are covered with pus. After recovery, there is a strong peeling of the skin at the site of pale spots.

Severe form is rare, accompanied by a temperature of up to 41 ° C with delirium and hallucinations. The rash is very strong. According to which symptoms prevail, 3 types of severe scarlet fever are distinguished:

Toxic scarlet fever. There are manifestations of severe intoxication. Possible lethal outcome.
Septic scarlet fever. Purulent inflammation spreads to the entire oral cavity, middle ear, lymph nodes.
Toxic-septic scarlet fever, in which all the symptoms are combined. This type of disease is the most dangerous.

Atypical scarlet fever

It can also take several forms.

Erased. There is no rash, other manifestations are mild. In this case, complications are possible, the patient is contagious.

Hypertoxic. It is extremely rare. Basically, there are signs of severe poisoning, from which the child can fall into a coma.

Hemorrhagic. Areas of hemorrhage appear on the skin and in the internal organs.

Extrapharyngeal. With this form of scarlet fever, the infection enters the body not through the throat, but through cuts on the skin.

Complications of scarlet fever

The appearance of complications is associated with the rapid spread of infection, inflammation of various organs. In addition, the consequences of the disease may appear due to exposure to erythrotoxin, which affects the kidneys, the nervous system, and destroys red blood cells.

Early complications occur already in the acute stage of the disease. These include:

inflammation of the paranasal sinuses (sinusitis);
enlargement and inflammation of the lymph nodes (lymphadenitis);
pneumonia;
inflammation of the kidneys (nephritis);
inflammatory damage to the myocardium - the heart muscle (myocarditis);
phlegmonous tonsillitis - purulent inflammation of the tissues located around the tonsils.

Late complications do not appear immediately, but after about 3-5 weeks. The reason for this is the defeat of the immune system by toxins, the appearance of an allergic reaction to the proteins contained in streptococcal bacteria. These substances are similar in composition to proteins in the tissues of the human heart and joints. Due to the accumulation of such substances in the body, for example, rheumatism occurs (inflammation of the connective tissue of various organs). First of all, the heart, blood vessels and joints are affected. The complication occurs both with a prolonged course of scarlet fever, and with the re-entry of streptococci into the body of recently ill children.

Video: Complications of scarlet fever. Disease in children, prevention

How the disease progresses

There are several periods of development of scarlet fever:

incubation (accumulation of infection in the body);
initial (the appearance of the first signs of the disease);
acute stage (the height of the disease with the most severe manifestations and a significant deterioration in the patient's well-being);
final (recovery).

Incubation period(from the moment of infection until the first symptoms appear) lasts from 3 to 7 days, and sometimes even 12 days. During all this time, the child is a distributor of infection. You can get infected from it about a day before the first signs of infection appear.

initial stage disease lasts 1 day. At the same time, the throat begins to hurt badly. The baby cannot eat and talk normally, the symptoms of deterioration in well-being are growing. Skin rash causes itching. In the most severe cases, due to the intense heat, the patient becomes delirious.

If there is a mild form of scarlet fever, then the rash may be absent, and the temperature does not rise above 38 ° C.

Acute stage illness lasts up to 5 days. At the same time, the temperature is high, the head hurts a lot, the child is sick and vomits. There are vivid symptoms of erythrotoxin poisoning.

The dots of the rash merge, darken. The nasolabial triangle stands out sharply in its whiteness. Throat red and sore. Tongue crimson, swollen. Otitis, pneumonia and other early complications often appear.

Recovery. After a few days, the manifestations begin to subside. The recovery phase can last from 1 to 3 weeks until the rash completely disappears and the skin stops peeling. It exfoliates on the arms, legs, and even on the ears and armpits. The tongue gradually turns pale, the throat stops hurting.

If the course of treatment was not completed and it was stopped with the first signs of recovery, then inflammation may flare up in the area of \u200b\u200bthe internal organs, the brain (chorea occurs - involuntary body movements caused by unusual muscle contraction).

It should be emphasized: A person with scarlet fever remains infectious from the last day of the incubation period (24 hours before the onset of rash and fever) until 3 weeks have passed since the onset of the disease. At this time, he cannot be taken to kindergarten or school. It is desirable to comply with bed rest and limit contact with others.

The course of scarlet fever in children under 1 year

In such babies, scarlet fever occurs less frequently than in older ones. Young children are less in close contact with each other. The likelihood of the disease is low if the baby is breastfeeding. With mother's milk, he receives antibodies to streptococci, which reduce the body's sensitivity to the effects of infection. However, with direct contact with a sick family member, the baby can become infected with scarlet fever. Meeting with carriers of infection is possible in crowded places or in a clinic.

The disease begins with fever and the appearance of signs of sore throat (it is difficult for the baby to swallow, he is naughty, refuses to eat and drink). Then his tongue turns red and covered with a rash, profuse red rashes appear on the skin all over the body, especially on the cheeks and in the folds.

After 3-4 days, the rash turns pale and disappears, and the skin begins to peel off. There is inflammation in the throat.

A small child cannot report that he is in pain; he reacts to indisposition only by screaming. In order to reduce the intoxication of the body, it is necessary to drink water often. Parents should carefully monitor his condition. The occurrence of early complications is indicated by the appearance of areas of hemorrhages on the mucous membranes and skin, an increase in temperature up to 40 ° C. The cause may be a purulent lesion of various organs. The baby's pulse quickens due to a violation of cardiac activity. With severe scarlet fever, after recovery, there are signs of kidney disease and other late complications.

The complexity of the treatment of scarlet fever in children under 1 year old is that most antibiotics and antipyretics are contraindicated for them. The treatment of the baby must be carried out in stationary conditions, since the disease is instantly complicated, urgent measures must be taken to remove the child from a serious condition.

