All about scarlet fever
The source of infection is a person with angina, scarlet fever or other forms of respiratory and skin streptococcal infection, as well as streptococcus A bacteria. Carriers of scarlet fever are most dangerous in the first few days of the disease.
Scarlet fever is streptococcal sore throat, but accompanied by a rash.
Clinical manifestations of scarlet fever is a “raspberry” tongue and a punctate rash with a pink skin background and a pale nasolabial triangle.
Streptococcus transmission path - airborne. Infection occurs by close long-term communication with the patient or bacterium. The causative agent is most often excreted into the external environment when coughing, sneezing, active conversation. High density of people in the premises, long-term close communication are conditions conducive to scarlet fever infection.
Available food and household contact infection (through contaminated hands and household items). Getting into certain foods, streptococci are able to multiply and stay in them for a long time in a virulent state (that is, in a state capable of causing disease).
Additional factors contributing to the transmission of the causative agent of scarlet fever are low temperature and high humidity in the room. Scarlet fever, acute respiratory infections and sore throat have a seasonal increase in incidence in September – December with a maximum in November.
Scarlet fever is sick once in a lifetime, but other streptococcal infections (for example, streptococcal sore throat) can hurt as much as you like.
Scarlet fever symptoms
The incubation period for scarlet fever (that is, the period from infection to the onset of the first symptoms of the disease) is from 1 to 7 days, most often it is 3 days.
The first symptoms of scarlet fever are signs of acute intoxication of the body:
- sharp rise in temperature. Body temperature usually rises sharply and on the 2nd day it reaches a maximum level of 39-40 ° C. Over the next 5-7 days, the temperature gradually normalizes,
- headaches and body aches, refusal to eat. Severe abdominal pain may occur. Small children may experience vomiting or diarrhea,
- drowsiness, lethargy, weakness, weakness, irritability,
- complaints of sore throat. There is redness of the throat (tonsils are often covered with bloom) as with tonsillitis or sore throat. There is an increase and pain in the regional lymph nodes.
These symptoms do not reveal scarlet fever, since exactly the same symptoms can occur in many other diseases, such as angina. However, symptoms characteristic of scarlet fever appear rather quickly:
- «raspberry tongue". In the first days of the disease, the tongue becomes covered with white bloom, through which the edematous red nipples appear through. After a few days, this plaque is expelled, the tongue becomes bright red, brilliant, "crimson."
- rash. A rash characteristic of scarlet fever appears after 12-48 hours. Skin eruptions appear as small red dots. Initially, the rash appears on the neck and upper chest, but then quickly spreads to the whole body and face. Scarlet fever rash never appears in the nasolabial triangle area. The pallor of the nasolabial triangle with scarlet fever is especially emphasized by the burning cheeks and the bright puffy lips of a child. If you hold your finger at the place of the rash, for a while there remains a white stripe that slowly changes its color back from white to bright red. In the deep folds of the skin (in the area of the elbows, in the axillary, popliteal folds, in the groin area), bands of dark red color may appear that do not fade when pressed.
On the 4–5th day of the disease (sometimes earlier), the rash begins to fade and disappears. After the disappearance of the rash at the end of the first - at the beginning of the second week of the disease on the face, the skin begins to peel off in the form of tender scales. Then peeling appears on the body and last of all - on the palms and soles of the feet. The skin of scarlet fever is exfoliated by layers, especially on the hands and feet. Duration and intensity of peeling depends on the severity of the rash, the duration of this period can be delayed up to 6 weeks.
Diagnosis of scarlet fever
Establishing a reliable diagnosis of streptococcal infections in all cases except for scarlet fever, requires microbiological research - smear from the nose and pharynx on hemolytic streptococcus.
The diagnosis of scarlet fever is fine if the child has a sore throat, a characteristic rash, vomiting. In the future, with peeling of the skin and the presence of a "crimson" language.
In general, a blood test shows signs of bacterial infection: neutrophilic leukocytosis, leukocyte shift to the left, increased ESR. In serum, the level of ASL-O (antistreptolysin-O) increases.
Each case of scarlet fever medical workers are obliged to submit to the territorial center of state sanitary and epidemiological surveillance
Scarlet fever treatment
All children with a complicated course of scarlet fever should be hospitalized in the infectious disease ward. Patients from families where there are children under the age of 10 who do not have scarlet fever, patients from families where there are people working in preschool institutions, children's hospitals and clinics, dairy kitchens are subject to mandatory hospitalization for scarlet fever. sick child. In all other cases, treatment is carried out at home.
In mild form of scarlet fever the child is isolated, and treatment is carried out at home: bed rest for 7 days, a diet with salt restriction and irritating products (table No. 15), gargling with furatsilina solution, decoction of antiseptic herbs (calendula, chamomile, sage). At elevated temperatures, it is necessary to provide the child with abundant drinking and, if necessary, to provide antipyretic drugs.
During scarlet fever, the main treatment is the administration of antibiotics to prevent the development of early and late complications. Antibacterial therapy is necessary for all patients with scarlet fever, regardless of the severity of the disease. Antibiotics are used to treat scarlet fever in children. penicillin group – phenoxymethylpenicillin - (Osp 750, Star-Pen). Penicillin combinations (amoxicillin + clavulanic acid - Amoxiclav). Or generation I cephalosporins (Cephalexin). In case of intolerance to penicillin or cephalosporin, macrolides are assigned - erythromycin or azithromycin (Sumamed). The course of antibiotic treatment is 10 days.
In case of adverse allergic status of the child, anti-allergic (hyposensitizing) therapy is carried out.
Persons who have had streptococcal infection (sore throat, scarlet fever) are advised to take a urine test 1-2 weeks after recovery.
What is dangerous scarlet fever. What are the possible complications?
Scarlet fever is a rather serious disease, as it leaves behind itself complications in the form of lesions of various organs: the heart, kidneys, ears, joints. The complication of scarlet fever in children is:
- purulent. Purulent-inflammatory processes (otitis, meningitis, lymphadenitis, sepsis)
- allergic. Complications associated with infectious-allergic mechanisms (carditis, arthritis, rheumatism, vasculitis, nephritis).
With the development of complications of the cardiovascular system, the patient needs to consult a cardiologist, an ECG and an ultrasound of the heart. In the event of otitis, an otolaryngologist examination and otoscopy are necessary. To assess the condition of the urinary system, ultrasound of the kidneys is performed.
Quarantine for scarlet fever
Discharge of scarlet fever from the hospital is carried out after his clinical recovery, not earlier than 10 days from the onset of the disease.
Children attending preschool institutions and the first 2 classes of schools, recover from scarlet feverallowed in these facilities after 12 days after clinical recovery.
Children attending preschool groups and the first two classes of school, previously not scarlet scarlet and communicating with the patient with scarlet fever in the family (apartment) before his hospitalization, are not allowed in the children's institution within 7 days since the last communication with the patient. If the patient is not hospitalized, children who have communicated with him are allowed in the children's institution after 17 days from the start of contact and the mandatory medical examination (pharynx, skin, etc.).
Children, previously sick scarlet fever and communicating with the patient throughout the illness, allowed in children's institutions. They are set daily medical observation for 17 days from the onset of the disease.
Persons who have had scarlet fever and sore throat are placed in a dispensary observation within one 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 electrocardiogram. Examination is repeated after 3 weeks, in the absence of deviations from the norm removed from the dispensary registration. In the presence of pathology, depending on its nature, the patient has been transferred under the supervision of an appropriate specialist (rheumatologist, nephrologist, etc.).
When registering scarlet fever in a preschool institution, the following measures are taken: a quarantine is imposed on the patient's group for a period of 7 days from the moment of isolation of the last patient. During the quarantine, the admission of new and temporarily absent children who had not previously suffered from scarlet fever ceases. Not allowed to communicate with children from other groups of children's institutions. In the quarantine group, children and staff must inspect the throat and skin with morning thermometry at least 2 times a day. Children who have had acute upper respiratory tract diseases from scarlet fever foci are admitted to the team after a full clinical recovery with a certificate from a pediatrician. Every day, up to 15 days after the onset of the disease, they are examined for the presence of peeling of the skin on the palms (for retrospective confirmation of streptococcal infection).
- Septic factor - determines the spread of microbes in the tissues surrounding the tonsils, and when microbes penetrate into the blood - in the internal organs. Severe septic forms of scarlet fever may be accompanied by the formation of foci of secondary dissemination of streptococci throughout the body.
