What is scarlet fever and why is it dangerous. Scarlet fever

20.10.2019 -

Baby infections- the most common problem that parents face as the baby grows and develops. These diseases are very dangerous, because untimely treatment leads to the fact that they take on the character of an epidemic. One of the few is scarlet fever- streptococcal disease, which may be accompanied by intoxication, sore throat and the appearance of a rash.

Scarlet fever is a common infection, the source of which is a sick person or her carrier. The most dangerous are patients who are affected by the nose, pharynx, mouth and other Airways.

Disease transmitted by airborne droplets. The spread of this infection is increased by coughing or sneezing. Group A streptococcus is transmitted by dusty air, contact with a patient or finding a source of infection in a large group of children. Also, the spread of streptococcus can occur through toys, various objects. Foodborne contamination cannot be ruled out. Mainly through dairy products.

Susceptibility to this disease is high in younger age. Newly born children have high titer streptococcal antitoxin, which they acquire from their mother. For this reason, in the first 3-6 months of life, children are practically not susceptible to scarlet fever. Intensive disease occurs at the age of 3 to 8 years. Moreover, it also affects climate where the child lives: in regions with a damp and cold climate, scarlet fever is very common, less often in hot places, in the tropics they don’t even know about this disease.

Why is this disease dangerous?

The infection most often spreads through palatine tonsils. less often streptococcus enters the body through wounds and burns, in extreme cases - through the respiratory tract. When a microbe enters, a pathological process begins to develop, which can be divided into separate syndromes: toxic, septic and allergic.

Toxic syndrome is formed as a result of influence on the body toxic substances streptococcus. Its development occurs in the first few hours after infection and is accompanied by fever, feeling unwell, rash, reaction lymph nodes, disruption of the cardiovascular system.

Septic syndrome occurs when exposed to microbial factors and is manifested by inflammation of the throat, which quickly turns into a purulent form.

Allergic syndrome is caused by certain substances of streptococcus, causes the development of allergic complications. In most cases, they appear at the 2nd week of illness, at the same time a new streptococcal process occurs in the child.

Manifestation of scarlet fever.

Scarlet fever is cyclical with distinct periods:

incubation period.

It can vary from several hours to 7 days, most often it is 2-4 days.

Initial period.

Time from the appearance of the first signs disease before the formation of a rash - can be from several hours to 1-2 days. This period is accompanied by intoxication and tonsillitis. Intoxication is manifested by an increase in temperature, the occurrence of headache, vomiting and palpitations. Angina expressed by sore throat, redness in the mucous membranes and tonsils, swollen lymph nodes.

Eruption period.

Appears rash on skin that lasts for 4-5 days. First comes the heat stage, which lasts 1-2 days, then the symptoms decrease, which is caused by the extinction stage.

The rash is small. In the early days she is quite abundant, bright red. The rash is localized on the neck, chest, abdomen, thighs and legs. In places of folds, the rash is stronger and stays much longer than on other parts of the body.

In addition, scarlet fever can be easily detected by external changes child: the nasolabial triangle becomes very pale, the cheeks acquire a bright blush, and the lips become cherry in color.

It also changes the view language baby. In the first days of the disease, it has a white coating, then after a few days it begins to clear, on the fifth day the tongue takes on a crimson appearance. This is due to hypertrophy of the papillae.

Recovery begins in the second week of illness. After 1.5-2 weeks the child is practically healthy. Scarlet fever reminds of itself only by peeling of the skin and a change in the tongue.

Treatment of scarlet fever.

Treatment carried out both at home and in the hospital. Hospitalization is carried out only in cases serious condition child if the child is under three years of age and if quarantine at home is not possible. During the entire illness, bed rest should be observed. In addition, there must be diet appropriate for the age of the child.

All patients with scarlet fever undergo antibacterial therapy. With streptococcus, antibiotics must be prescribed so as not to damage the heart and kidneys. In most cases, the doctor recommends the use of penicillin and similar preparations, which are administered intramuscularly or intravenously for two weeks.

If scarlet fever took more than severe form, carried out detoxification therapy, in which the administration of a solution of glucose, albumin, rheopolyglucin and hemodez is prescribed.

Timely detected scarlet fever and correctly prescribed treatment very quickly help to cope with the disease without development subsequent complications.

Should Russians be afraid of an epidemic of scarlet fever, the site found out.

This cold February turned out to be hot for reports of infections:, anthrax in Turkey, flu in the USA. Among other things, in the UK there is a serious outbreak of scarlet fever, about which Rospotrebnadzor warned the Russians.

A warning will not be superfluous even for those who are not going to England or Wales, because scarlet fever is not uncommon in our area. Although many read about it only in books, where they wrote about this disease as fatal. Let's see what is in reality.

