Scarlet fever is an acute infectious disease known since the Middle Ages. Its name comes from the English phrase scarlet fever, which means "scarlet fever". The disease was named so because of the characteristic red rash on the skin. Today, this disease is not very widespread. However, we must remember that scarlet fever often occurs with severe symptoms. This disease is highly contagious. Periodically there are outbreaks of scarlet fever in kindergartens or schools. Usually, the incidence increases in winter, in summer children get sick much less often. During the incubation period, the child may not feel any unpleasant symptoms, but he becomes a source of infection for others.
Pathogen
Scarlet fever is a disease that is caused by group A streptococcus. Once inside a person, this microorganism affects the nasopharynx, which leads to sore throat. In addition, streptococcusproduces toxic substances that poison the body. Due to exposure to microbial poisons, a rash (exanthema) appears in a person, he alth worsens, nausea and headache occur. These are signs of general intoxication of the body.
Group A streptococcus causes not only scarlet fever in humans, but also other infectious diseases, such as tonsillitis, streptoderma, rheumatism, nasopharyngitis. All these ailments occur with symptoms of general intoxication and often with rashes.
Transmission routes
The cause of scarlet fever is always the penetration of group A streptococcus into the body, and the infected person becomes the source of infection. The patient begins to pose a danger to his environment about 1 day before the onset of exanthema (rash) and other first symptoms. 3 weeks after the onset of manifestations of the pathology, the patient ceases to be contagious.
Infection can pass from a sick person to a he althy person in the following ways:
- Airborne. In this way, patients are most often infected. With prolonged communication with the patient, streptococci enter the body through the nose and throat. An infected person sheds germs during breathing, sneezing and coughing.
- Food (alimentary). In this case, streptococcus is transmitted through food and unwashed dishes.
- Contact. Infection occurs through dirty hands and household items that the patient has touched.
- Through skin lesions. This is a fairly rare route of infection. If streptococcus getsinto the body through wounds and scratches, then scarlet fever proceeds without inflammation of the throat.
It often happens that a person becomes infected, even never having contact with patients with scarlet fever. Where does the infection come from? The patient can get the disease through contact with people suffering from tonsillitis or nasopharyngitis, if these ailments were caused by group A streptococcus. However, in this case, the pathology will proceed in a special form. Only the throat is affected, without pronounced signs of general intoxication.
Some people are asymptomatic carriers of streptococcal infections. They can also become a source of infection.
Usually, infection is promoted by factors such as hypothermia, a decrease in the body's defenses, frequent colds and chronic throat diseases. Adults with diabetes mellitus and adrenal pathology are susceptible to the disease. It can also be noted that group A streptococcus is more likely to infect children with diathesis and low weight. After suffering from scarlet fever, a person has lifelong immunity. It is impossible to re-infect this disease. Scarlet fever in adults is quite rare. More often this disease affects children.
Stages of disease
Several stages of scarlet fever can be distinguished:
- incubation period;
- acute period;
- disappearance and recovery stage.
During the incubation period, it is impossible to notice deviations in a person's well-being. Usually there are no symptoms at this time.observed. Usually the disease begins acutely, the patient's condition deteriorates rapidly.
Incubation period
The incubation period for scarlet fever is 1 to 10 days. But most often the disease proceeds hidden within 2-4 days after infection. The state of he alth of a person is still normal. But streptococcus is already beginning to have a negative effect on the body.
During the incubation period of scarlet fever, the causative agent of the disease is fixed at the site of introduction: on the mucous membranes of the respiratory organs or on the skin. Streptococcus then enters the bloodstream and lymphatic vessels and spreads throughout the body. After that, the acute stage of the disease begins.
Symptoms of the acute stage
The onset of scarlet fever symptoms begins with a deterioration in general well-being. The patient has a migraine-like headache, weakness and fever. The temperature can rise to 39-40 degrees. Due to the poisoning of the body with streptococcus toxins, nausea and vomiting occur.
One of the main signs of scarlet fever is a sore throat. It becomes painful to swallow. The tonsils, posterior pharynx, uvula and arch become bright red. In some cases, a purulent plaque forms on the throat, it has a white or yellow color. The symptoms of the respiratory tract are similar to a sore throat, but the redness and pain in the throat with scarlet fever are more pronounced.
Lymph nodes increase. On examination, you can notice painful bumps under the jaw, on the neck and behind the ears. In the first days of the illness, the tongue is covered with white orgray deposits. After 4 - 5 days it becomes clear, but acquires a crimson color. In severe forms of the disease, hyperemia is noted not only of the tongue, but also of the lips. When listening to the heart with a phonendoscope, tachycardia is determined, but blood pressure remains within the normal range.
Sometimes in the first days of illness, the patient is disturbed by pain in the abdominal cavity. In such cases, it is necessary to conduct a differential diagnosis of scarlet fever and appendicitis.