- Toxic factor - determines the destruction and separation of the upper layer of the epidermis, as well as impaired function of the brain and heart. A characteristic feature of scarlet fever is the "scarlet heart" - an increase in the size of the patient's heart due to the influence of a toxic factor on this organ.
- An allergic factor in the acute phase of the disease determines the appearance of a rash, and during the recovery period, it can cause multiple lesions of the internal organs and connective tissue such as rheumatism or vasculitis.
The initial period, usually very short (several hours), covers the period from the onset of the first symptoms of the disease to the appearance of the rash. The beginning can be sudden.
The patient becomes infectious the day before the first symptoms. The duration of the infectious period can vary from several days to several weeks, but with no complicated course against the background of penicillin, the child after 7-10 days does not represent an epidemic danger to others.
A special role in the diagnosis of the disease is played by the condition of the skin and rash in scarlet fever in children:
- with pressure on the skin in the abdomen for 10-15 seconds. there is a white mark
- white nasolabial triangle with a rash on the face,
- bright crimson blush on the cheeks, the same color becomes the tongue at 5-6 days from the onset of the disease,
- flaking and flaking of the skin on the palms and feet, lasting 2-3 weeks,
- thickening of the rash in places of the folds. [source not specified 333 days]
- Intoxication - fever, malaise, headaches.
- Scarlet fever - small-point rash, with moderate pressure with a glass spatula, the specks are more visible. When pressed harder, the rash gives way to a golden yellowish skin tone. Performs on 1-3 day of illness and is localized mainly on the cheeks, in the groin, on the sides of the torso. The skin of the nasolabial triangle remains pale and free from rash. The rash usually lasts 3-7 days, then dies away, leaving no pigmentation. Characterized by thickening of the rash on the folds of the limbs - axillary, ulnar, popliteal areas.
- Scarlatinic tongue -
Treatment is usually done at home. Inpatient treatment is necessary in severe cases and in the presence of complications. Until the temperature drops, patients should observe bed rest. In the acute period of the disease, plenty of warm drink (tea with lemon, fruit juice), liquid or semi-liquid food with some restriction of proteins is necessary. Patients are shown bed rest, they appoint table number 2 (in the Pevsner Diet system).
Penicillin antibiotics in tablets (phenoxymethylpenicillin, retarpen, amoxicillin, Amoxicillin + clavulanic acid) are prescribed as drug treatment for 7-10 days. Additionally prescribed vitamin therapy (B vitamins, vitamin C). In severe cases, infusion therapy is prescribed (glucose solution or intravenous hemodez) to reduce intoxication.
Currently there are two points of view on treatment and prognosis. One of them connects the ease of modern scarlet fever with the invention of antibiotics. Other authors believe that improved nutrition and living conditions had a major impact on significantly alleviating the course of scarlet fever and reducing mortality. An important argument in favor of the second point of view is the fact that scarlet fever often proceeds so easily that antibiotics simply do not apply (sometimes deliberately, but sometimes due to late diagnosis), but, with proper care for the child, it almost does not affect the complications and does not lead to the death of children.
Normally, after transferring scarlet fever, antibodies to erytotoxin are produced in the body. But, if the immunity is extremely weakened, a repeated attack by pathogens is possible, which occurred even before complete cure. And then the disease enters a new stage in a seemingly beginning to recover child.
Recurrent disease of scarlet fever after a long time after the illness is noted in 2 - 4% of cases. This is attributed to the fact that the use of an antibiotic from the first days of the disease does not allow the body to have time to develop antibodies to erytotoxin.
But the second time scarlet fever, as a rule, takes place in a lighter form. The treatment applies the same, except that the doctor may prescribe another antibiotic, not the one that was the first time. 
What is the cause of scarlet fever?
Scarlet fever - This is an infectious disease caused by a microorganism. In this case, the causative agent of the disease is group A streptococcus. It is also called beta-hemolytic streptococcus. This bacterium has a spherical shape. It releases Dick's toxin, which causes intoxication (poisoning of the body with toxins) and small rash (exanthema). Settled on the mucous membranes of man. Most often they breed in the nasopharynx, but can live on the skin, in the intestines and in the vagina. To protect the bacteria can create a capsule around them, tend to form clusters - colonies.
In some people, streptococcus A may be part of the microflora. That is, it peacefully coexists with the human body without causing illness. But after stress, hypothermia, when the immune system falls, streptococci begin to actively multiply. At the same time, they poison the body with their toxins.
Source of infection with scarlet fever is a man. It may be:
- A patient with scarlet fever, sore throat or streptococcal pharyngitis. Such a person is especially dangerous for others in the first days of the illness.
- Reconvalescent is a person who has recovered from an illness. It may still excrete streptococci for some time. Such carriage can last up to three weeks.
- A healthy carrier is a person who has no signs of disease, but group A streptococci live on the mucosa of his nasopharynx and are released into the environment. There are quite a few such people, up to 15% of the total population.
Epidemiology of scarlet fever.
Today, this disease is considered a childhood infection. Most patients are less than 12 years old. But the disease can be observed in adults. But kids up to a year almost do not get sick. This is due to the fact that they inherited maternal immunity.
The patient is considered contagious from day one to day 22. Существует мнение, что заразить окружающих он может за сутки до появления первых симптомов. Это вызвано тем, что в этот период стрептококки уже в большом количестве находятся в носоглотке и выделяются при разговоре.But the body's immune cells still keep the situation under control, so the signs of the disease are not noticeable.
Peaks of the disease are observed in September-October and in the winter, when children return from their holidays to school or kindergarten. In the summer, the number of cases decreases.
Due to the greater population density, the incidence is higher in cities. Urban children suffer this disease in preschool and early school age and become immune. And in the countryside scarlet fever often adults are sick, if they communicated with a patient with scarlet fever.
Every 3-5 years there are scarlet fever epidemics. Over the past decades scarlet fever has become a much milder disease. If earlier the death rate from it reached 12-20%, now it does not reach even a thousandth of a percent. This is due to the use of antibiotics for the treatment of scarlet fever with the weakening of the toxicity of staphylococcus. However, some researchers argue that every 40-50 years there are epidemics of "malignant" scarlet fever. When the number of complications and mortality rates increase to 40%.
What are the signs and symptoms of scarlet fever in children?
Scarlet fever in children causes severe erythrogenic streptococcal toxin poisoning. Its action causes all the changes that occur in the body during illness.
The onset of the disease is always acute. The temperature rises sharply to 38-39 °. The child becomes lethargic, feels severe weakness, headache and nausea. Often this is accompanied by repeated vomiting. By evening, a characteristic rash begins to appear. About its features will be discussed below.
Children complain of sore throat, especially when swallowing. The palate becomes red, the glands enlarge and become covered with a whitish bloom. This is due to the fact that Streptococcus A colonizes the tonsils and intensively multiplies there. Therefore, almost always with strep throat develops streptococcal tonsillitis.
Lymph nodes, which are at the level of the corners of the mandible, are increasing and sore. With the flow of lymph toxins and bacteria from the nasopharynx enter them, causing inflammation.
If the entrance gate for the infection was a wound or cut, then the angina does not develop. The remaining symptoms characteristic of scarlet fever persist.
How does a child with scarlet fever look like (photo)?
General state like a cold (fever, weakness)
For the first hours, the course of scarlet fever is like flu or another acute illness.
But about a day later, a specific rash and other external symptoms appear. A rash with scarlet fever is called rash. It is caused by an erythrogenic toxin, which is part of the exotoxin secreted by group A streptococcus.
Erythrotoxin causes acute inflammation of the upper layers of the skin. A rash is an allergic reaction of the body.
By some characteristic external signs, scarlet fever can be distinguished from other infectious diseases. The first small pimples appear on the neck and upper torso. The skin becomes red and rough. Gradually, in 2-3 days, the elements of the rash spread throughout the body. The rash lasts from several hours to five days. Then peeling occurs in its place. These are cells of the epidermis that are affected by Streptococcus toxin.
The face of the baby becomes puffy, swollen. When you first look at the child draws the attention of a pale area around the lips. It contrasts sharply with red cheeks and crimson lips. Eyes feverishly shine.
What does tongue look like for scarlet fever?
In the first days of the disease, the tongue is coated with white or brownish bloom.
For about the fourth day, it is cleansed and acquires a characteristic coloring for scarlet fever. The tongue becomes brightly crimson with enlarged smooth nipples. He remains so until the 12th day of illness. This feature is called "raspberry" or "strawberry" language.