Like angina, but with features

Scarlet fever is quite common in children. Causes it, like sore throats, pharyngitis, some skin diseases, group A beta-hemolytic streptococcus. Scarlet fever is very similar to angina, however, except for high temperature and sore throat, it also manifests itself small rash all over the body, which lasts for several days, sometimes itches, and finally flakes off. Another characteristic feature is first "strawberry" (white with red dots), and then just a red tongue. At the same time, a blush appears on the face. Actually, with Latin name This disease is translated as “red color”.

Very contagious

Scarlet fever is highly contagious and its pathogen is very persistent. It is transmitted by airborne droplets, so a sick child (or a healthy child) must be isolated. Quarantine in this case - with washing hands and toys, separate dishes, wet cleaning and a protective mask if you have to go out public places. While fever, it is better to lie down. Sometimes you have to lie in the hospital - unfortunately, scarlet fever can be severe or with a serious threat of complications.

Children get sick more often

Most often, scarlet fever affects children under 10 years of age. With adults, this happens much less often - their body is stronger, less risk infections, in addition, many have already been ill in childhood (often without knowing it) and have immunity. Unfortunately, there is no vaccine or any other prevention in the case of scarlet fever - fortunately, there is a treatment.

Need antibiotics

Scarlet fever is treated with antibiotics. Actually, including their invention turned this disease from a deadly one (100 years ago, every fifth sick person died!) Into a “children's” infection. Ideally, antibiotics should be prescribed after testing for hemolytic streptococcus, but in reality, a doctor can only make a diagnosis based on symptoms. By the way, scarlet fever is the only streptococcal infection that is subject to control: that is, the doctor is obliged to notify the surveillance authority about it. There is also quarantine: for those who have been ill - another 12 days after recovery, for healthy children from families where scarlet fever was found, or for kindergarteners, if someone in the group was diagnosed with such a diagnosis - 7 days.

The material was published in the publication "Interlocutor" No. 09-2018 under the heading "Blush from scarlet fever."

- it's sharp infection which are more common in children of preschool and school age. At proper treatment and proper care, the disease is treated for 2-3 weeks. The disease is not severe, but the complications of scarlet fever are dangerous.

The causative agent of the disease is the streptococcus bacterium. Getting on the mucous oral cavity or damage to the skin, it produces erythrogenic toxins that cause general intoxication of the body and a scarlatinal rash. The disease is highly contagious - upon contact with a sick person, infection occurs with a high probability.

The infection spreads as follows:

Scarlet fever is transmitted through the air

Airborne, during a conversation, sneezing, coughing.
Contact, when using common subjects life.
Alimentary - through contaminated food.

The threat of infection comes from a human carrier and patients with streptoderma, tonsillitis or other streptococcal infections. It is believed that they become infected with scarlet fever once in a lifetime. But if a person has a weakened immune system, he can get sick again.

The development of complications after scarlet fever in children

Previously, complications from scarlet fever led to the death of the patient. Now lethality is reduced to almost zero.

There are early (immediate) and late (remote) secondary complications. The appearance of the first is directly proportional to the severity of the course of scarlet fever. Usually they are observed in its toxic-septic form. Complications arise due to the action of enzymes that produce hemolytic streptococcus. With their help, pathogens are able to devour healthy tissue and spread unhindered.

The occurrence of late complications does not depend on the severity of symptoms and is usually the result of allergic complications that arise due to the action of toxins. As an immune response, the number of antibodies necessary to fight the infectious agent increases. After recovery, they remain and circulate through the bloodstream until they are utilized by the body. Their excess "attacks" the cells of the heart, kidneys, brain, joints.

It is noticed that secondary pathologies occur less frequently in adolescents than in young children.

Early Complications

Already in the active phase of the disease, such secondary diseases develop:

With an early complication of scarlet fever, otitis media develops

or catarrhal.
Inflammation of the sinuses (). The reason is the migration of bacteria along the ascending path from the oropharynx.
Pneumonia. It occurs as a result of the spread of microbes into the lower respiratory tract.
Toxic damage to the heart (starting from the second week). It increases, blood pressure decreases, heart rate slows down.
Purulent (necrotic) lymphadenitis. Fever is observed, lymph nodes increase and become painful, suppuration occurs without treatment.
Scarlet rash in the mouth leads to inflammation of the mucosa, the appearance of ulcers - it develops.
Throat abscess.
Phlegmon of the neck.
Damage to blood vessels. They become brittle and may bleed. The most dangerous of them is the brain.
Meningitis. Occurs as a result of the spread of infection in scarlet fever.

Immediate complications relate mainly to organs and tissues located close to the tonsils, and are of an infectious nature.

Late Complications

Remote secondary pathologies occur when the symptoms of scarlet fever already disappear:

body temperature normalizes;
peeling of the skin takes place.

But there are cases when complications appeared after a few months and years.

Remote pathology, or allergic complications, include several processes.

It appears 2 weeks after streptococcal tonsillitis. There is pain in the joints of the extremities. The joints swell, increase in size, the skin around them turns red, and the temperature rises locally. Over time, rheumatic heart disease may develop.