How to distinguish scarlet fever from other diseases

A red rash on the skin can also appear with some other diseases: measles, rubella, atopic dermatitis. Purulent inflammation of the tonsils is also not necessarily a manifestation of scarlet fever, since the defeat of the tonsils and the area closest to them is possible, for example, in diphtheria.

Scarlet fever can be distinguished by the following features:

"Flaming Throat". Mouth and throat red, swollen. The area of reddening is separated from the sky by a sharp border.
"Crimson tongue" - an edematous tongue of crimson color, on which enlarged papillae stand out.
Spotted rash on red swollen skin. The rash is especially dense in the folds of the skin and on the folds of the limbs.
White nasolabial triangle.
Peeling of the skin after the start of recovery. On the palms and feet, it comes off in stripes, and in other places - in small scales.

When examining a patient, the doctor presses his finger on the rash. She disappears and then reappears. Scarlet fever is characterized by high (from 38.5 to 41°C) temperature.

Diagnostics

The doctor makes an assumption about the presence of scarlet fever according to the results preliminary examination and detection of characteristic features. It turns out whether the child had scarlet fever before, whether he was in contact with sick people. The diagnosis is confirmed by laboratory tests.

General blood analysis shows the content of leukocytes and erythrocytes (with scarlet fever there are deviations from the norm).

Is taken swab from the throat and nasopharynx, bacteriological culture is done. This allows you to determine the presence and type of streptococcal infection, the sensitivity of bacteria to antibiotics.

Throat smear on antigens to streptococci shows whether an infection is present in the body or not. The patient's blood is also examined for antigens.

Laboratory diagnostics in some cases, it makes it possible to detect an infection even in the incubation period, to avoid complications.

Video: Rash in a child. How to recognize the disease

Treatment of scarlet fever in children

Treatment of scarlet fever consists in the destruction of streptococci, lowering the temperature, eliminating sore throat, reducing itching, removing toxins from the body. Usually it is carried out at home. Children who have moderate to severe scarlet fever are hospitalized, especially if there are other babies in the house who have not had scarlet fever, or pregnant women.

To combat streptococcal infection, antibiotics are used, such as amoxicillin, sumamed. The dose is prescribed depending on the age of the child and his weight. The duration of treatment is not less than 10 days. If you stop taking antibiotics earlier, as soon as you feel an improvement in the condition, then the cure is not only impossible, but also fraught with complications. If necessary, children are given antimicrobial agents (biseptol, metronidazole).

To prevent complications (such as myocarditis, rheumatism), non-steroidal anti-inflammatory drugs are prescribed. As antipyretics, ibuprofen and paracetamol are used, which are available for children both in the form of tablets and in the form of syrups and suppositories. They also relieve sore throats.

Gargling is carried out with a solution of furacilin or soda, infusion of chamomile, calendula. Lugol solution is used to lubricate the throat.

Warning: Children can only be given drugs prescribed by a doctor. Adult medications such as aspirin can cause acute liver failure, a life-threatening condition.

To eliminate a burning sensation in the mouth and sore throat, the baby can be given cold water or ice cream. Food should be slightly warm, liquid. Drinking plenty of water helps to quickly get rid of toxins, lower the temperature, and prevent dehydration.

Strepsils helps with throat irritation. It should be borne in mind that a child under 4 years old can easily choke on a medicinal lollipop. With extreme caution and only after consulting a doctor, they give medicines to very young children. From inflammation of the throat, syrups (broncholithin and others) are used for them.

The skin can be lubricated with brilliant green, the combs can be treated with powders. To eliminate itching, antihistamines are used (Zyrtec, Suprastin - in the form of syrups or tablets). In some cases, cortisone skin creams are used.

For 1 month, a person who has been ill with scarlet fever is under the supervision of a doctor. Blood and urine tests are done, and an electrocardiogram is taken to detect complications and timely referral for treatment to a rheumatologist, cardiologist or urologist.

Video: Dr. E. Komarovsky about what scarlet fever is, its treatment and complications

Prevention of the spread of scarlet fever

In order for the ill baby not to infect other children, he is allowed to kindergarten only 12 days after recovery.

If a case of the disease is detected in a children's institution, then quarantine is declared there for 7 days. At this time, new children are not accepted there. The facility is operating as usual. Leaving the rest of the children at home during the quarantine is not worth it. This makes no sense, since they have already been in contact with the patient, the infection has entered the body.

Daily measurement of body temperature, examination of the throat and skin of children and staff is carried out. After each meal, the throat is rinsed with disinfectant solutions. Weakened children are given an injection of gamma globulin.

The content of the article

Scarlet fever- an acute infectious disease that is caused by hemolytic streptococcus, transmitted by airborne droplets, characterized by fever, tachycardia, acute tonsillitis (tonsillitis) with regional lymphadenitis, rosaceous (pinpoint) rash, vomiting.

Historical data on scarlet fever

Scarlet fever has been known since ancient times. The name of the disease comes from Italian. scartattina - scarlet, purple. The first report was made in 1554 by the Sicilian physician G. Ingrassia, who separated the disease from measles and gave it the name "rossania". A complete description of the clinical manifestations of scarlet fever was made by the English physician T. Sydenham under the name of purple fever (scarlet fever). The founders of the streptococcal theory in the etiology of scarlet fever were G. N. Gabrichevsky and I. G. Savchenko (1907). A significant contribution to the study of its etiology was made by V. I. Goff, spouses G. Dick and G. N. Dick (1924).