What does a skin rash look like for scarlet fever?
Exposure to group A Streptococcus toxin leads to the expansion of all small vessels. At the same time through the walls of the capillaries leak lymph containing toxin. There is swelling and inflammation of the skin, a rash appears.
What are the symptoms of scarlet fever in adults?
Scarlet fever is considered a childhood disease. This is due to the fact that by the age of 18–20 most people have already developed immunity to streptococci. But still outbreaks of the disease are among adults. Especially often in tight, closed teams: in student dormitories, among military personnel.
Currently, severe epidemics among adults are not common. In most cases, they occur in the form of streptococcal pharyngitis without a rash.
Signs of scarlet fever in adults may not be as bright as in children. Often a rash on the body is invisible and insignificant, it takes a few hours. This complicates the diagnosis.
Scarlet fever in adults begins acutely and has much in common with angina. Changes in the nasopharynx are due to the fact that beta-hemolytic streptococcus multiplies most rapidly in this area. It causes destruction of the mucous membrane. The intense red color of the sky and tongue is explained by the fact that small vessels dilate under the influence of toxins secreted by bacteria. Also arise:
- severe sore throat, which increases dramatically when swallowing
- a whitish yellow patina appears on the tonsils, purulent foci and sores may occur
- submandibular lymph nodes grow and inflame
- high temperature, often up to 40 °
- weakness and severe headache
- nausea and repeated vomiting in the early hours of the disease
- first rash appears on face
- the area below the nose to the chin without a rash and sharply pale
- Roseol most of all is in the folds of the body and above the pubis
- dermographism is observed - a white mark after pressing, which is visible for 15-20 seconds
- in severe cases, the rash may become bluish. This is due to minor hemorrhages under the skin.
What is the duration of the incubation period for scarlet fever?
The incubation period is the time from the moment the beta-hemolytic streptococcus enters the body until the first manifestations of the disease. This period of the disease is also called hidden. A person is already infected, but the number of bacteria is still not large and they do not have a noticeable effect.
Incubation period for scarlet fever Lasts from 1 to 12 days. In most cases, from 2 to 7 days. Duration depends on the state of immunity and the number of streptococci in the body.
During this period, streptococci settle on the mucous membrane of the upper respiratory tract and multiply there intensively. The immune cells of the body are trying to destroy them, and at first they are doing their job. The body begins to produce special antibodies to combat the disease.
But then there comes a time when streptococci become too much and they intensively release toxins, undermining the strength of the body. Human immunity is not able to cope with them independently and treatment is required.
How to prevent scarlet fever?
In order to protect against scarlet fever, it is necessary to avoid contact with patients with scarlet fever and carriers of staphylococcus. But unfortunately, this is not always possible. After all, the carriers look absolutely healthy.
To protect yourself and your child, you need to know how the disease is transmitted.
- airborne - infection occurs when communicating, staying in the same room
- food (alimentary) - Staphylococcus get on the products that then use a healthy person
- contact - transfer of bacteria from a sick person to a healthy one through household items, toys, clothes
Major preventive measures: identification and isolation of patients. In the team where the patient was, impose a quarantine for a period of 7 days. If the child went to kindergarten, then the group does not accept those children who have not been in contact with the sick person. They are temporarily transferred to other groups.
During this period, conduct a daily inspection of all children or adults who were in contact. In children's groups daily measure temperature, inspect the throat and skin. This is necessary in order to identify the newly ill. Particular attention is paid to signs of respiratory infection and tonsillitis. Since this may be the first symptoms of scarlet fever.
Children who communicated with the patient are not allowed into kindergartens and the first two classes of the school for 7 days after contact. This is necessary to ensure that the child is not infected.
A patient with scarlet fever is isolated and admitted to the team 22 days after the onset of the illness or 12 days after clinical recovery.
Everyone who communicated with the patient is prescribed Tomitsid. The drug must be rinsed or sprinkled throat 4 times a day, after meals for 5 days. This helps prevent the development of the disease and get rid of streptococci that could get on the nasopharynx.
Most often, treatment is carried out at home. Patients with a severe course of the disease are sent to the hospital even if it is necessary to prevent infection of young children or workers of the prescribed professions. These are the people who work with children, in hospitals and in the field of nutrition. They are hospitalized for at least 10 days. Another 12 days after recovery such people are not allowed in the team.
If a child is sick in the family, then you must follow these rules:
- exclude communication with other children
- put the patient in a separate room
- take care of a child should one family member
- do not wash baby clothes with the rest of the family
- separate the dishes, linens, towels, hygiene products
- process the toys thoroughly with a disinfectant solution, and then rinse under running water
In order to prevent the carriage of streptococcus, patients are under medical supervision for a month, after discharge from the hospital. After 7 days and a month, control blood and urine tests are performed. If necessary, make a cardiogram. If the tests did not reveal bacteria, then the person is removed from the dispensary registration.
What are the possible consequences of scarlet fever?
All complications of scarlet fever are explained by the peculiarity of the bacteria that causes it. Beta-hemolytic streptococcus has a triple effect on the body:
- toxic - Poisons with bacterial poisons. Dick's toxin affects the heart, blood vessels, nervous system, adrenal cortex, protein and water-mineral metabolism is disturbed
- allergic - proteins that are formed as a result of the breakdown of the bacteria cause an allergic reaction. This factor is considered the most dangerous.
- septic - spreads through the body through the bloodstream and causes purulent foci of inflammation in various organs.
Complications after scarlet fever are divided into early and late.
Early complications of scarlet fever appear 3-4 days after the onset of the disease.
The consequences associated with the spread of the infectious process and the spread of beta-hemolytic streptococcus.
- necrotic angina - destruction caused by streptococcus can lead to the death of mucous membrane areas on the tonsils
- paraamygdalic abscess - accumulation of pus under the mucous membrane of the nasopharynx around the tonsils
- lymphadenitis - inflammation of the lymph nodes as a result of the accumulation of bacteria and decay products in them
- otitis - inflammation of the middle ear
- pharyngitis - inflammation of the pharyngeal walls
- sinusitis - inflammation of the paranasal sinuses
- purulent foci (abscesses) in the liver and kidneys
- sepsis - blood poisoning
Allergic. An allergic reaction of the body to the bacterium and its toxins cause temporary kidney damage. Its severity depends on the individual reaction of the organism and on whether it has previously encountered this bacterium.
The manifestation of allergies are vascular damage. They become brittle, internal bleeding occurs. Of these, hemorrhage in the brain is especially dangerous.
Late complications of scarlet fever
Late consequences are most dangerous and are associated with sensitization of the body - allergies. As a result, immune cells attack their own tissues and organs. The most serious allergic complications are:
- Valvular heart disease - valves that provide blood flow in the right direction, thicken. At the same time, the fabric becomes fragile and torn. Blood circulation in the heart is disturbed, heart failure develops. Manifested by shortness of breath and aching chest pain.
- Sinovit- Serous inflammation of the joints - the result of allergization, occurs in the second week of the disease. Small joints of fingers and feet are affected. Manifested by swelling and soreness. Passes independently without treatment.
- Rheumatism - the defeat of large joints, occurs at 3-5 week. In addition to pain in the extremities, complications of the heart may also appear. Rheumatism cread the most common and unpleasant complication of scarlet fever.
- Glomerulonephritis - kidney damage. After recovery, the temperature rises to 39 °. There are swelling and back pain. Urine becomes turbid, its amount decreases. In most cases streptococcal glomerulonephritis treatable and passes without a trace. But if time does not take action, it can develop renal failure.
- Chorea - brain damage that occurs 2-3 weeks after recovery. The first manifestations: laughter and crying without a cause, restless sleep, distraction and forgetfulness. Later, uncontrolled movements in the limbs appear. They are fast and erratic. Coordination, gait, speech. In some cases, the brain manages to compensate for impaired function, in others, inconsistency of movements remains for life.
Prevention of complications - the correct and timely treatment of scarlet fever. At the first signs of illness, you should consult a doctor. Intake of antibiotics, antiallergic drugs and intake of large amounts of liquid, is a reliable protection against the occurrence of complications.
Is contagion scarlet fever contagious?
Scarlet fever is a contagious disease. In order to get sick of it, you need to communicate with a patient with a sore throat, scarlet fever or a carrier of streptococcal infection. Also dangerous are people from the patient’s environment who have acute tonsillitis, nasopharyngitis, and bronchitis. Most often they also secrete hemolytic streptococcus.