Appears after recovery. It has symptoms similar to rheumatism of the joints. Arthritis usually resolves without causing sequelae.

This phenomenon is irreversible. Blood circulation is disturbed, which leads to heart failure. More often such problems are observed in boys.

It is dangerous because it is the beginning of the development of rheumatism of the heart. The disease is long-term, causes heart disease.

Affecting the functioning of the brain. Manifested in uncontrolled movements of the limbs. The disease may remain for life, but may be reversible.

It occurs 3-4 weeks after the onset of the disease. Back pain, swelling, oliguria appear, the temperature rises again. More often, glomerulonephritis occurs in boys, it is treated strictly in a hospital, because it can turn into chronic stage and end in death.

Repeated relapse occurs after recovery as a result of contact with the pathogen.

Prevention of complications

dangerous because the heart, blood vessels, kidneys are affected. Brain malfunctions, diseases

Scarlet fever is an acute infectious disease, manifested by a small punctate rash, general intoxication of the body, fever, tonsillitis. The causative agent of the disease is group A streptococcus.

The disease is very contagious, and is transmitted from patients and carriers by airborne droplets (when sneezing, coughing, talking), and through household items (toys, dishes, underwear). At the same time, it is almost impossible to prevent infection.

Scarlet fever: causes of the disease

The causative agent of the disease, as already mentioned, is group A streptococcus, which is also the cause of other streptococcal infections - tonsillitis, chronic tonsillitis, rheumatism, acute glomerulonephritis, streptoderma, erysipelas and other equally dangerous diseases.

How does scarlet fever work?

Toxigenic group A beta-hemolytic streptococcus usually colonizes the nasopharynx, sometimes the skin, provoking local inflammatory changes (tonsillitis, regional lymphadenitis). The exotoxin produced by it causes symptoms of general intoxication (poisoning) and exanthema in the body.

At favorable conditions for the growth and reproduction of microbes, streptococcus causes a septic component, which is manifested by otitis media, lymphadenitis, septicemia. An important role in the development of pathologies of the disease is played by allergic mechanisms, which are involved in the occurrence and development of complications manifested in late period diseases. Often, the development of scarlet fever complications is directly related to reinfection or streptococcal superinfection.

Where is the source of infection?

"Reservoir", the source of infection is a person who is sick with tonsillitis, scarlet fever or other clinical forms of streptococcal respiratory infection. And, besides, scarlet fever, the reasons for its spread are "healthy" carriers of the infection - group A streptococci.

For others, the patient is most dangerous in the early days of the disease. Contact with him becomes relatively safe most often after 3 weeks from the onset of the disease - that is, all 3 weeks, he is contagious to others. As for carriers of group A streptococci, this is a widespread phenomenon among the population (according to statistics, 15-20% of the average healthy population are carriers). Many of the carriers, without even suspecting it, are able to isolate the causative agent of infection over a very long time period - months and even years, being carriers.

Mechanism of distribution of scarlet fever.

The mechanism of infection transmission is aerosol, airborne. As a rule, infection occurs in the case of prolonged close contact with a carrier or a patient. Possibly also infected by contact(through household items and contaminated hands) and alimentary infection (through food).

Scarlet fever has a high prevalence, because the natural susceptibility of people to this infection is very high. Scarlet fever occurs in people who do not have antitoxic immunity when they "catch" toxigenic strains of bacteria that produce erythrogenic toxins such as types A, B, and C. After past infection In the body, type-specific immunity is produced, that is, a person will not be infected again with this infection. However, if there is an infection with group A streptococci, but a slightly different serovar, as they say, re-infection is possible.

The main epidemiological signs of scarlet fever.

The disease is ubiquitous, but most common in regions where the climate is temperate and cold, that is, in our latitudes. Basically, the overall level of the disease and its dynamics, assessing the long-term and monthly incidence of scarlet fever, determines exactly scarlet fever in children. preschool age who attend organized groups: kindergartens, educational groups, circles, etc. Every year, scarlet fever in children attending children's institutions occurs more often 3-4 times than in children who are brought up at home. This difference is most pronounced in children of the first 2 years of their lives - the level of the disease is 6-15 times higher, and already among children of 3-6 years of age it is less noticeable. In these same age groups the highest indicators of the so-called "healthy" bacteriocarrier are also observed.

Characteristic of scarlet fever is the connection with diseases preceding it, in particular, with tonsillitis and other respiratory streptococcal infections. Most high level incidence occurs in the autumn-winter-spring period.

What happens when you get infected with scarlet fever

Through the mucous membranes of the nasopharynx and throat, this pathogen enters the human body, in rare cases, infection occurs through damaged skin or mucous membranes of the genital organs.

An inflammatory-necrotic focus is formed at the site of bacteria colonization. Infectious intoxication (poisoning) develops primarily due to the entry into the blood of erythrogenic streptococcal toxin (in medicine - Dick's toxin), and the action of peptidoglycan cell wall. Subsequently, this leads to an expansion in all organs of small vessels, including mucous membranes and skin resulting in a characteristic rash.