Etiology of scarlet fever

The causative agent of scarlet fever is group A beta-hemolytic streptococcus (Streptococcus haemolyticus), which belongs to the Lactobacillaceae family, order Eubacteriales. These are Gram-positive microorganisms of a spherical shape. Group A streptococci secrete toxins, the main of which is erythrogenic (Dick's toxin) - a rash toxin, or a general action. Streptococcal toxin consists of two fractions: thermolabile and thermostable. Thermolabile (exotoxin) - the most important pathogenic product of the pathogen, has pronounced antigenic properties. Thermostable (endotoxin) - non-specific agglutinating fraction (streptococcal allergen), has a nucleoprotein composition. Streptococci also produce the enzymes streptolysin, hemolysin, leukocidin, ribonuclease and deoxyribonuclease, streptokinase, protease, hyaluronidase. The pathogenicity of group A hemolytic streptococci is due to erythrogenic toxin, and enzymes enhance their virulent properties. Any of the 80 types of beta-hemolytic streptococcus group A, produced by a homogeneous toxin, can be the causative agent of scarlet fever.
Streptococci are quite resistant to physical and chemical factors. At a temperature of 70 ° C, they remain viable for 1 hour, and at 65 ° C - 2 hours. They tolerate freezing well. Long remain in manure, dried blood. Sensitive to disinfectants.

Epidemiology of scarlet fever

The source of infection in scarlet fever is patients who are contagious for 10 days from the moment of illness. The most dangerous are patients with erased forms of scarlet fever. The infectious period becomes longer with complications, especially purulent ones, which prolong the release of the body from streptococcus, chronic inflammatory processes of the nasopharynx (tonsillitis, pharyngitis, etc.). Apparently, healthy carriers of beta-hemolytic streptococcus, patients with tonsillitis, have epidemiological significance as a source of infection.
The main mechanism of infection is airborne by contact with a sick person or a carrier. It is possible to transmit the infection through another person or household items that the patient used. Contagion has been proven through products, predominantly infected raw milk.
Children aged 2-7 years are more likely to get sick, less often at an older age due to acquired immunity. The contagiousness index for scarlet fever is 40%. Infants in the vast majority are immune to infection due to transplacental immunity and physiological resistance to erythrogenic toxin.
The incidence increases in autumn, winter, spring and decreases in summer. Periodicity of epidemics after 4-6 years is characteristic, explaining the formation of a susceptible contingent.
After scarlet fever, a stable antitoxic immunity is formed. However, due to the use of antibiotics, its intensity in some individuals is insufficient, so cases of recurrent illness have become more frequent.

Pathogenesis and pathomorphology of scarlet fever

The entrance gate of infection is the mucous membrane of the pharynx, nasopharynx, less often - damaged skin or wound surface and (very rarely) the mucous membrane of the uterus in the postpartum period. A feature of scarlet fever, unlike other streptococcal diseases, is that the main symptoms are caused by erythrogenic toxin, so the disease develops in the absence of antitoxic immunity in the body. In the presence of sufficiently intense antitoxic immunity, reinfection can lead to the development of not scarlet fever, but some other form of streptococcal disease - tonsillitis, erysipelas, etc.
There are three main components of the pathogenesis of scarlet fever(A. A. Koltypin, 1948) - toxic, infectious(septic) and allergic. The degree of manifestation of each of them depends on the reactivity and individual characteristics of the macroorganism. The toxic component of the pathogenesis is caused by streptococcal toxin and causes hyperemia, skin rash, dysfunctions of the central and autonomic nervous system, which manifest themselves from the very beginning of the disease. When scarlet fever occurs against the background of specific or nonspecific sensitization, a hypertoxic form of the disease develops.
From the very beginning of the disease, due to the circulation and decay of the pathogen, the body's sensitivity to the protein component of the bacterial cell changes and up to 2-3 weeks an infectious allergy is formed - an allergic component of pathogenesis; its clinical manifestations are observed mainly in the form of so-called allergic waves (wide secondary rash, fever, diffuse glomerulonephritis, etc.). Since sensitization is accompanied by an increase in vascular permeability, a decrease in immunity and a violation of the barrier functions of the body, conditions are created for the implementation of an infectious (septic) component.
Infectious (septic) component due to the influence of streptococcus itself. Getting on the mucous membrane or damaged skin, it multiplies and causes local inflammatory and necrotic changes. Septic manifestations may occur regardless of the severity of the initial period of scarlet fever. Sometimes the septic component becomes the leading one from the first days of the disease, which is characterized by widespread necrotic processes in the pharynx, damage to the paranasal sinuses, and early purulent lymphadenitis. Forms of the disease with such a component are observed mainly in young children, in which the infection is easily generalized. The pathogen enters the regional lymph nodes through the lymphatic vessels. After overcoming the lymphatic barrier, the microorganism enters the bloodstream, a septic condition develops, purulent complications appear (lymphadenitis, adenophlegmon, otitis media, mastoiditis, etc.).
In the pathogenesis of scarlet fever, an important role is played by the defeat of the toxin of the autonomic nervous system. At the onset of the disease, in the phase of toxicosis, the tone of the sympathetic nervous system (sympatheticus phase) increases, and later - the parasympathetic (vagus phase) with subsequent balancing of the activity of both parts of the autonomic nervous system in the period of convalescence. In the sympathetic phase, an increase in the tone of the sympathetic-adrenal system is associated not only with the direct action of the toxin, but also with changes in cellular metabolism and the presence of sympathetic agents in the blood, which act like adrenaline. Therefore, in the first 2-3 days of the disease, tachycardia, arterial hypertension, negative cardiac Ashner reflex, sonorous heart sounds, white dermographism with an extended latent and short overt period are detected. In the vagus phase, substances similar to acetylcholine or histamine are formed, which are mediators of the parasympathetic nervous system.
The vagus phase at the 2-3rd week of the disease is characterized by bradycardia, arterial hypotension, positive ocular-cardiac Ashner reflex, white dermographism with a shortened latent and prolonged overt period, hypersecretion of the glandular apparatus, and eosinophilia.
Morphological changes depend on the form and duration of the disease. In the place of primary fixation of the pathogen, inflammation develops with regional lymphadenitis - the so-called primary scarlatinal affect. Inflammation in the area of affect has a predominantly alterative character with exudation, tissue necrosis. Scarlatinal rash is a focus of hyperemia with perivascular infiltrates in the dermis. The epidermis in the area of foci is impregnated with exudate, gradually becomes keratinized and flakes off. Where the horny layer of the skin is normally especially thick (palms, soles), rejection occurs in layers.
In the case of the toxic form, intense catarrhal inflammation of the mucous membrane of the pharynx and even the esophagus is characteristic. In the spleen, there is hyperplasia of the follicles, pulp plethora. In the liver, kidneys, less often in the myocardium, microcirculation disorders and degenerative changes in the parenchyma are found. In patients with septic forms in the tonsils, sometimes on the posterior surface of the soft palate, in the nasopharynx, foci of necrosis are found. In the regional lymph nodes there are also foci of necrosis with the development of purulent lymphadenitis.