There are four mechanisms of infection:
- Airborne - infection occurs when communicating with the patient or carrier. The disease spreads quickly in children's groups. When coughing, talking in the air, an aerosol is formed from small droplets of saliva containing the pathogen. When exposed to the mucous membrane of the upper respiratory tract of a healthy person, the bacteria first colonize the tonsils (glands) and begin to produce a toxin. Over time, they spread to surrounding tissues and regional lymph nodes.
- Domestic - through household items used by the patient. Toys, dishes, and laundry can be a source of infection if they have saliva or mucous secretions from a sick person. Although streptococcus somewhat loses its dangerous properties in the environment, it can cause infection. This happens if the microorganism from things with dust gets into the mouth or nose of a healthy person. Бактерия, оказавшись в благоприятных условиях, прикрепляются к слизистой носоглотки, начинают активно размножаться и вырабатывать токсины.Therefore, it is important to carry out the current disinfection in the room where it is located and to prevent sharing of its things.
- Food (alimentary) - if bacteria got into it when cooking, then such a dish could become their breeding ground and breeding ground. Especially dangerous in this regard, dairy products, which are not subjected to boiling and various jellies. When using such food, a large number of microorganisms immediately enter the body. They linger on the nasopharyngeal mucosa and cause illness. Therefore, examination of the bacterial carriage of cooks and other kitchen workers pay so much attention.
- Through damaged skin - wounds, burns, damaged mucous genital organs, the inner lining of the uterus after childbirth - can be the entrance gate for infection. Staphylococcus in this case breeds not in the glands, but on the damaged tissue. This causes the concentration of the rash around the wound and inflammation of the nearest lymph nodes.
Do I need to use antibiotics for scarlet fever?
Scarlet fever, one of the infections that is caused not by a virus, but by a bacterium. And if antibiotics do not affect the virus and cannot help a speedy recovery, then in this case the situation is different.
Antibiotic drugs effectively fight streptococcus. One day after the start of the reception, it is possible to stop the spread of the infection throughout the body. Bacteria die and stop secreting toxins. The patient feels much better. Therefore, antibiotics for scarlet fever are required. The choice of drug depends on the severity of the disease:
- in mild form, penicillins and macrolides are prescribed in tablets or in suspension for children: Erythromycin, Azimed, Azithromycin. Duration of treatment - 10 days
- with moderate form - penicillins in the form of injections intramuscularly: Oxacillin for 10 days
- in severe form, cephalosporins of the I-II generation: Clindamycin, Vancomycin for 10-14 days. Injected intravenously
How to treat scarlet fever?
When scarlet fever is necessary to comply with bed rest for 3-7 days. Its duration depends on the condition of the patient and the characteristics of the course of the disease.
In most cases, the treatment takes place at home. In the hospital sent in such cases:
- with severe illness
- children from orphanages and boarding schools
- patients from families where there are persons who work in kindergartens, hospitals, workers of trade and public catering, as well as other representatives of decreed professions
- patients from families where there are children under 10 years old who did not have scarlet fever
- if it is not possible to isolate the patient and arrange care for him
In parallel, other drugs are prescribed:
- Antiallergic (antihistamine) drugs - to eliminate the manifestations of allergies and complications that may arise due to allergization of the body: Loratadin, Cetrin,
- Antipyretic - to normalize temperature and relieve headache: Paracetamol, Ibuprofen,
- Strengthening the wall of blood vessels - to eliminate the effect of the toxin on the blood capillaries: Ascorutin, Galascorbin,
- Means of local sanitation - preparations for cleansing the nasopharynx from bacteria: gargle with Chlorophyllipt, Furacilin,
- In a serious condition of the patient, saline solutions and glucose are administered intravenously. This is necessary to maintain the water-salt balance and the early elimination of toxins.
- Irradiation of the tonsils with UV rays - they destroy the proteins of bacteria and cause their death.
- Centiwave (CMW) tonsil therapy - treatment of tonsils with microwaves.
- Magnetic-laser therapy - improves blood circulation and provides increased activity of immune cells.
- UHF-therapy - has anti-inflammatory effect, accelerates healing.
- KUF-therapy - kills microorganisms, clears glands from plaque.
Scarlet fever diet
Nutrition of the patient should be aimed at maintaining the strength of the body, increasing resistance to infection and reducing allergization. Food should be easy to digest. It must also be remembered that the sore throat is worse when swallowing. Therefore, the dishes must be semi-liquid and pureed. Doctors recommend therapeutic diet number 13, which is prescribed for infectious diseases. It is necessary to eat often - 4-5 times a day, but the portions should be small.
How is scarlet fever infection
The causative agent of scarlet fever is group A streptococcus, one of the most dangerous infections of this type. Once in the blood of a person, the bacterium begins to release erythrotoxin, a toxic substance that spreads throughout the body. Poisoning is accompanied by the appearance of specific painful symptoms. In the first days of scarlet fever can be confused with the usual sore throat.
The infection is transmitted mainly by airborne droplets (when coughing, sneezing), less often by households (if the patient’s saliva gets on clothes, toys, furniture, dishes). Streptococcal infection can be infected from a sick or already convalescent person. Sometimes scarlet fever occurs with little or no symptoms, and parents take the baby to an institution for children, 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 bodies are protected from infection by maternal immunity, transmitted through breast milk. After suffering scarlet fever, a person develops a stable immunity. The second time scarlet fever get sick extremely rarely.
Typical scarlet fever
Depending on the severity of symptoms of typical scarlet fever, there are several forms of the disease.
Easy The temperature of the child does not rise above 38 ° C. There is no nausea, vomiting and headache. Sore throat in purulent form does not go. The tongue turns red, nipples appear on it. But the spots of skin rash are slightly, they are pale. In some cases, the rash does not appear at all, the skin barely peels. Temperature and sore throat exist in the first 5 days. Redness of the tongue is noticeable for about 10 days. This form of the disease is most common, as treatment usually begins immediately when the first symptoms appear. It contributes to the easy course of scarlet fever immunity strengthening, healthy nutrition and good physical development of children.
Moderate severity. The temperature rises to 39-40 ° C, you may experience hallucinations and delusions. Headache, nausea, vomiting. Heartbeat becomes more frequent, a condition of the so-called "scarlet heart" arises: shortness of breath and pain behind the sternum appear. A bright red rash forms on the skin, merging into spots.
Especially extensive spots are formed in the armpits, inguinal folds, on the elbow bends. The redness covers the neck and face, and the area around the mouth and nose (nasolabial triangle) remains white. Tonsils covered with pus. After recovery, there is a strong peeling of the skin at the site of pale spots.
Heavy form rare, accompanied by temperatures up to 41 ° C with delusions and hallucinations. The rash is very strong. According to what 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, which combines all the symptoms. This type of disease is the most dangerous.
Atypical Scarlet Fever
It can also occur in several forms.
Erased. Rash is absent, other manifestations are mild. In this case, complications are possible, the patient is infectious.
Hypertoxic. It is extremely rare. Basically there are signs of severe poisoning, from which the child may fall into a coma.
Hemorrhagic. On the skin and internal organs appear areas of hemorrhage.
Extrafaringealnaya. In this form of scarlet fever, the infection enters the body not through the throat, but through cuts on the skin.
Scarlet fever complications
The appearance of complications is associated with the rapid spread of infection, inflammation of various organs. In addition, the effects of the disease may occur due to exposure to erythrotoxin, which affects the kidneys, the nervous system, and the destruction of red blood cells.
Early complications occur in the acute stage of the disease. These include:
- purulent inflammation of the middle ear (otitis),
- inflammation of the paranasal sinuses (sinusitis),
- lymphatic gland swelling and inflammation (lymphadenitis),
- kidney inflammation (nephritis),
- inflammatory damage to the myocardium - cardiac muscle (myocarditis),
- phlegmonous sore throat - 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 - defeat toxins of the immune system, the appearance of an allergic reaction to 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). Primarily affects the heart, blood vessels and joints. Complication arises as with the prolonged course of scarlet fever, and with the repeated ingress of streptococci into the body of newly ill children.
Note: That is why it is recommended to hold the baby at home for at least 2 weeks after recovery in order to prevent accidental contact with bacteria carriers.