In the future, the body synthesizes and accumulates antitoxic antibodies that bind the toxins of the infection, and the manifestations of toxicosis decrease, and the rash gradually disappears. In places of the rash, the skin becomes horny, a crust forms, and after the extinction of the scarlatinal rash, the skin peels off. The connection of keratinized cells in the thick layers of the skin is quite strong, so the peeling on the palms and soles has a large-lamellar character.

Scarlet fever in adults and children: possible complications of the disease

Most frequent complications scarlet fever is necrotic and purulent lymphadenitis, purulent otitis media, and in addition, infectious-allergic complications that often occur when scarlet fever in adult patients, in the form of diffuse glomerulonephritis, myocarditis. Possible further inflammation of the paranasal sinuses, middle ear, rheumatism.

Scarlet fever in adults and children, as a result, often provokes the development of hypersensitivity, fixation and formation of immune complexes, autoimmune reactions, disorders of the hemostasis system. In most cases, these manifestations are the cause of the development of arteritis, glomerulonephritis, endocarditis and other immunopathological complications.

From the lymphatic formations located in the mucous membrane of the oropharynx, streptococcal pathogens enter the regional lymph nodes through the lymphatic vessels. There they accumulate, accompanying their reproduction. inflammatory reactions with necrotic foci and foci of leukocyte infiltration. If you do not stop the development of the disease on this stage, subsequently, in some cases, this may lead to penetration pathogens in different organs and systems of the body, to the formation of purulent-necrotic processes in them. All this can eventually result in purulent lymphadenitis, otitis media, in lesions of bone tissue in the area of the temples, temporal sinuses, hard meninges, etc.

Scarlet fever: symptoms of caring

The incubation period of scarlet fever can last from 1 to 10 days. The typical symptoms of scarlet fever are an acute onset of the disease, sometimes in the very first hours of the illness, an increase in body temperature occurs to high numbers, up to 40 degrees. Accompanying symptoms of scarlet fever are malaise, headache, weakness, tachycardia, sometimes abdominal pain. When high fever in the first days of the disease, patients are overly excited, mobile and euphoric, or, on the contrary, incredibly lethargic, drowsy and apathetic. Due to severe intoxication of the body, vomiting often occurs. However, it should be emphasized that the modern course of scarlet fever may differ in the absence of a high body temperature.

Scarlet fever: symptoms of inflammation of the larynx.

Very quickly there is a pain in the throat when swallowing. brightly pronounced signs scarlet fever, which does not allow it to be confused with a sore throat and other diseases similar in symptoms, is a bright diffuse hyperemia of the tonsils, arches, soft palate, uvula and posterior pharyngeal wall, the so-called “flaming pharynx”, which cannot be overlooked when examining patients. Hyperemia is much more intense in scarlet fever in children and adults than in cases of ordinary catarrhal angina, while it is sharply limited where the mucous membranes pass to the hard palate.

It is also possible to form follicular-lacunar tonsillitis: on enlarged, highly loosened and hyperemic tonsils, mucopurulent, sometimes fibrinous deposits or even necrotic, are formed in the form of separate and widespread foci. At the same time, regional lymphadenitis develops; on palpation, the anterior cervical lymph nodes are dense and painful.

Diagnosis of scarlet fever does not pose any difficulties by the 4-5th day of illness. Since the tongue, which was first coated with a grayish-white coating, by this time is cleared, becoming bright red, rather even raspberry, with hypertrophied papillae. That is, the most striking symptom of scarlet fever is the “crimson tongue”. In cases heavy flow scarlet fever, such a "raspberry" color is also noted on the patient's lips. By the same period of time, the signs of angina begin to regress, although the disappearance of necrotic raids occurs much more slowly.

Scarlet fever also appears on the cardiovascular system, accompanied by tachycardia against the background of a moderately increased blood pressure.

Symptoms of scarlet fever: scarlatinal exanthema.

Scarlet exanthema, as doctors call it, or simply a rash, appears on the 1-2nd day of illness. Rash is very important diagnostic sign scarlet fever. First, small-dotted elements appear on the skin of the face, neck, and also the upper body, after which the rash rapidly spreads to all surfaces of the folds of the limbs, to the inner surface of the thighs, to the sides of the abdomen and chest. In most cases, white dermographism is clearly visible.

A characteristic feature of scarlet fever is a thickening of the rash in places of natural folds on the folds of the skin in the form of dark red stripes, for example, in the elbows, armpits, inguinal folds (Pastia's symptom). In places, finely punctate abundant elements can merge completely, creating a picture of continuous erythema.

The rash on the face is usually located on the cheeks, and to a much lesser extent - on the temples and forehead. At the same time, the nasolabial triangle is absolutely free from rash and is characterized by pallor (Filatov's symptom).