Scarlet fever clinic

The incubation period lasts 2-7 days, can be reduced to a day or last up to 11-12 days. The disease begins acutely, the body temperature rises to 39-40 ° C, chills, vomiting, sore throat when swallowing, headache, weakness, rapid pulse appear. In severe cases - anxiety, delirium, convulsions, meningeal symptoms. On the first day (less often on the second), a rash appears on the face, neck, upper chest, which quickly spreads to the trunk and limbs. It is roseolous, punctate on a hyperemic background of the skin, confluent on the cheeks, which become bright red. The nasolabial triangle is pale (symptom of Filatov), the lips are scarlet (cherry) and thickened (Rosenberg's symptom). The rash is more intense on the flexor surfaces of the arms, inner thighs, anterior and lateral surfaces of the chest and lower abdomen. Characterized by the accumulation of a rash in the natural folds of the skin (axillary, inguinal, elbow, popliteal), dark red color of the skin folds and pinpoint hemorrhages in the folds and around them. In these areas, the rash persists for a long time, which makes it possible to diagnose the disease at a later date. Scarlatinal rash accompanied by moderate itching. The skin is dry, rough, clear white dermographism. Sometimes, in addition to the typical rash on the neck, hands and lateral surfaces of the chest, a miliary rash appears on the back in the form of numerous small vesicles with transparent or cloudy contents (miliaria crystalline).
Depending on the severity of the disease, the rash refrains from 2-3 to 4-7 days. When it fades, peeling begins on the face and torso with small scales of the pityriasis type, and on the palms and soles - a large plate, typical of scarlet fever.
Angina - obligatory and typical symptom of scarlet fever- can be catarrhal, lacunar and necrotic. Characterized by a bright hyperemia of the mucous membrane of the pharynx and soft palate ("burning sore throat", "fire in the throat", according to N. Filatov) with a clear border between the soft and hard palate. Sometimes in the first hours of the disease on the soft palate, more often in its center, one can find a dotted or dribnoplemis enanthema, which then merges into a continuous redness. The tonsils are enlarged, a yellowish-white coating is often observed on their surface, and in the case of necrotic tonsillitis, foci of necrosis of a dirty gray color appear. Catarrhal and lacunar tonsillitis last 4-5 days, necrotic - 7-10. From the first day of the disease, according to the degree of damage to the tonsils, the submandibular lymph nodes increase, which harden, become painful on palpation.
The mucous membrane of the oral cavity is dry. The tongue is first lined with a thick white coating, from the 2-3rd day of the disease it begins to clear from the tip and edges (with a clear border between the coating and the clean surface) and until the 4-5th day it becomes bright red (bluish) with clear papillae, resembling a raspberry - a symptom of raspberry tongue, which can be observed for 2-3 weeks. At the height of the disease, an increase in the liver is detected, and in severe forms, the spleen.
Changes in the circulatory organs in the initial period are characterized by tachycardia, increased blood pressure (sympathetic phase). On the 4-5th day of illness, sometimes later, already against the background of good health and in the absence of the main clinical symptoms, observed slowing of the pulse, arrhythmia, lowering of blood pressure, a slight expansion of the boundaries of relative cardiac dullness to the left, sometimes - systolic murmur over the apex (vagus -phase). Changes in the heart were first described by N. F. Filatov under the name of scarlet heart. Later it was found that they are due to extracardiac disorders and only in some cases - myocardial damage. These changes are observed within 10-12 days, with the establishment of a balance between the tone of the sympathetic and parasympathetic nervous system, the activity of the circulatory organs also normalizes.
A blood test reveals neutrophilic leukocytosis, from the 3rd-5th day of illness, the number of eosinophils increases, the ESR is increased.
Clinically, typical and atypical forms of scarlet fever are distinguished. Atypical include scarlet fever without a rash, erased (rudimentary) and extrapharyngeal (extrabuccal). According to the nature and severity of the course, mild, moderate and severe (toxic, septic and toxic-septic) forms are distinguished.

Standard forms

The mild form is more common, characterized by subfebrile body temperature, a slight violation of the general condition, catarrhal sore throat, and a liquid pale rash. Clinical manifestations are observed within 3-4 days.
In the moderate form, all the above symptoms are clearer: body temperature 38-39 ° C, lacunar tonsillitis. By the 7-8th day of the disease, the body temperature decreases, the initial symptoms disappear. The severe toxic form is characterized by a rapid onset, repeated vomiting, a thick rash with a cyanotic tinge, sometimes with a hemorrhagic component, severe symptoms of damage to the central nervous system, vascular insufficiency syndrome.
In the case of a severe septic form, necrotic tonsillitis is observed, necrosis can spread to the palate, arches, soft palate, and pharynx. There is a significant inflammatory reaction from the regional lymph nodes and surrounding tissue, the development of purulent lymphadenitis and adenophlegmon. Suppurative complications are frequent. There is hepatosplenomegaly. Recently, severe forms of scarlet fever are observed very rarely.