How the disease proceeds
There are several periods of development of scarlet fever:
- incubation (accumulation of infection in the body),
- initial (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 and until the first symptoms) lasts from 3 to 7 days, and sometimes even 12 days. During all this time the child is the distributor of the infection. You can get infected from it about a day before the first signs of infection appear.
initial stage the disease lasts 1 day. At the same time, the throat starts to hurt badly. The baby cannot eat and talk normally, the symptoms of deterioration of health increase. Skin rash causes itching. In the most severe cases, due to the intense heat, the patient begins to wander.
If there is a mild form of scarlet fever, the rash may be absent, and the temperature does not rise above 38 ° C.
Acute stage the disease lasts up to 5 days. At the same time, the fever keeps, the head is very sore, the child becomes sick and tears. Vivid symptoms of erytotoxin poisoning manifest themselves.
Dots rash merge, darken. Nasolabial triangle stands out sharply for its whiteness. The throat is red, hurts. The tongue is crimson, swollen. Often there are otitis, pneumonia and other early complications.
Recovery. After a few days, the manifestations begin to subside. The stage of recovery 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 in the armpits. Gradually paler tongue, no sore throat.
If the treatment was not completed and it was stopped with the first signs of recovery, the inflammation may flare up in the region of the internal organs and the brain (chorea occurs - involuntary body movements caused by an unusual contraction of the muscles).
It should be emphasized: Ill scarlet fever remains infectious from the last day of the incubation period (24 hours before the onset of rash and fever) and 3 weeks after the onset of the disease. At this time, he cannot be taken to kindergarten or school. It is desirable to maintain bed rest and limit contact with others.
Scarlet fever in children under 1 year
These babies have scarlet fever less frequently than older ones. Small children are less in close contact with each other. The probability of the disease is low if the baby sucks the breast. With mother's milk, he receives antibodies to streptococci, lowering the body's sensitivity to the effects of infection. However, with direct contact with a sick family member, the baby may become infected with scarlet fever. Meeting with carriers of the infection is possible in crowded places or in the clinic.
The disease begins with a rise in temperature and the appearance of signs of inflammation of the throat (it is difficult for the crumbs to swallow, it is capricious, refuses to eat and drink). Then his tongue turns red and covered with a rash, there are abundant red skin rash all over his body, especially on his cheeks and in the folds.
After 3-4 days the rash fades and disappears, and the skin begins to peel off. An inflammation in the throat takes place.
A small child cannot report that he has a pain, reacts to discomfort only by crying. In order to reduce the intoxication of the body, it must often be watered with water. Parents should carefully monitor its condition. The appearance of early complications is indicated by the appearance of areas of hemorrhage on mucous membranes and skin, an increase in temperature to 40 ° C. The reason may be purulent damage to various organs. The baby's pulse rate increases due to impaired cardiac activity. With severe scarlet fever after recovery, there are signs of kidney disease and other late complications.
The difficulty of treating scarlet fever in children under 1 year is that most antibiotics and antipyretics are contraindicated for them. Treatment of the baby must be carried out in stationary conditions, since the disease is instantly complicated, it is necessary to urgently take measures to remove the child from a serious condition.
How to distinguish scarlet fever from other diseases
Red skin rashes can also appear in 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 nearest 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 redness is separated from the sky by a sharp boundary.
- “Raspberry tongue” is a puffy tongue of a crimson color, on which enlarged nipples stand out.
- Scatter rash on red swollen skin. Particularly dense rash is located 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 soles, it comes off in strips, and in other places - in small scales.
On examination of the patient, the doctor presses a finger on the rash. She disappears and then reappears. Scarlet fever is characterized by the presence of high (from 38.5 to 41 ° C) temperature.
Preventing the spread of scarlet fever
In order for the ill child to not infect other children, he is allowed into kindergarten only 12 days after recovery.
If a case of illness is detected in an institution, then quarantine for 7 days is announced there. At this time new children are not accepted there. The institution works as usual. Leaving the rest of the house at the time of 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.
A daily measurement of body temperature, examination of the throat and skin in children and staff. After each meal, the throat is rinsed with disinfectant solutions. Weakened children are given an injection of gamma globulin.
Scarlet fever: etiology and symptoms of the disease
The disease is known for a long time as dangerous for children aged 1 to 9 years with a significant number of deaths. Before the advent of modern medicine in most countries of the world during the epidemics of scarlet fever killed a huge number of children. The reason for limiting the age period is the presence of the child's protection with maternal antibodies in the first period of life up to 1-2 years, depending on the type of feeding and immunity of the mother and the formation of the body’s own immune protection in children 8–9 years old.
History of scarlet fever
Scarlet fever as a separate disease was isolated in 1675 by Zinedgam (Sidengam). In the years 1789-1824 Bretonneau (Bretonneau) was engaged in drawing up a complete clinical picture. Loffler was the first doctor to express in 1882 the idea of streptococcus as the causative agent of scarlet fever on the basis of isolating it from the throat, blood and organs of the dead. Затем инфекционисты Пирке и Музер (Pirquet, Mooser) в 1903 году в подтверждение этой гипотезы сообщили, что скарлатинозный стрептококк, в отличие от других видов бактерий данной группы, агглютинируется сывороткой реконвалесцентов (выздоравливающих) после скарлатины.
И. Г. Savchenko (1905) was the first to isolate streptococcal toxin, which he successfully immunized in the course of experiments on horses, which made it possible to create an antitoxic serum that exerts a therapeutic effect in this disease.
In the future, GNGurbichevsky in 1906 was offered anti-streptococcal vaccine for the prevention of the disease. G. F. Dick, G. H. Dick (1923 - 1925) suggested an intracutaneous test with a streptococcus toxin to determine susceptibility to this infection.
Etiology and types of infection
The name is based on the description of the symptoms of the disease. The Latin word scarlatum, meaning "bright red", "scarlet", describes one of the characteristic symptoms of scarlet fever — a rash of bright red. The characteristic scarlet-like rash, a rash of a certain shape, size and location is the main clinical sign that allows the doctor to diagnose infection with streptococcus.
The bacterium of the type of streptococci, namely beta-hemolytic streptococcus group A, is the causative agent of infection and the cause of scarlet fever. Infection occurs through contact with sick people or hidden carriers, as well as without direct contact, when using certain items of hygiene, dishes, toys, other objects and food. Also, the disease is transmitted through a third party who has come in contact with a sick person or a carrier of streptococcal infection of this type.
Manifestations of the disease
The characteristic scarlet rash that occurs with scarlet fever is the body's response to erythrotoxin, which from the first day of the development of the disease produces streptococcus during reproduction on mucous surfaces. Under the influence of this toxin, the small blood vessels dilate, forming patches of red color and round shape.
This clinical symptom clearly indicates scarlet fever. The combination of sore throat and red rash, gradually exciting the surface of the body, starting from the head and going down, allows you to confidently diagnose this disease during an external examination.
Specific symptoms also include the absence of a rash in the nasolabial triangle, which, together with severe hyperthermia, reddening of the cheeks and puffiness of the neck due to an increase in cervical lymph nodes, constitutes a characteristic picture of the appearance of the sick child. The symptom of Filatov, a pale nasolabial triangle, is not pantognomic only for scarlet fever, it is manifested in other diseases.
The exanthema manifests itself several hours after the acute manifestation of the disease. The incubation period from the moment of infection to the onset of overt symptoms averages 5-7 days, but there are cases when the hidden phase lasted from several hours to 12 days. At the same time, the child who is sick with scarlet fever is contagious from the very first day until clinical recovery, that is, for about three weeks.
The stages of the rash and its variations depending on the form and severity of the disease
First of all, pink dotted rashes appear on the face, side surfaces of the body, in the skin folds of the armpits, in the groin, neck, etc. In places of increased friction of the skin on clothes and bedding (for example, on the back), the rash has a draining character and can cover large areas of the skin almost entirely. Scarlatinal exanthema polymorphism, uneven manifestations are characteristic of severe, septic forms and early layering of allergic reactions. In case of severe intoxication, an uneven, scanty cyancous exanthema with hemorrhagic events is possible.
The most pronounced rash on 3-5 days after the onset of scarlet fever, after which the rash fades, disappears without a trace, and begins a significant peeling of the skin, which is also a consequence of the impact of a specific toxin on the body.
The pronounced exfoliation of epidermis particles is noticeable on the hands and the soles of the feet: the so-called “palm symptom” describes skin detachment in the form of a kind of “glove”, in whole layers, spreading from the area around the nail plates to the entire surface.