An important sign of scarlet fever is a rash. It is necessary to pay attention to the nature of the exanthema, this will help to separate streptococcal infection from other pathologies (measles, chickenpox). Rashes usually appear on the first or second day of illness. The rash with scarlet fever has its own characteristics. It looks like small red dots. The size of the spots is not more than 2 mm.
In the early days of illness, exanthema appears on the face, upper body and neck. In the future, red dots spread to the abdomen, limbs, armpits and buttocks. A characteristic symptom of scarlet fever is a sharp contrast between areas with a rash and he althy skin. This is especially noticeable on the face. Red spots cover the cheeks, the skin looks a little swollen, while the area around the nose and lips usually remains free of rashes. Doctors call this symptom "Filatov's symptom".
When scarlet fever in children, rashes may look like pustules filled with liquid contents (vesicles). For this reason, the disease is often confused with chickenpox. The child may be disturbed by itching in the affected areas. Howeverthis is not a characteristic feature. The rash of scarlet fever is not always itchy, unlike chickenpox and herpes infections.
Recovery stage
On the 4-5th day of illness, the rash turns pale, and then completely disappears. After that, the patient has peeling of the skin on the affected areas for 2 weeks. On the palms and feet, the epidermis can come off in large layers. From day 5, the temperature usually decreases. The general condition is gradually improving.
However, during this period there is a risk of complications of scarlet fever. In the second week of illness, streptococcus can affect the kidneys, heart, and joints. Therefore, despite the improvement in the patient's well-being, treatment must be continued and completed.
Disease forms
In medicine, it is customary to classify this disease according to severity and course. Scarlet fever can occur in mild, moderate and severe forms. They are characterized by the following features:
- Easy shape. Intoxication is weakly expressed, the temperature is raised to +38 degrees. The patient's state of he alth is practically not disturbed. There is a slight sore throat and pale pink dots on the skin. This form of the disease is dangerous for others, since the patient's condition has changed slightly, a person can come into contact with other people and be a source of infection.
- Moderate form. The disease begins acutely, the temperature rises to +39 degrees. A sore throat is pronounced, a bright red rash in the form of dots is noticeable, lymph nodes are enlarged, and he alth deteriorates sharply.
- Heavy form. It proceeds with a predominance of signs of intoxication or septic damage to the body. In some cases, the symptoms are combined (toxic-septic form). Currently, this type of scarlet fever is very rare. This is due to the use of penicillin antibiotics, which can affect streptococcus already in the first hours of the disease.
The severe form of scarlet fever, in turn, is divided into three types:
- Toxic form. This type of scarlet fever develops in children under 7-10 years old. The temperature rises to +40 degrees, delirium occurs. There may be vomiting with diarrhea. The mucous membranes of the throat become bright red. The general condition worsens sharply: the pulse becomes weak, blood pressure drops, vascular insufficiency develops. The rash is small, may have a bluish color with hemorrhages. In some cases, the phenomena of intoxication grow rapidly (fulminant form), and the patient may die on the 1st day of illness.
- Septic form. With this type of scarlet fever, the deterioration of he alth increases over several days. The temperature rises to +40 degrees. Symptoms of intoxication are mild, signs of inflammation predominate. Streptococcus quickly penetrates from the throat to other organs. There are secondary foci of inflammation: in the maxillary sinuses, temporal bone, middle ear. In the blood, leukocytes and ESR are sharply increased. The patient may die from sepsis in the first week of illness.
- Toxic-septic form. It is characterized by a combination of toxic and septic symptoms. In the early days of the disease, predominatephenomena of intoxication, and then symptoms of inflammation join them.
Sometimes scarlet fever can occur in atypical forms, in which the classical picture of the disease is not observed. In such cases, the sore throat and rash are mild and it is sometimes difficult to diagnose the pathology. The following atypical types of the disease are distinguished:
- Erased form. The temperature is slightly elevated, the rash may be completely absent. There is a slight inflammation in the throat, as in SARS, the lymph nodes are not enlarged. Scarlet fever in adults occurs in this form quite often.
- Extrabuccal scarlet fever. Occurs when infection is transmitted through skin lesions. There is no inflammation in the throat. Patients complain of slight weakness. A rash occurs around a sore or cut where the streptococcus has entered.
- Hemorrhagic scarlet fever. This is a severe and dangerous form of the disease. The general condition worsens at lightning speed, and often a fatal outcome occurs even before the onset of specific manifestations of scarlet fever. There is a severe headache with vomiting, hemorrhages in various organs, convulsions. Patients die against the backdrop of collapse and a critical drop in blood pressure.
Hemorrhagic and extrabuccal varieties of the disease are extremely rare. The erased form is an epidemiological danger, since the patient can spread the infection without even knowing that he is sick.