Atypical forms

Scarlet fever without rash occurs predominantly in adults. It is characterized by all clinical signs with the exception of the rash, which goes unnoticed due to the short duration and indistinctness. With an erased (rudimentary) form, all the symptoms of scarlet fever are mild. The extrapharyngeal form (wound, burn, postoperative) is rarely observed. It is characterized by a shortened (up to a day) incubation period, the absence of a sore throat or its mild symptoms, the rash appears intense and expressive at the entrance gate of the infection, and regional lymphadenitis also appears there. The infectiousness of such patients is insignificant due to the impossibility of the airborne transmission mechanism.
In infants, scarlet fever is observed very rarely, characterized by a slight toxic syndrome, catarrhal angina, a small amount and pallor of the rash, the absence in most cases of a crimson tongue symptom and peeling. The severity of the disease is associated with a large number of septic complications, when purulent foci appear already on the 1st-2nd day of illness.
Complications. There are early and late purulent complications, which are usually the result of streptococcal reinfection or superinfection. These include purulent lymphadenitis, adenophlegmon, otitis media, mastoiditis, purulent arthritis, etc.
Allergic complications (lymphadenitis, synovitis, glomerulonephritis, myocarditis) develop in the second - fourth week of illness, more often in older children.
In the second or third week of the disease, after the disappearance of all manifestations of the initial period, allergic waves are sometimes observed. The patient's body temperature rises for 1-3 days or longer, a diverse ephemeral rash appears (dribnoplemis, urticaria or anular), a moderate increase in all peripheral lymph nodes, leukopenia, lymphocytosis, and eosinophilia appear. Sometimes the symptoms resemble a serum sickness clinic. Allergic waves may recur.
Relapses of scarlet fever develop in 1-4% of cases, more often on the 3rd-4th week of the disease, mainly from reinfection. A certain role is played by the allergization of the body and the inferiority of the immune system.
Relapse is characterized by a recurrence of the main symptoms of the initial period of the disease. When differentiating true and pseudo-relapses, i.e. allergic waves, it must be borne in mind that during the first, the same vascular changes are observed as at the beginning of scarlet fever, on the part of the blood - leukocytosis, neutrophilia.
Recently, the features of scarlet fever are a mild course, the absence of purulent complications, the rapid release of the body from hemolytic streptococcus, but repeated scarlet fever is more often observed.
The prognosis is favorable due to the widespread use of antibiotics.

Scarlet fever diagnosis

The main symptoms of the clinical diagnosis of scarlet fever are tonsillitis with a clear border of bright hyperemia of the soft palate (flaming pharynx), vomiting, tachycardia (scarlatinal triad), the presence on the first day of illness of a bright small-pointed roseolous rash against the background of hyperemic skin with predominant localization on the flexor surfaces of the extremities and accumulation in places of natural folds, symptoms of Filatov, Pastia, Rosenberg, later - crimson tongue, lamellar peeling, lymphadenitis, eosinophilia. Important for the retrospective diagnosis of scarlet fever are the symptoms of Pastia, raspberry tongue, large-scale peeling on the palms and soles, late complications of the disease (streptoderma, lymphadenitis, arthritis, etc.).

Specific diagnosis of scarlet fever

Specific diagnostics in the generally accepted form (isolation of the pathogen, serological reactions) has not been developed due to the peculiarities of the pathogenesis of scarlet fever. The detection of streptococcus in the pharynx using the bacteriological method has no diagnostic value, since this microorganism can be found in the nasopharynx even in the absence of scarlet fever.
Auxiliary diagnostic method- the phenomenon of extinguishing the rash of Schultz-Charlton - is the disappearance of the rash at the injection site of antitoxic therapeutic serum or convalescent serum. It has not been widely used recently.

Differential diagnosis of scarlet fever

Scarlet fever should be differentiated from measles, rubella, Far East scarlatina-like fever (pseudotuberculosis), staphylococcal infection, rash after taking drugs, miliaria, etc.
Diagnostic signs of measles - progressively increasing catarrhal manifestations, symptoms of Belsky-Filatov-Koplik, the timing of the onset of a maculopapular rash and pigmentation after it; rubella - the absence of acute tonsillitis and hyperemic skin background, the presence of a rash in the nasolabial triangle, an increase and soreness of the occipital lymph nodes.
Staphylococcal infection with scarlatiniform syndrome is characterized by the presence of a purulent focus, a rash around it, and the absence of tonsillitis. With pseudotuberculosis, there is no real angina, hyperemia of the mucous membrane of the pharynx, bradycardia, pain in the joints and muscles of the extremities, sharp pain in the right iliac region, dyspeptic manifestations, hyperemia and swelling of the hands, feet, the rash is larger than with scarlet fever, localized around the joints and often becomes hemorrhagic. The rash after taking medications is located on an unchanged background of the skin, has a diverse character without localization typical for scarlet fever, covers the nasolabial triangle. Prickly heat appears in children under one year old on the neck, chest when overheated. In the case of cooling, it decreases.