Scarlet rash, especially in children with a diagnosis of exudative diathesis, may be accompanied by moderately severe itching. In some cases, most often with mild and moderately severe disease, groups of whitish small vesicles with initially transparent and then cloudy content are added to the classical type of rash at the places of the folds and natural folds. According to N. F. Filatov, a similar rash, miliaria crystalline, has a favorable prognostic value. By the end of the disease the bubbles dry up, leaving a slight peeling of the skin.
Angina and other symptoms of the disease
If the clinical picture is insufficient, scarlet fever can be diagnosed as a sore throat, since the disease is accompanied by laryngeal inflammation, also provoked by streptococci. Primary localization of the introduction and reproduction of streptococci in most cases - the nasopharynx, and in the first place during infection and the development of scarlet fever in a child, the inflammatory process in this area begins, angina develops with reddening of the soft palate, enlarged tonsils, grayish purulent bloom, accompanied by an increase and tenderness of local lymph nodes due to an allergic reaction to toxins. The characteristic "scarlet" language of a bright crimson color with prominent taste buds is observed on the fourth day from the onset of the disease. It can also develop purulent-septic foci of inflammation on the mucous membrane and skin, especially during primary infection with streptococcus through the surface of wounds and abrasions.
Thus, the symptoms of scarlet fever include:
- a sharp onset of the disease with fever, high fever, significant deterioration of health, signs of intoxication of the body (nausea, vomiting, signs of increased sympathetic nervous system may occur),
- streptococcal sore throat, accompanied by an increase in local lymph nodes,
- "Flaming throat", hyperemia, redness of the mucous throat, limited by the line of the hard palate,
- rash of a characteristic type and localization,
- "Raspberry" language.
Depending on the severity of the disease and the degree of intoxication of the body, the clinical picture may be supplemented by symptoms of septic complications, allergic reactions, and damage to internal organs.
Varieties and complications of scarlet fever in children
Scarlet fever in recent decades, most often occurs in a mild form. This is connected both with the invention of effective medicines and the possibility of treatment with antibiotics, and with improving lifestyles, a variety of food, medical care, allowing children to form a higher body resistance compared to previous centuries.
Symptoms of mild disease
The mild form of the disease is quite mild, manifested by the following symptoms:
- hyperthermia is not higher than 38.5 ° C
- vomiting, nausea, headache are absent or mild,
- catarrhal manifestations (pharyngitis, sore throat) occur without complications,
- purulent-necrotic plaque on the tonsils and soft palate is absent,
- rash dim, not abundant or absent,
- peeling of the skin is mild.
The course of the disease is moderate, the acute febrile stage ends in 3-4 days, by 5-6 there is a sore throat, skin rashes. Complications develop in rare cases.
Their characteristic signs of scarlet fever, which make it possible to distinguish an erased form from a sore throat, emit a scarlet-colored tongue of crimson color with pronounced papillae, this symptom is also present during the mild stage of the disease.
Moderate form of scarlet fever
Scarlet fever in moderate form has the following characteristic features:
- significant increase in body temperature - 39-40 ° C,
- a sharp deterioration in health, chills, weakness, headache, nausea, vomiting (sometimes exhausting, repeated)
- possible phenomena of delirium, hallucinations as a result of intoxication and excitation of the sympathetic nervous system,
- tachycardia, palpitations, a symptom of "scarlet heart", accompanied by shortness of breath, shallow breathing, pain in the sternum,
- purulent-necrotic plaque on the tonsils, purulent tonsillitis,
- bright, numerous rashes on the skin, abundant peeling of the skin during recovery.
The duration of the manifestation of the primary symptoms and the acute period in the moderate form of the disease is 7-8 days, during which hyperthermia persists. This form is characterized by early and late complications of the course of the disease, which often requires placement of the sick child in the hospital for the timely detection of symptoms.
Severe scarlet fever
Due to the timely prescription of antibiotics and immunization of the population as a whole, the severe form is quite rare today. The disease is characterized by the following symptoms:
- increase in body temperature to critical limits (41 ° C),
- severe nausea, repeated vomiting, headache, tachycardia,
- mental disorders: confusion, delusions, hallucinatory phenomena,
- inflammation of the nasopharynx extends to the soft palate, mouth area, local lymphatic system, middle ear,
- rash plentiful, uneven, merging, pronounced.
There are three forms of severe scarlet fever:
- toxic, provoked by abundant release of erytotoxin. This form is accompanied by severe intoxication of the body and can be the cause of toxic shock and death,
- purulent-necrotic lesion of the nasopharynx and adjacent tissues characteristic of the septic form in the severe stage,
- toxic-septic, the most dangerous combined form of scarlet fever, combining septic phenomena and severe intoxication.
Severe scarlet fever requires the mandatory placement of both children and adult patients.
Early and late complications of scarlet fever in children
As a rule, the occurrence of complications of the early and late period is associated with late diagnosis or failure of treatment of the disease. Treatment of scarlet fever requires strict adherence to all appointments of a specialist, not only for quick and effective recovery, but also to prevent the development of numerous and sufficiently serious complications of this infection.
Rheumatism affecting the joints is one of the frequent late complications of scarlet fever. The first symptoms are observed on average two weeks after clinical recovery and include the following manifestations:
- pain in large joints of the limbs,
- asymmetrical localization of inflammatory processes,
- redness, swelling over the joint.
Inflammation of the heart muscle or myocarditis develops as a result of the inflammatory process in the tissues of the myocardium, as a result of which the elasticity of the tissues and their contractility are reduced.
Inflammation develops when Streptococcus enters the heart muscle. To cure myocarditis, it is necessary to eliminate the cause of the disease, which implies a complete treatment of scarlet fever.
To reduce the likelihood of myocarditis during the period of illness and within two weeks after recovery, it is necessary to limit physical activity. Therefore, scarlet fever in children requires the release of physical education classes for a period of two weeks and bed rest during the treatment of scarlet fever.
Hemolytic streptococcus group A causes a strong allergic reaction in the body, provoking the destruction of body tissues by immune cells. With the defeat due to allergy of the renal glomeruli, the main filtering elements of the kidneys, the child develops glomerulonephritis.
Manifestations of glomerulonephritis can be observed as after a few days, and a few weeks after the scarlet fever disease. At the onset of the disease, the following symptoms appear:
- hyperthermic turn, fever,
- lumbar pain
- decrease in the total volume of excreted urine, change in its transparency, the presence of sediment,
- swelling, especially manifested after sleep.
Treatment of glomerulonephritis after scarlet fever in children is carried out in stationary conditions and requires strict medical supervision after convalescence to prevent the acute form of the disease from becoming chronic.
In 5% of cases, a late complication of scarlet fever is pneumonia or pneumonia. As a rule, streptococcal pneumonia develops in the first week of the disease of septic scarlet fever due to streptococci entering the lungs through the respiratory tract.
If pneumonia is noted later, then usually the pathogen is pneumococcus, which joins against the background of a weakened immunity of the child’s body.
Pneumonia is a dangerous disease at any age, requiring long-term therapy and a recovery period. Timely administration of antibiotics for scarlet fever helps to prevent the infection from moving from the nasopharynx to the lungs and to avoid the development of such a complication.
Principles of treatment for scarlet fever in childhood
In the diagnosis of scarlet fever treatment is determined by a specialist. The first choice of therapy is based on the form of the disease, the severity of its course and associated diseases, dysfunctions and the individual characteristics of the child.
The mild form does not always require antibiotics, the need for antibiotic therapy is determined by the pediatrician. In compulsory maintenance therapy aimed at alleviating symptoms and reducing the likelihood of complications, include antihistamines, anti-inflammatory drugs for the nasopharynx, antipyretic, if there is such a need. A prerequisite is abundant drinking, as well as the observance of bed rest of the patient, lack of exercise, rest, diet food.
The moderate and severe forms of scarlet fever are cured by antibiotics of the penicillin group, the most effective against streptococci. If, with the established diagnosis of scarlet fever, treatment with penicillin-type antibiotics is not possible (for example, if there is an allergic reaction to penicillin), drugs of other groups are selected, to which the sensitivity of the infectious agent has been established.
In addition to the mandatory antibiotic therapy, antihistamines, antipyretics, detoxification preparations and vitamins are prescribed. When joining complications, an appropriate course of treatment is selected.
Scarlet fever is treated by a pediatrician, independent prescriptions are unacceptable. In any form of scarlet fever disease, plenty of drink is necessary to remove erytotoxins and alleviate the patient's condition, as well as bed rest and complete rest of the patient. It should be remembered that scarlet fever in mild form, in case of non-compliance with doctor's prescriptions, can cause serious complications leading to chronic diseases or disability of a person.