A characteristic sign of scarlet fever is also a “symptom of the palm” - when pressed with the palm of the hand on the skin, the rash temporarily disappears in this place.

As a result of increased fragility of blood vessels, small pinpoint hemorrhages are possible on the skin in places of articular folds, and friction or squeezing of the skin by clothing. For scarlet fever, the symptoms of gum and tourniquet (Konchalovsky-Rumpel-Leede) are also characteristic. In some cases, the typical scarlet fever rash may be filled with small vesicles and maculo-papular elements.

Among other things, the rash may appear late, only on the 3-4th day of illness, or not appear at all.

As a rule, by the 3-5th day the patient's state of health improves significantly, the body temperature gradually begins to decrease. The rash turns pale, gradually disappearing and changing by the end of the first week, the beginning of the 2nd, finely scaly peeling of the skin (large-lamellar peeling on the soles and palms).

The intensity of the rash and the timing of its disappearance vary. Sometimes, in cases of a mild course of the disease, a scanty rash disappears just a few hours after its appearance. As for the severity of skin peeling and its duration, it directly depends on the abundance of the preceding rash.

"Special" forms of scarlet fever

There are three main forms of scarlet fever, which differ in foci, symptoms and course of the disease, from a common disease.

Extrabuccal scarlet fever.

Currently, this form of the disease is quite rare. The gates of infection in this case are the places of skin lesions - wounds, burns, foci of streptoderma, and so on. The rash spreads throughout the body from the place where the pathogen has taken root. Another feature of this form of the disease is the absence of inflammatory changes in the oropharynx and cervical lymph nodes.

Erased forms of scarlet fever.

Such scarlet fever in adults is most common. Erased forms of the disease are characterized by mild general toxic symptoms, changes in the oropharynx of a catarrhal nature, a scanty, pale and quickly disappearing rash. At the same time, scarlet fever in adults can sometimes take place in very severe form, the so-called toxic-septic.

Toxic-septic scarlet fever.

This form of the disease rarely develops, fortunately, and, as a rule, it is scarlet fever in adults. It is characterized by a rapid onset with hyperthermia, rapid development vascular insufficiency(threaded pulse, drop in blood pressure, muffled heart sounds, cold extremities), often with the appearance of hemorrhages on the skin. In the following days, infectious-allergic complications (damage to the heart, kidneys, joints) or septic complications (otitis media, lymphadenitis, necrotic tonsillitis, etc.) join these symptoms.

Scarlet fever and pregnancy

During pregnancy, a woman can just as well become infected with scarlet fever, as in any other period of her life, because contact with a carrier or patients with scarlet fever is quite likely. Scarlet fever during pregnancy threatens any woman who does not have specific immunity for this infection.

Scarlet fever and pregnancy: symptoms.

As for the question "scarlet fever and pregnancy, symptoms", they are the same as in all other cases. And they depend on the degree, complexity of infection and the course of a particular form of the disease. I.e:

1. fever, fever;
2. malaise, headache, weakness, tachycardia;
3. intoxication of the body (scarlet fever during pregnancy is often marked by vomiting);
4. sore throat, "flaming throat";
5. development of symptoms of purulent tonsillitis;
6. "crimson tongue";
7. characteristic rash.

Effect of scarlet fever on pregnancy.

Scarlet fever during pregnancy is an unpleasant and unsafe phenomenon. First of all, because scarlet fever is treated mainly with antibiotics, which is completely unacceptable during pregnancy, especially in the first trimester. During the formation of the fetus, antibiotics are strictly contraindicated, since pathological deviations are possible in the development of the organs of the future man.

The effect of scarlet fever on pregnancy in its early stages often results in spontaneous abortion or simply miscarriage. Scarlet fever during later pregnancy proceeds with more optimistic prognosis. In the second trimester, antibiotics are already allowed, but one way or another, after the recovery of the potential mother, additional fetal ultrasound and tests will be required.

The negative impact of scarlet fever on pregnancy can result in problems such as premature pregnancy, intrauterine hypoxia of the fetus, complications during childbirth, pneumonia in the newborn.

However, sensitivity to this pathogen, that is, the risk of getting sick, decreases significantly after 20 years. In addition, immunity after once suffering scarlet fever is quite persistent, which means that if a woman was once sick with scarlet fever, then there is, in fact, nothing to be afraid of - the same pathogen will not take her a second time.

Scarlet fever and pregnancy: treatment.

Scarlet fever is treated with antibiotics penicillin series, erythromycin, not contraindicated in pregnant women after 12 weeks.

As a rule, the treatment of scarlet fever during pregnancy consists of strict bed rest in the first week of illness and a sparing diet. Mandatory is plentiful drink to quickly remove toxins from the body. Also for the treatment of scarlet fever during pregnancy is prescribed local therapy in the form of gargles with a solution of furacilin, calendula, decoction of chamomile, eucalyptus and other natural substances.