Scarlet fever treatment

Due to the recent prevalence of mild forms of the disease, treatment in most cases is carried out at home. Compulsory hospitalization is subject to children of the first year of life, patients with moderate and severe forms and according to epidemiological indications (children from large families, hostels, closed children's institutions).
Patients are placed in boxes or scarlet fever departments from small wards, where they remain for the entire duration of their stay in the hospital, without communicating with children from other wards in order to prevent cross-infection. Bed regimen for the first 5-6 days.
The leading role in the treatment of patients, regardless of the form and severity of the course of scarlet fever, is played by antibiotic therapy. It is more expedient to prescribe benzylpenicillin intramuscularly 100,000 - 150,000 IU / kg per day every 3 hours. With a septic form, the daily dose increases to 200,000-300,000 U / kg. If treatment is carried out at home and parenteral administration of benzylpenicillin is not possible, it is recommended to prescribe phenoxymethylpenicillin orally at a double dose or a long-acting drug bicillin-3 once at a dose of 20,000 IU / kg, but not more than 800,000 IU. Ampiox (50-100 mg/kg per day), cephalosporins (50-100 mg/kg per day), erythromycin (20 mg/kg per day), lincomycin (15-30 mg/kg per day), tetracyclines are also used.
If intoxication is significant, detoxification treatment is carried out. With signs of damage to the circulatory organs by the type of scarlet heart, they are limited to bed rest, drugs are not prescribed.
Treatment for complications depends on their nature.
Patients are discharged no earlier than the 10th day of illness in the absence of complications and inflammatory changes in the nasopharynx, after control blood and urine tests.

Prevention of scarlet fever

Regardless of the severity of scarlet fever, the patient is subject to isolation for at least 10 days from the onset of the disease. In the room where the patient is located, current disinfection is carried out. Convalescents are not allowed into preschool institutions and the first two grades of the school for another 12 days after the end of isolation. At the end of this period, a second examination by a doctor and a control urine test are necessary. For children from preschool institutions and the first two grades of the school who were in contact with the patient and did not get sick before, quarantine is established for 7 days from the moment the patient is isolated. All persons after contact with the patient are subject to examination to identify erased forms of the disease. Final disinfection in the foci is not carried out.

The incubation period lasts from 1 to 12 days (usually 2-7 days). Scarlet fever is characterized by an acute onset: chills, fever up to 38-39 degrees. C on the 1st day of illness. 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. The linear thickening of the rash in the natural folds of the skin (elbows, popliteal, inguinal, axillary regions) persists somewhat longer - 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.

Scarlet fever- an acute infectious disease, manifested by a small punctate rash, fever, general intoxication, tonsillitis. The causative agent of the disease is group A streptococcus. Infection occurs from patients by airborne droplets (when coughing, sneezing, talking), as well as through household items (dishes, toys, linens). Patients are especially dangerous as sources of infection in the first days of illness.

Brief historical information

The clinical description of the disease was first made by the Italian anatomist and physician D. Ingrassia (1564). The Russian name of the disease comes from the English scarlet fever - “purple fever” - this is how scarlet fever was called at the end of the 17th century. Streptococcal etiology of scarlet fever, assumed by G.N. Gabrichevsky and I.G. Savchenko (1905), proved by the works of V.I. Ioffe, I.I. Levin, spouses Dick, F. Grifft and R. Lancefield (30-40s of the XX century). A great contribution to the study of the disease was made by N.F. Filatov, I.G. Savchenko, A.A. Koltypin, V.I. Molchanov and other famous Russian doctors.

The onset of Scarlet fever

Pathogen- group A streptococcus (S. pyogenes), which also causes other streptococcal infections - tonsillitis, chronic tonsillitis, rheumatism, acute glomerulonephritis, streptoderma, erysipelas, etc.

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

Reservoir and source of infection- a person with a sore throat, scarlet fever and other clinical forms of respiratory streptococcal infection, as well as "healthy" carriers of group A streptococci. The patient is most dangerous to others in the first days of illness; its contagiousness stops most often after 3 weeks from the onset of the disease. The carriage of group A streptococci is widespread among the population (on average 15-20% of the healthy population); many of the carriers excrete the pathogen over a long period of time (months and years).

Transfer mechanism- aerosol, transmission route - airborne. Usually, infection occurs during prolonged close contact with a patient or carrier. Alimentary (food) and contact (through contaminated hands and household items) routes of infection are possible.

Natural susceptibility of people high. Scarlet fever occurs in persons who do not have antitoxic immunity when they are infected with toxigenic strains of bacteria that produce erythrogenic toxins of types A, B, and C. Post-infection immunity is type-specific; when infected with group A streptococci of another serovar, re-infection is possible.

Main epidemiological signs. The disease is ubiquitous; more often it is found in regions with a temperate and cold climate. The general level and dynamics of long-term and monthly incidence of scarlet fever mainly determine the incidence of preschool children attending organized groups. Every year, children attending children's institutions fall ill 3-4 times more often than children brought up at home. This difference is most pronounced in the group of children of the first 2 years of life (by 6-15 times), while among children 3-6 years old it is less noticeable. Among the same groups, the highest rates of "healthy" bacteriocarrier are noted.

The connection of scarlet fever with previous diseases of angina and other respiratory manifestations of streptococcal infection that occurs in preschool institutions, especially soon after their formation, is characteristic. The incidence in the autumn-winter-spring period is the highest.

One of the characteristic features of scarlet fever is the presence of periodically occurring ups and downs in the incidence. Along with 2-4-year intervals, intervals with larger time intervals (40-50 years) are noted, followed by a significant increase in the number of cases. In the early 60s of the 17th century, T. Sydenham characterized scarlet fever as "... an extremely insignificant, hardly worth mentioning suffering." The description of the clinical picture of scarlet fever made at that time resembled scarlet fever of the second half of the 20th century. However, after 15 years, Sydenham was faced with severe scarlet fever and attributed it on the basis of severity to the same category as the plague. The 17th and 19th centuries were characterized by alternating periods of severe and mild scarlet fever. Among the well-known generalizations on this subject, one can refer to the description by F.F. Erisman. Here is how he wrote about scarlet fever based on the literary materials of two centuries: “At times there are periods of exceptionally benign or only malignant epidemics of scarlet fever. Mortality in malignant epidemics is 13-18%, but often rises to 25% and even reaches 30-40%.

Due to the imperfection of the registration system, poorly developed and not always accessible to the population of medical care, the official statistics of tsarist Russia do not reflect the true incidence of scarlet fever. In contrast to past centuries, we have quite extensive information for the 20th century.