Scarlet fever: disease prevention methods
Scarlet fever is a disease that is not yet preventable by vaccination methods. Therefore, in order to avoid scarlet fever disease, non-specific prophylaxis measures are taken to prevent the spread of infection in children's groups. In the absence of an effective vaccine, quarantine, isolation of the diseased and personal hygiene rules are the basic ways to prevent the incidence of scarlet fever.
Therefore, in the diagnosis of scarlet fever in a child attending a preschool or school educational institution in the classroom or kindergarten group, a weekly quarantine is established. In the presence of contact with a child with scarlet fever, other children are allowed into the team only after 17 days in the absence of symptoms of the onset of the disease.
Those who have suffered scarlet fever at home are allowed to visit the children's institution after 22 days from the first day of illness, and those discharged from the hospital - 12 days after discharge.
Such quarantine measures help reduce the incidence rate and prevent epidemics in kindergartens, schools and other forms of children's groups.
Personal hygiene is also one of the methods of preventing scarlet fever disease. Obligatory washing of hands with soap for 30 seconds, careful treatment of them, especially after returning from crowded places, regular sanitization of toys, objects, surfaces, and washing food can effectively destroy most pathogens.
In the house where the sick scarlet fever is located, special hygienic measures are carried out, including regular surface treatment with chloramine, boiling of bedding, underwear and dishes, and antiseptic processing of toys.
In contact with scarlet fever patients, regular gargling with an antiseptic is recommended, especially in the presence of chronic nasopharyngeal diseases (pharyngitis, tonsillitis, sinusitis, etc.), washing the nasal passages with saline.
Causes of scarlet fever
Возбудитель скарлатины (особый вид стрептококковой инфекции) передается через дыхательные пути при контакте человека с человеком воздушно-капельным путем. Иногда возможна передача вируса прямым контактным способом (через инфицированную пищу, игрушки, вещи и т. п.). Заражение скарлатиной у взрослых чаще всего происходит через кровеносную систему, когда возбудитель болезни проникает в кровь через мелкие ссадины и царапины на коже.
Что такое скарлатина?
Scarlet fever - an acute infectious disease, which is accompanied by intoxication of the body, a rash all over the body, fever, redness of the tongue and throat.
The main cause of scarlet fever is the ingestion of a streptococcal infection - Streptococcus pyogenic (Streptococcus pyogenes), a member of serogroup A, which infects humans mainly by airborne droplets. However, it is worth considering that streptococci cannot provoke the development of any disease with good immunity, and therefore, a weakened immune system or its absence is the second condition for the development of scarlet fever.
Based on this we can say that scarlet fever in children appears most often, especially between the ages of 2 and 10 years. Scarlet fever in adults can also occur, but for this to happen, a number of additional conditions must be fulfilled, which we will discuss in the section “Causes of Scarlet Fever”.
How is scarlet fever transmitted?
As we have said, scarlet fever is transmitted by airborne droplets, for example, when sneezing, coughing, talking at close range, kisses. It is also possible to become infected during the period of catarrhal diseases, when the concentration of infection in the air of the room in which a person stays reaches a critical level. That is why we must not forget, even in cold weather, to ventilate the premises in which a person is a large amount of time - a bedroom, office space, classrooms and playrooms in schools and kindergartens.
Another popular way to enter the causative agent of scarlet fever into the human body - contact-household path. This may be the simultaneous use with the infected person of common utensils, cutlery, bedding (pillow, blanket, bed linen), toys, handshake.
Among the more rare methods of infection with streptococcal infection, and, accordingly, scarlet fever, can be identified:
- air-dust path - with rare wet cleaning in the room,
- medical treatment when a person is examined or treated with contaminated instruments,
- through cuts, when the infection enters the body through the violation of the integrity of the skin,
- sexual way.
The development of scarlet fever
The development of scarlet fever begins with an infection in the nasal cavity or oropharynx. At the same time, an infected person does not feel anything, since the incubation period - from infection in the body to the first signs of the disease ranges from 24 hours to 10 days. In the place of sedimentation of bacteria, an inflammatory process develops, which is caused by toxins produced by streptococcus in the course of its vital activity. If we talk about the appearance, the inflammation is displayed in the form of a reddened throat, inflamed palatine tonsils and tongue crimson, with enlarged papillae, sometimes with a characteristic white bloom at the root.
Erythrogenic toxin, or as it is also called "Dick toxin", produced by the infection, enters the blood and lymphatic systems, destroys red blood cells (red blood cells), causing signs of intoxication (poisoning) of the body. In the fight against infection includes a rise in body temperature, which is aimed at "burning out" of bacteria. At the same time, the toxin in the blood vessels, mostly small ones, provokes their generalized expansion, which is why a characteristic rash appears on the mucous membranes and skin.
Further, as the body produces antibodies that bind poisonous substances and remove them from the patient's body, the rash begins to pass, but at the same time, the skin becomes swollen, the appearance of liquid exudate from pimples, which then permeates the affected skin, in which keratinization appears . Over time, as the rash progresses and the skin heals, these places begin to peel off. A particularly large amount of horny skin compartment occurs on the palms and soles of the feet.
If necessary measures are not taken, infectious agents and their toxins spread throughout all organs and systems, causing a number of complications, in some cases highly dangerous - endocarditis, rheumatism, glomerulonephritis, tonsillitis, necrosis, purulent otitis, damage to the dura mater and others.
Of course, the above process for the development of scarlet fever is very superficial, but it is capable of reflecting the essence of the disease.
Scarlet fever incubation period
Scarlet fever incubation period (from the moment the streptococcus enters the body to the first signs of the disease) ranges from 24 hours to 10 days. A person after infection becomes a carrier of the infection, and is able to transmit it in the next 3 weeks, from the moment of infection.
In the early days of the disease, the carrier of the infection is most contagious.
Prevalence of scarlet fever
Scarlet fever disease is most often observed in children of preschool age. This is primarily due to the not yet fully developed immune system, which performs the protective function of the body against various infections. Doctors pay attention to the fact that children up to 2 years old, if they are often in a group of other children, are sick up to 15 times more often than those who spend more time at home. In the period from 3 to 6 years, this figure is up to 4 times.
Scarlet fever has its own specific seasonality - autumn, winter and spring. It is inextricably linked with two factors - an insufficient amount of vitamins and a period of acute respiratory diseases (sore throat, flu, SARS, etc.), which further weakens the immune system.
The main symptoms of scarlet fever
- Increased and / or high body temperature of 37.5-39 ° C
- General malaise, weakness,
- Increased excitability, or vice versa, apathy towards everything and drowsiness,
- Nausea, sometimes with abdominal pain and vomiting,
- Sore throat,
- "Burning pharynx" - hyperemia (redness) of the mucous membranes of the oropharynx (uvula, tonsils, palate, arches and posterior pharyngeal wall), and the color intensity is more pronounced than with angina,
- The tongue has a whitish-grayish bloom, which is cleared after a few days, after which you can observe the tongue of bright red with a crimson shade of color, with papillae enlarged on it,
- Perhaps the formation of follicular-lacunar tonsillitis, which is expressed in enlarged hyperemic tonsils with mucopurulent plaque, although the nature of the lesion of the tonsils may be different,
- An increase in the anterior cervical lymph nodes (lymphadenopathy), which are hard and painful on palpation,
- Slightly elevated blood pressure
- A rash all over the body, which develops starting from the upper part of the body, and gradually goes down, covering the person completely,
- Increased amount of rash in areas of skin folds and natural folds of body parts - armpits, groin area, elbows,
- In some places there are small pinpoint hemorrhages, vesicles and maculo-papular elements,
- Upper nasolabial triangle is pale, without rash (Filatov symptom),
- After the disappearance of the rash, usually after 7 days, the skin becomes very dry, and on the palms and soles of the feet peel off in large layers.
Important! In some cases, the course of scarlet fever can occur without a rash!
Scarlet fever in adults is more often less pronounced - a bit of a quickly passing rash, increased body temperature, redness of the throat, mild nausea, and malaise. However, in some cases, with abundant infection on the background of a very weakened immunity (after suffering another infectious disease with complications), this disease can be extremely difficult.
1 condition for scarlet fever disease
The causative agent of scarlet fever - bacteria, beta-hemolytic streptococcus group A - Streptococcus pyogenes (Streptococcus pyogenes).