Possible Complications
Early complications of scarlet fever are associated with the impact of streptococcus on the organs. These include:
- Inflammation andenlargement of the lymph nodes. This symptom always accompanies scarlet fever. However, if the nodes are enlarged excessively, reach the size of an egg and make chewing and swallowing difficult, then this is not a manifestation of the disease, but a complication. In severe cases, adenophlegmon may occur - a purulent inflammatory process in the subcutaneous tissue. This is also a complication caused by damage to the lymph nodes.
- Formation of secondary purulent foci in other organs. Most often, streptococcus affects the kidneys and liver. This complication is observed in children with severe forms of scarlet fever.
- Secondary inflammatory processes in the middle ear (otitis media), maxillary sinus (sinusitis), pharynx (nasopharyngitis). Occurs as a result of the spread of infection from the throat to nearby organs.
- Hemorrhages. Occur due to the effect of toxins on the vessels. Patients develop nosebleeds or a hemorrhagic rash.
- Toxin damage to the heart and kidneys. Such complications are manifested by pathological changes in the walls and chambers of the heart, bradycardia and a decrease in blood pressure. Damage to the kidneys leads to infrequent urination, up to anuria (the complete absence of urine production).
The late effects of scarlet fever are often observed. These are pathologies of autoimmune origin associated with the destruction of body tissues by their own antibodies. The following diseases are most common after recovery from scarlet fever in patients:
- Rheumatism. Joint lesions are observed approximately 2-3 weeks after recovery. Pathology often resolves on its own, but mayflow into a chronic form.
- Glomerulonephritis. This kidney disease is a common consequence of scarlet fever. Patients have swelling of the face and body, back pain, high blood pressure. Without treatment, the disease tends to become chronic.
- The defeat of the heart. There are pathological changes in the heart valves (mitral and aortic). This is also associated with autoimmune processes and the formation of antibodies. Such a pathology needs treatment (sometimes even surgical), as it does not disappear on its own and becomes chronic without therapy.
Diagnostic Methods
In terms of its symptoms, scarlet fever resembles many other infectious diseases, accompanied by rashes. Therefore, it is important to conduct a differential diagnosis with allergic manifestations, rubella, chickenpox, dermatitis, measles, pseudotuberculosis.
The specialist makes a preliminary diagnosis when examining the patient and taking an anamnesis. If you press your palm on the patient's skin, the rash usually disappears. This is a specific sign of the disease. The doctor draws attention to the acute onset of the disease, the nature of the rash, signs of sore throat. To clarify the diagnosis, the following examinations are prescribed:
- complete blood count;
- throat swab with culture;
- test for antibodies to streptococcus A;
- analysis for a specific antigen - streptolysin O;
- electrocardiogram.
These studies help distinguish scarlet fever from other infectious pathologies with a rash.
How to treat the disease
In the treatment of scarlet fever, antibiotics of the penicillin group are used. The following drugs are prescribed:
- "Benzylpenicillin";
- "Phenoxymethylpenicillin".
If the patient is allergic to penicillin drugs, then Azithromycin, Erythromycin, Clarithromycin are used.
When scarlet fever is recommended to stay in bed for at least 10 days. During the acute period, mechanically sparing food should be consumed, as swallowing may be painful. It is recommended to drink more liquid to remove toxic substances from the body. In addition to antibiotic therapy, symptomatic treatment of scarlet fever is carried out. It is recommended to gargle with herbal decoctions and disinfectant solutions, take ascorbic acid to strengthen the immune system. Antihistamines are also prescribed to prevent allergic reactions. If necessary, physiotherapy is carried out on the throat area (quartz, UHF).
Three weeks after the onset of the disease, it is necessary to undergo an examination by a cardiologist and a rheumatologist in order to identify possible complications on the joints and heart in time.
Infection prevention
Specific prevention of scarlet fever has not been developed. The only way to prevent the spread of the disease is to limit contact with sick people. To do this, the following measures are being taken:
- If it is not possible to isolate the patient from childrenfrom 3 months to 10 years, then he is hospitalized in a hospital according to epidemiological indications.
- Children who have been in contact with the patient are placed under medical observation for a period of 7 to 17 days.
- A person who has been ill with scarlet fever is discharged to work, study or a preschool institution no earlier than 10-12 days from the onset of the first symptoms. In this case, it is necessary that there are no signs of sore throat, rashes, and blood and urine parameters should be within normal limits.
This prevention of scarlet fever will help minimize the risk of infection.
Often parents ask if it is possible to vaccinate their children against this disease. There are currently no specific vaccinations. However, a few decades ago, such a vaccine existed. The scarlet fever vaccine was invented in those years when this disease was considered very dangerous and was accompanied by high mortality. But practice has shown that such a vaccine has many side effects and negatively affects the young body. Therefore, its use was abandoned back in the 1980s.
These days there is no need for a scarlet fever vaccine, and therefore there is no vaccination. This disease responds well to treatment with modern antibiotics and has a favorable prognosis.