In the centenary interval, one can distinguish three major disease cycles.

- First cycle characterized by a gradual rise in incidence since 1891 (115 per 100,000 population) for about 10 years. Subsequently, for about 10 years, the incidence remained at a high level (within 220-280 per 100,000 population), then there was a pronounced decrease in the incidence by 1917-1918. (up to 50-60 per 100,000 population). There is no reliable data on the incidence of scarlet fever during the years of the civil war and intervention.

- Second cycle fell on the interval between 1918-1942. with a peak incidence in 1930 (462 per 100,000 population). In the next 4 years, an equally intensive decrease was registered to 46.0 per 100,000 population in 1933. In terms of incidence in these years, scarlet fever occupied the second or third place among other childhood droplet infections, retaining its main epidemiological features (periodic and seasonal fluctuations, focality, etc.). The decrease in the incidence rate, which had begun, somewhat stopped during the war years. However, despite the difficult situation in the country, this infection has not become epidemic. After an increase in the incidence in 1935-1936. its next decline began, which continued during the Great Patriotic War, and in 1943 the incidence rate of scarlet fever in the USSR was more than 2 times lower than before the war.

The longest was third cycle that began immediately after the Second World War. The incidence peaked in 1955 (531.8 per 100,000 population). Since the complex of anti-scarlet fever measures in the foci was canceled in 1956, one could expect an intensification of the epidemic process in subsequent years due to an increase in the possibilities of infection through contact with patients left at home, and a reduction in the period of their isolation. Data from the literature dating back to the late 1950s and 1960s indicate that this did not happen. And vice versa, the 60-70s were characterized by a decrease in the incidence with its minimum in 1979-80. From 1950 to 1970 in the USSR, periodic increases in the incidence of scarlet fever were recorded three times (1955, 1960 and 1966); each subsequent one was lower than the previous one. Simultaneously with the decrease in the overall incidence of scarlet fever, changes in the nature of epidemiological features were registered: the intensity of regular periodic rises decreased, annual seasonal increases in incidence became less pronounced, the proportion and incidence of scarlet fever in the group of children of senior school age increased.

The course of Scarlet fever

The pathogen enters the human body through the mucous membranes of the pharynx and nasopharynx, in rare cases, infection through the mucous membranes of the genital organs or damaged skin is possible. In the place of adhesion of bacteria, a local inflammatory-necrotic focus is formed. The development of an infectious-toxic syndrome is primarily due to the entry into the bloodstream of erythrogenic streptococcal toxin (Dick's toxin), as well as the action of cell wall peptidoglycan. 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.).

Symptoms of Scarlet fever

Incubation period ranges from 1 to 10 days. The acute onset of the disease is considered typical; in some cases, already in the first hours of the disease, the body temperature rises to high numbers, which is accompanied by malaise, headache, weakness, tachycardia, and sometimes abdominal pain. With a high fever in the first days of the disease, patients are excited, euphoric and mobile, or, conversely, lethargic, lethargic and drowsy. Due to severe intoxication, vomiting often occurs. At the same time, it should be emphasized that with the current course of scarlet fever, body temperature may be low.

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 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.

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 should be distinguished from measles, rubella, pseudotuberculosis, medicinal dermatitis. In rare cases of the development of fibrinous deposits, and especially when they go beyond the tonsils, the disease must be differentiated from diphtheria.

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.

Treatment of Scarlet fever

Currently, scarlet fever is treated at home, with the exception of severe and complicated cases. It is necessary to observe bed rest for 7-10 days. The etiotropic drug of choice remains penicillin at a daily dose of 6 million units (for adults) for a course of 10 days. Alternative drugs are macrolides (erythromycin at a dose of 250 mg 4 times a day or 500 mg 2 times a day) and 1st generation cephalosporins (cefazolin 2-4 g / day). The course of treatment is also 10 days. If there are contraindications to these drugs, semi-synthetic penicillins, lincosamides can be used. Assign gargling with a solution of furacilin (1: 5000), infusions of chamomile, calendula, eucalyptus. Showing vitamins and antihistamines in the usual therapeutic doses.

Prevention of Scarlet fever

Epidemiological surveillance

Taking into account the position that scarlet fever is recognized as a “disease of organized groups”, it is necessary to monitor the dynamics of the incidence of tonsillitis and other manifestations of respiratory streptococcal infection on a daily basis in order to recognize signs of a worsening epidemic situation and predict the occurrence of scarlet fever and rheumatism. Of great importance is the monitoring of the typical structure of the pathogen and its biological properties. It is known that the population of group A streptococci is extremely heterogeneous and variable in its typical structure and ability to cause rheumatism, glomerulonephritis and toxic-septic forms of infection (necrotizing fasciitis, myositis, toxic shock syndrome, etc.). The rise in incidence is usually associated with a change in the leading serovar of the pathogen (according to the structure of the M protein).

Activities in the epidemic focus

With scarlet fever, the following persons are subject to mandatory hospitalization:

Patients with severe and moderate forms of infection;

Patients from children's institutions with round-the-clock stay of children (orphanages, orphanages, boarding schools, sanatoriums, etc.);

Patients from families where there are children under the age of 10 who did not have scarlet fever;

Any sick person who is unable to provide proper home care;

Patients from families where there are people working in preschool institutions, surgical and maternity wards, children's hospitals and clinics, dairy kitchens, if it is impossible to isolate them from the sick person.

A patient with scarlet fever is discharged from the hospital after clinical recovery, but not earlier than 10 days from the onset of the disease.