The mechanism of infection - the ingress of bacteria into the body by airborne droplets, contact-household, through injury of the skin or mucous membrane, medical and sexual way. We covered in more detail about the infection processes at the beginning of the article, in the paragraph “How Scarlet fever is transmitted”.
Streptococcal infection almost always surrounds people and animals in moderate amounts, however, when its quantity rises and the body is not in the best shape at that time, it is then that the development of streptococcal diseases begins - tonsillitis, pharyngitis, laryngitis, tracheitis, bronchitis, pneumonia, meningitis, endocarditis, scarlet fever and others.
The highest peak concentrations of viral and bacterial infections are autumn, winter and spring.
2 condition for scarlet fever disease
Now let's consider what factors contribute to a weakening of the human immune system (protection):
- in children, the immune system is fully formed by the age of 5-7 years, therefore, often children most often suffer from various infectious diseases, including scarlet fever,
- insufficient amount of vitamins and trace elements in the body (hypovitaminosis),
- lack of healthy rest, sleep,
- the presence of chronic diseases, especially of an infectious nature - sore throats, pneumonia, ARVI, influenza, acute respiratory infections, diabetes, tuberculosis, malignant tumors, etc.,
- exposure to constant stress, emotional distress,
- sedentary lifestyle,
- abuse of certain drugs
- bad habits - alcohol, smoking.
Here it is also worth noting that, after suffering scarlet fever, immunity develops resistance to it, which makes it harder to get the disease for the second time. However, a bacterial infection tends to mutate, therefore, repeated illness of this disease is possible. This is all said to the fact that we should not neglect the rules for the prevention of scarlet fever.
Scarlet fever classification
According to the classification by A.A. Koltypin, scarlet fever can be divided as follows:
- The typical form is the classic course of the disease with all its characteristic symptoms,
- Atypical form - the disease can pass without symptoms typical for scarlet fever,
The typical form is also classified according to the severity and course of the disease ...
Atypical forms of scarlet fever:
Erased forms - the development and course of the disease tend to more adults, and passes in a mild form, fairly quickly, without any special clinical manifestations - a mild, quickly passing rash, redness of the throat, slight indisposition and nausea, slightly elevated body temperature. However, there is a rather complicated course - with a toxic-septic form.
Forms with aggravated symptoms:
Extrabuccal scarlet fever - the course of the disease occurs without common clinical manifestations (symptoms). This is usually a slight weakness and rash, mostly at the site of the cut or burn, i.e. where the integrity of the skin was broken, and where the infection has penetrated.
Toxic-septic form - develops rarely and, as a rule, in adults. Characterized by a rapid onset of hyperthermia, the rapid development of vascular insufficiency (deaf heart sounds, a drop in blood pressure, filamentous pulse, cold extremities), hemorrhages on the skin often occur. In the following days, complications of infectious-allergic genesis (lesions of the heart, joints, kidneys) or of a septic nature (lymphadenitis, necrotic tonsillitis, otitis, etc.) are added.
1. Bed rest
Bed rest with scarlet fever, as with many other diseases, especially of an infectious nature is necessary for the accumulation of the body's forces to fight infection. In addition, in this way the patient, and the carrier of a streptococcal infection, is isolated from society, which is a preventive measure for the safety of the latter.
Compliance with bed rest should occur within 8-10 days.
The room where the patient is lying should be well ventilated and ensured that he is at rest.
2.1. Antibacterial therapy (antibiotics for scarlet fever)
As we have repeatedly noted, the causative agent of scarlet fever - streptococcus bacterium. In this regard, the treatment of this disease includes the mandatory use of antibacterial drugs (antibiotics).
Antibiotics help to stop infection from further spread, as well as affecting the bacteria, destroy them.
Among the antibiotics for scarlet fever can be distinguished: penicillins ("Amoxicillin", "Retarpen", "Phenoxymethylpenicillin"), macrolides ("Azithromycin", "Erythromycin"), cephalosporins of the first generation ("Cefazolin").
If there are contraindications to the above preparations, semi-synthetic penicillins or linkosamides are prescribed.
The course of antibiotic therapy - 10 days.
Important! It is very important to consume antibiotics during the whole course of treatment, even if the symptoms of scarlet fever have disappeared. This is due to the fact that a small number of bacteria may still remain, and over time, develop immunity to the antibacterial drug, which, with repeated illness of this disease, the previously used antibiotic may have the desired result.
2.2. Maintenance therapy
In order for the course of the disease to be favorable, and recovery as fast as possible, supportive therapy is recommended along with antibacterial therapy.
Strengthening the immune system. If the disease got its typical development in the body, then something is wrong with the immune system and it needs to be strengthened. To strengthen the immune system and stimulate its activity, immunostimulants are prescribed - Immunal, Imudon, Lizobact.
A natural immunostimulant is vitamin C (ascorbic acid), which is present in large quantities in dogrose, cranberries, Kalina, sea buckthorn, lemon and other citrus fruits.
In addition to vitamin C, additional supplementation of other vitamins is recommended, especially group B, each of which contributes to the normalization of the activity of all organs and systems in general. To do this, you can use vitamin complexes - "Undevit", "Kvadevit", "Complivit" and others.
Restoration of normal intestinal microflora. Antibiotics, together with the pathological microflora, getting into the human body, often partially destroy the beneficial microflora, which in the digestive organs contributes to normal digestion. To restore it, they have recently used probiotics.
Among probiotics can be distinguished: "Acipol", "Bifiform", "Linex".
Detoxification of the body. While in the body, a bacterial infection produces a toxin, which poisons the body and causes a number of clinical manifestations of scarlet fever. To remove the toxin (toxic substances) from the body, detoxification therapy is applied, which implies:
- drink plenty of liquids, at least 2 liters of fluid per day, it is desirable that part of the drink be with vitamin C - rosehip decoction, cranberry juice, tea with raspberry and viburnum and others,
- rinsing the nose and oropharynx with a slightly salt or furatsillinovym (1: 5000) solution, as well as infusions of chamomile or calendula,
- the use of detoxification drugs inside that bind toxins inside the body and contribute to their rapid elimination - "Atoksil", "Albumin", "Enterosgel".
With allergic reactions. When taking antibacterial drugs can cause allergic reactions, in addition, scarlet fever can also cause itchy skin. To stop these processes, use antihistamines.
Among the antihistamines can be distinguished: "Claritin", "Suprastin", "Cetrin".
With a high body temperature. It is very important not to lower the body temperature if it does not rise above 38.5 ° C, since Increased body temperature is the response of the body to the disease microflora, so that it literally “burns out” the infection. If the temperature is above 38.5 ° C or is present in a patient for more than 4 days, then you should consult a doctor.
Among the lowering body temperature drugs can be distinguished: "Paracetamol", "Ibuprofen", "Diclofenac", "Nimesil".
The above drugs have an age limit.
It is better for children to lower the temperature with the help of wet cool compresses - on the forehead, neck, wrists, underarm area, calf muscles, “acetic socks”.
With nausea and vomiting can be applied: "Motilium", "Pipolfen", "Zerukal".
Prevention of scarlet fever
Prevention of scarlet fever includes the following preventive measures:
- with outbreaks of infection in kindergarten or school, leave the child in your care,
- in the autumn-winter-spring period, supplement your body with vitamins and trace elements - fresh vegetables and fruits, as well as vitamin complexes,
- follow the rules of personal hygiene,
- Teach your child not to touch his face, nose or mouth with unwashed hands, for example, while walking on the street,
- Avoid large gatherings of people during public outbreaks, public transport, places of public festivals / recreation in closed areas during an outbreak of ORZ
- Do not allow hypothermia,
- do not use at work or other places common dishes for drinking or food - a bottle, mug, plate, tableware,
- if there is scarlet fever at home, provide him with personal use of kitchen and tableware, bedding and bath accessories,
- when communicating with someone, try to keep a certain distance, so that when you talk, the interlocutor's saliva cannot reach your face,
- после выздоровления от скарлатины, детям дошкольного возраста и первых двух классов школ можно помещать учебные заведения только спустя 12 дней,
- ventilate the room where you often stay, and also do a wet cleaning in it, at least 3 times a week,
- if the house has an air conditioner, an air cleaner, there is a vacuum cleaner, do not forget to clean them periodically, because their filters eventually become the place of residence and reproduction of various infections,
- try to move more, so that the blood in your body is always perfectly circulating,
- avoid stress, if necessary, change jobs,
- do not leave the disease to chance so that they do not become chronic.