If necessary, treatment of scarlet fever during pregnancy with antibiotics is prescribed, the safest for use during pregnancy. In addition, the obligatory intake of vitamin and restorative preparations is recommended.

Scarlet fever itself does not affect the condition of the fetus, moreover, the disease mild form, does not threaten anything and the condition of a pregnant woman, too.

Thus, for the health of a woman and a baby, in the vast majority of cases, the prognosis is favorable. However, the obligatory supervision of a specialist and the determination of the tactics of therapy and management of pregnancy in the future are required.

Diagnosis of scarlet fever

It is important to distinguish scarlet fever from measles, rubella, medicinal dermatitis, pseudotuberculosis. In rare cases, it is necessary to differentiate the development of fibrinous deposits, especially when they go beyond the tonsils, from diphtheria.

Medical checkup.

Main features scarlet fever for medical examination- This:

1. "flaming pharynx" (diffuse bright hyperemia of the oropharynx), which has a sharp limitation in the place where the mucous membrane passes to the hard palate;
2. "crimson tongue" - bright red, even crimson tongue with hypertrophied papillae;
3. elements of the rash are small-pointed, thickening of the rash in the places of folds and on skin folds in the form of dark red stripes;
4. pronounced distinctly white dermographism;
5. "symptom of the palm" - when pressing the palm on the skin, the rash disappears for a while, positive endothelial symptoms;
6. pallor of the nasolabial triangle;
7. after the disappearance of the rash, in its place appears finely scaly skin peeling or large-lamellar on the soles and palms.

Laboratory diagnosis of scarlet fever.

Diagnosis of scarlet fever in the laboratory is carried out using a blood test. Note hemogram changes that are typical bacterial infection: leukocytosis, increase in ESR, neutrophilia with a shift to the left of the leukocyte formula.

Direct isolation of the pathogen is extremely rare, since it is very characteristic and remarkable clinical picture diseases, and the spread of bacteria in healthy people and patients with other forms of streptococcal infection is very wide. For express diagnosis of scarlet fever, RCA is used, which detects streptococcal antigens.

Scarlet fever treatment

Treatment is carried out mainly at home, in the same way as with angina. You can learn in detail about the methods of treating scarlet fever in the article:.

Only patients who have a severe and moderate form of the disease are subject to hospitalization. Also hospitalize those who have children in the family from 3 months to 7 years of age and elementary school students who had not previously suffered from scarlet fever. This is done in order to prevent and prevent infection with scarlet fever in the family.

A patient with scarlet fever must be isolated in a separate room from the rest of the family. He should have separate tableware, towels, etc.

Isolation of the patient can be stopped after recovery, but not earlier than 10 days from the onset of the disease. As for visiting children who have had scarlet fever, pre-school and primary school institutions, it is allowed only after additional isolation of the child at home for 12 days after recovery.

Children who were in contact with the patient, but did not themselves suffer from scarlet fever, are not allowed into the team for a week after contact, and if they stayed with the patient for the entire period of illness, then isolation from the team should last up to 17 days.

A little more about scarlet fever in children:

Most people in in general terms heard about such a disease as scarlet fever, but even with the current level of medicine, it is worth learning more about it. What is scarlet fever that it causes so dangerous symptoms. This acute infectious disease mainly affects the oropharynx, while there is severe intoxication of the body and a specific rash. The “culprit” of scarlet fever is group A streptococcus, which spreads by airborne droplets and contact routes. Typical symptoms are tonsillitis, regional lymphadenitis, fever, and a rash followed by flaky skin.

The disease was already known to Hippocrates, for the first time scarlet fever, what it became clear and described in detail in the middle of the 16th century.

Children are very susceptible to scarlet fever: the majority of cases are children from one to nine years old (susceptibility to infection among them is up to 40%). It is easier to get infected with scarlet fever in a team: children in kindergarten and school get sick 3-4 times more often than children who do not attend them. At the same time, this disease is not typical for infants and adults. Children under 3 months old practically do not get sick with scarlet fever - for this they still have insufficiently mature immunity, in them infection with streptococcus causes mainly pneumonia.

There are several factors that multiply the risk of getting sick:

low immunity;
lack of vitamins;
low hemoglobin (with iron deficiency anemia);
high stress on the body (including mental).

Scarlet fever is caused by group A beta-hemolytic streptococcus. It can also cause sore throat, rheumatism, acute glomerulonephritis, streptoderma ... Which of them will develop in each case will depend on the interaction of streptococcus and the child's body.

The danger is not only a patient with scarlet fever, but also any carrier of streptococcal infection. In fact, there are quite a lot of carriers of streptococcus A: about 15–20% of people excrete it for months and even years, although outwardly they are completely healthy. The most dangerous are slightly ill children in contact with healthy ones, and adults with angina, since quite often angina is caused by the same microbe as scarlet fever.

