Scarlet fever

Scarlet fever - acute airborne anthroponosis, affecting mainly children under 10 years; Characterized by fever, general intoxication, sore throat and small-to-small rash. The morbidity rises in the autumn-winter months.

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

Symptoms, course. The incubation period lasts 5-7 days. The disease begins acutely. The body temperature rises, there is severe malaise, headache, pain when swallowing. A typical and persistent symptom of angina, characterized by a bright hyperemia of the soft palate, an increase in tonsils, lacunae or on the surface of which plaque is often found. Upper neural lymph nodes are enlarged, painful. Often there is vomiting, sometimes repeated. In the 1st, less often on the 2nd day, a bright pink or red small-point rash appears on the skin of the entire body. The nasolabial triangle remains pale (Filatov's symptom); White dermographism; In the limb folds, spot hemorrhages are common. The rash lasts from 2 to 5 days, and then pale, while the body temperature decreases. In the second week of the disease, skin peeling appears - lamellar on the distal parts of the limbs, small and coarse-coarse - on the trunk. The tongue is at first covered, from the 2nd to 3rd day it is cleared and by the 4th day it takes on a characteristic appearance: a bright red color, sharply protruding papillae ("crimson" tongue). In the presence of severe intoxication, the CNS is affected (excitation, delirium, obscuration of consciousness). At the beginning of the disease symptoms of an increase in the sympathetic tone are noted, and from the 4th-5th day, the parasympathetic nervous system.

With a mild form of scarlet fever intoxication is poorly expressed, fever and all other manifestations of the disease disappear by the 4-5th day; This is the most frequent variant of the current course of scarlet fever. The moderate form is characterized by greater severity of all symptoms, including intoxication; The febrile period lasts 5-7 days. The severe form, now very rare, occurs in two main variants: toxic scarlet fever with pronounced intoxication phenomena (high fever, symptoms of CNS involvement - darkening of consciousness, delirium, and in young children convulsions, meningeapic signs), all symptoms from the side Throat and skin are pronounced; Severe septic scarlet fever with necrotic angina, violent reaction of regional lymph nodes and frequent complications of septic order; Necroses in the throat may be located not only on the tonsils, but also on the mucous membrane of the soft palate and pharynx. Toxico-septic scarlet fever is characterized by a combination of symptoms of these two variants of severe form. Atypical forms of the disease include erased scarlet fever, in which all symptoms are expressed rudimentary, and some are completely absent. If the entrance gates of the infection is the skin (burns, injuries), then there is an extrafarinating, or extra-buccal, form of scarlet fever, in which such an important symptom as angina is absent. With mild and worn out forms of scarlet fever, changes in peripheral blood are small or absent. With moderate and severe forms, leukocytosis, neutrophilia with a nuclear shift to the left and a significant increase in ESR are observed. From the 3rd day of the disease, the content of eosinophils increases, but with a severe septic form, their decrease or complete disappearance is possible. Complications: glomerulonephritis (mainly in the third week), synovitis, the so-called infectious heart, less often myocarditis. If there is a septic component of the disease, purulent complications can occur: lymphadenitis, adenophlegmon, otitis, mastoiditis, sinusitis, septicopyemia. Possible pneumonia. Relapses of scarlet fever and recurrence of angina are associated with streptococcal reinfection. In recent decades, the frequency of complications has dramatically decreased. After the transferred scarlet fever, as a rule, lifelong immunity is preserved. However, the frequency of repeated diseases has recently increased somewhat.

Difficulties in recognition arise when atypical forms of the disease. Differentiate should be from measles, rubella, drug rash, scarlet fever-like form of pseudotuberculosis. There are cases of staphylococcal infection with a scarlatina-like syndrome. Treatment. If appropriate, the therapy is carried out at home. Hospitalized patients with severe and complicated forms of scarlet fever, as well as by epidemiological indications. Bed rest for 5-6 days (and longer in severe cases). Antibiotics are administered: prescribe benzylpenicillin at a rate of 15,000-20,000 units / (kg. Day) IM for 5-7 days. At home, with a light form of scarlet fever, you can use phenoxymethylpenicillin inside, doubling the indicated daily dose. When toxic form in hospital conditions, intravenous infusions of neocompensan, hemodeza, 20% glucose solution with vitamins are used. The septic form shows intensive antibiotic therapy. Treatment of complications (lymphadenitis, otitis, nephritis) is carried out according to the usual rules.

The prognosis is favorable.

Prevention. The patient is isolated at home or (according to indications) hospitalized. Chambers in the hospital are filled in at the same time within 1-2 days, excluding contacts of convalescents with patients in the acute period of scarlet fever. Convalescents are discharged from the hospital in the absence of complications on the 10th day of the disease. In a children's institution, convalescent is admitted on the second day after the disease. Children who were in contact with the patient and who had not previously had scarlet fever were admitted to the pre-school or the first two classes of the school after 7 days of isolation at home. In the apartment where the patient is kept, regular ongoing disinfection is carried out, under these conditions the final disinfection is unnecessary.