The procedure for admitting those who have been ill with scarlet fever and tonsillitis to children's institutions:

Convalescents from among children attending preschool institutions and the first two grades of schools are admitted to these institutions 12 days after clinical recovery;

For children with scarlet fever from closed children's institutions after discharge from the hospital, an additional 12-day isolation is permissible in the same closed children's institution if there are conditions for reliable isolation of convalescents;

Adult convalescents from the group of decreed professions from the moment of clinical recovery for 12 days are transferred to another job (where they will not be epidemiologically dangerous);

Patients with angina from the focus of scarlet fever (children and adults) identified within 7 days from the date of registration of the last case of scarlet fever are not allowed to enter the institutions listed above within 22 days from the date of their illness (as well as patients with scarlet fever).

When registering diseases with scarlet fever in preschool institutions, the group where the patient is identified is quarantined for a period of 7 days from the moment of isolation of the last patient with scarlet fever. In the group, it is mandatory to carry out thermometry, examination of the pharynx and skin of children and staff. If any of the children have an elevated body temperature or symptoms of an acute disease of the upper respiratory tract, they should be immediately isolated from others with a mandatory examination of the skin.

All those in contact with patients, as well as persons with chronic inflammatory lesions of the nasopharynx, are subjected to sanitation with tomicide for 5 days (rinsing or irrigation of the pharynx 4 times a day after meals). In the room where the patient with streptococcal infection is located, regular current disinfection is carried out with a 0.5% solution of chloramine, dishes and linen are regularly boiled. Final disinfection is not carried out.

Children attending pre-school institutions and the first two grades of the school, who did not suffer from scarlet fever and communicated with a patient with scarlet fever at home, are not allowed to enter a children's institution for 7 days from the moment of the last contact with the patient. Adults of decreed professions who communicated with the patient are allowed to work, but they are placed under medical supervision for 7 days for the timely detection of possible scarlet fever and tonsillitis.

Persons with identified acute respiratory lesions (tonsillitis, pharyngitis, etc.) should be examined for the presence of a rash and removed from work, informing the local doctor. Their admission to children's institutions is carried out after recovery and the provision of a certificate of antibiotic treatment.

Dispensary observation of patients with scarlet fever and tonsillitis is carried out within 1 month after discharge from the hospital. After 7-10 days, a clinical examination and control tests of urine and blood are carried out, according to indications - an ECG. In the absence of deviations from the norm, a re-examination is carried out after 3 weeks, after which they are removed from the dispensary record. In the presence of pathology, depending on the localization of the ill person, it is necessary to transfer it under the supervision of a rheumatologist or nephrologist.

Scarlet fever is an acute infectious disease manifested by lesions of the tonsils (tonsillitis), skin and mucous membranes, with a typical rash and subsequent peeling, purulent-septic and allergic complications.

Etiology

The causative agent is group A hemolytic streptococcus.

Pathogenesis

Streptococci, getting on the mucous membrane of the tonsils, soft palate, posterior pharyngeal wall, cause an inflammatory reaction. In weakened individuals, local changes can be necrotic in nature and spread to nearby tissues - neck tissue, middle ear, paranasal sinuses, mastoid process, etc. Regional lymph nodes are often involved in the process. Erythrogenic exotoxin causes fever, intoxication, typical exanthema, changes in the mucous membranes and causes the formation of antitoxic immunity. Other toxins and enzymes of the pathogen (streptolysins, leukocidin, streptokinase, hyaluronidase, etc.) determine a number of its aggressive properties. In immunocompromised patients, streptococci can penetrate hematogenously into various organs and tissues, causing a septic course of the disease. On the 2-3rd week of the disease, some patients develop immunopathological conditions, manifested in the form of glomerulonephritis and cardiovascular pathology. After suffering from scarlet fever, the vast majority develop strong immunity, but 2-4% of scarlet fever may recur.

Epidemiology

The source of infection is a person with streptococcal tonsillitis, scarlet fever, or a carrier of streptococcus. Susceptible only those individuals who do not have antitoxic immunity. Patients with scarlet fever in the first days of the disease have the greatest epidemiological significance, since streptococcus during this period is actively released into the external environment with droplets of nasopharyngeal mucus. The disease is transmitted by airborne droplets. Of secondary importance are airborne, contact (through dressings, care items) and food transmission routes of infection. Most often, children from 1 to 10 years old get sick. The incidence of scarlet fever increases in the cold season.

Clinic

The incubation period lasts from 1 to 12 days (usually 2-7 days). Scarlet fever is characterized by an acute onset: chills, fever up to 38-39 degrees. C on the 1st day of illness.

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 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

Differential diagnosis should be carried out with a number of diseases similar in clinical symptoms. A common symptom of rubella and scarlet fever is a rash. But with rubella, it is more often polymorphic - along with scarlet-like elements of the rash, morbilliform are noted in places, most often they are located on the limbs and buttocks. With scarlet fever, the elements of the rash are monomorphic, localized on the flexion areas of the limbs, in places with delicate skin (see above).

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 3-4th, less often - on the 6-8th day of the disease (with scarlet fever on the 1-2nd 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 extremities, dim, there are no sore throats characteristic of scarlet fever, a "raspberry" tongue, dry skin, and 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

Children are admitted to the team 12 days after discharge from the hospital with negative culture results from the nasal mucosa and oropharynx for group A p-hemolytic streptococcus. transferred to another job for up to 12 days.

Diagnostics

Diagnosis of scarlet fever is based on epidemiological data and a typical symptom complex. In the study of peripheral blood, neutrophilic leukocytosis is detected with a shift of the formula to the left, an increase in ESR. Confirm the diagnosis by isolating group A beta-hemolytic streptococcus.

Treatment

Treatment of patients with scarlet fever is carried out, as a rule, at home. Children and adults from closed groups, as well as patients with severe forms of the disease, are subject to hospitalization. In a hospital, the placement of patients in the wards must be necessarily simultaneous in order to avoid re-cross-infection with other types of streptococcus.

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.