Streptococcus is spread by aerosol. A child can excrete it while coughing or even talking, so the infection is mainly transmitted by airborne droplets. However, the causative agent of the disease settles on objects, so another way of transmission is important in the children's team - household (through shared toys, towels, etc.). Another possible route is through damaged skin. If streptococcus inoculates foods, the infection passes into the child's body with food.

After infection incubation period lasts from several hours to 12 days. The child is most contagious in the first 10 days of his illness, and 20 days after the appearance clinical symptoms the risk of infection disappears. Immunity to scarlet fever is usually lifelong, but will not protect against other diseases caused by streptococcal infection.

The disease of children with scarlet fever can be called seasonal: in the cold season, there are much more cases, since the immune system is weakened. Doctors also note the connection of scarlet fever with streptococcal tonsillitis and pneumonia.

Children get scarlet fever all over the world. The incidence of scarlet fever is characterized by periodicity, and epidemic outbreaks of scarlet fever have periodically occurred in the past. The short-term interval between rises is 2-4 years. At the same time, researchers also talk about longer time intervals (about 50 years), when the number of infected people is much more significant.

One of the well-known descriptions of scarlet fever is as follows: “At times there are periods of exceptionally benign or only malignant epidemics of scarlet fever. Mortality in malignant epidemics is 13-18%, but often rises to 25% and even reaches 30-40% ”(F. F. Erisman). However, in recent decades, doctors have noted that scarlet fever in children is not as severe as it used to be.

Metabolic products secreted by streptococci after entering the child's body act on the local and general level. local action is an inflammation of the mucous membranes or damaged skin at the site of entry of streptococcus. After being introduced into the body, the bacteria enter the lymph nodes and bloodstream with blood and lymph, affecting the cardiovascular, nervous, endocrine and other systems.

Streptococci have a toxic, septic and allergic effect on the child's body:

Specific intoxication is characteristic of all cases of scarlet fever at the onset of the disease, although its degree may vary significantly;
Septic manifestations - purulent and necrotic changes - are due to the influence of streptococcus itself. They can occur even with a relatively mild onset of the disease. Sometimes the septic effect becomes the main one from the first days - in the form of early purulent lymphadenitis, adenophlegmon, damage to the paranasal sinuses and other complications.
Allergic action is caused by sensitization of the body to beta-hemolytic streptococcus. It mainly manifests itself in late deadline and represents the so-called allergic waves. Occasionally, an allergy manifests itself initially: in addition to a punctate rash, an urticaria rash forms, the face and eyes become swollen, all lymph nodes increase, and the number of eosinophils in the blood increases.

With a pronounced allergic state of the body, the vessels become more permeable, immunity decreases, and barrier functions are violated. All this leads to the creation of conditions conducive to the penetration of microbes and an increase in septic action. Therefore, all three types of effects of streptococcus on the child's body are closely related.

If the course of scarlet fever is typical, it will not be difficult for the doctor to diagnose it. To fully confirm the diagnosis, the following diagnostic measures are carried out:

during the examination of a sick child, the condition of the skin, oral cavity, anterior cervical lymph nodes is checked, revealing external manifestations diseases, measure temperature, blood pressure;
carry out laboratory research blood to determine the level of neutrophils, eosinophils and ESR;
take a swab from the throat to determine the presence of group A streptococci;
take blood from a vein to find out if there are antibodies to the causative agent of scarlet fever.

At first glance, the clinical picture of scarlet fever is so expressive that it is impossible to make a mistake in the diagnosis. However, practicing pediatricians easily confuse it with rubella, measles, allergies, just a sore throat, and even prickly heat. This is due to the immunity of a particular child. If it is low, the disease can be erased - with virtually no rashes, high fever and severe sore throat. AT similar cases a swab from the pharynx becomes the main one: if group A streptococcus is determined, the diagnosis is considered confirmed.

No matter how easy scarlet fever is, the mainstay of treatment is antibiotic therapy (if the diagnosis is confirmed).

What is dangerous scarlet fever

Streptococcus DNA has a special molecular structure that allows you to very quickly cover the entire body of an infected child. Now there is already information about more than fifty of its strains, and all of them affect not only the mucous membrane of the oropharynx, but also the immune system as a whole. These bacteria can cause acute purulent inflammation, therefore, with scarlet fever, complications in the upper respiratory tract are not uncommon, paranasal sinuses, lymphatic system.

Streptococcus is dangerous because it perfectly adapts to different conditions: maybe long time remain viable when frozen, heated, dried. Boiling, applying disinfectants and ultraviolet.

In the process of life, streptococcus produces special toxins that adversely affect the human body. One of the toxins is able to destroy various cells - blood, mucous membranes, epithelium. The second of them is a very strong allergen that can provoke autoimmune processes that are difficult to correct in the future. Streptococcus bacteria intensively secrete lytic enzymes that have a destructive effect on many tissues in the human body, such as muscle fibers or articular cartilage, which leads to complications in the activity of the musculoskeletal system.

Because of this a wide range The impact of the pathogen on the body of scarlet fever was one of the main causes of infant mortality in the world. This continued until the beginning of the 20th century. After the invention of antibiotics, the death rate from scarlet fever has dropped significantly, and now most often the prognosis for a child with this disease is favorable.

Success in the fight against streptococcal infection provides the use of antibiotics. If they are used early in the course of the disease, the course will be mostly benign, although the possibility of toxic or severe septic scarlet fever cannot be ruled out.

Contrary to popular belief about lifelong immunity, there is a risk of contracting scarlet fever a second time. 2-3% of children are subject to this. Researchers believe that this is due to overly active treatment, when the body fights the disease so rapidly that the immune system simply has no time to form.

If a needed help is not fast enough, scarlet fever can lead to such complications:

damage to the lymph nodes (lymphadenitis);
inflammation of the ear (purulent otitis media);
allergic kidney disease (glomerulonephritis);
joint inflammation (arthritis, synovitis);
heart damage (allergic myocarditis);
inflammation of the lungs (pneumonia).

If a sick child started taking antibiotics at the very beginning and took their full course, the likelihood of complications is quite low. If treatment was not carried out or stopped too early, complications are almost inevitable. The most severe are rheumatic fever with damage to the heart and joints and glomerulonephritis: they begin two to three weeks after scarlet fever, and are mostly hidden.

To prevent this from happening, in addition to taking antibiotics, other measures must be observed:

bed rest until the temperature returns to normal;
drinking plenty of water to remove toxins from the child's body;
special diet (mashed and warm food, rich in vitamins, but with limited protein).

Even if the child feels quite normal, it is worth limiting contact with other people for two to three weeks: this will also protect him from complications.

If suddenly complications arise, it is necessary to consult specialized doctors:

a cardiologist if there are complaints about the work of the cardiovascular system (you may also have to do an ultrasound of the heart and an ECG);
otolaryngologist, if otitis has appeared;
urologist, if there are complaints about the state of the urinary system (sometimes ultrasound of the kidneys is necessary).

In order to detect such delayed complications on early stage, doctors recommend about a month after the child's recovery to examine him (at least, make an ECG and pass general analysis urine).

By the way, it has been noticed that in the youngest children there are mainly purulent complications, and in older children - allergic ones.

Unfortunately, there is no vaccination against scarlet fever yet, so all preventive measures come down to two directions. The first is strengthening the immune system and observing the rules of personal hygiene so as not to become infected by contact with a patient or a carrier of hemolytic streptococcus. The second is the observance of quarantine by a sick child, so as not to infect others.

A sick child should not visit the team and generally contact with strangers. He needs to allocate separate dishes, towels, and other personal hygiene items. Family members are encouraged to wash their hands frequently and diligently with soap and water. Clothes, bedding after the recovery of the child must be washed in hot water, toothbrush - replace.

In general, a sick child will not become dangerous to others a day after the start of antibiotics, but due to the vulnerability of the body, it is still better to limit contact with others.

Development of scarlet fever

The peddler of scarlet fever is exclusively a person; it is impossible to catch this disease from animals. The danger may come from the patient in various ways. respiratory diseases, which are based on streptococcal infection (most often - tonsillitis or scarlet fever). Also able to infect a carrier of group A streptococcus, even if he does not have any clinical manifestations diseases. For the most part, children become infected in the garden or school, for a long time and closely communicating with each other.

The main route of invasion of scarlet fever bacteria into the body is the upper respiratory tract, or rather, their mucous membranes. Where streptococcus has invaded, a local focus of infection appears, which has characteristics. In it, bacteria multiply, producing poisons that cause infectious intoxication.

Due to toxins that have entered the general circulation, small vessels expand various bodies, and a scarlatinal exanthema forms on the skin. Gradually, the child develops a specific antitoxic immunity, as a result of which the signs of intoxication and skin rashes gradually decrease.

In those rare cases when streptococcus enters directly into the bloodstream, it can affect a variety of organs - such as the membranes of the brain, lymph nodes, and the hearing aid. As a result, purulent-necrotic inflammation occurs, which, of course, is much more difficult to cure.

Scarlet fever begins in most cases abruptly. Sometimes the temperature rises to high levels in a couple of hours, the child begins to feel overwhelmed, weak, he may have a headache, his heart rate will increase. Due to severe intoxication, vomiting is possible, as well as abdominal pain. Sometimes children do not become lethargic and indifferent, but, on the contrary, they become excited and fall into euphoria. However, it is worth remembering that at present scarlet fever is not always accompanied by a high fever.

At the very beginning of the disease, it becomes painful for the child to swallow. On examination, you can see brightly reddened tonsils, soft sky and palatine arches, uvula and back wall pharynx (this is a characteristic - "flaming pharynx"). In contrast to the usual sore throat, with scarlet fever, the redness is much brighter, and a clear border of redness is also visible in the place where the soft palate turns into a hard one.

Occasionally, a child develops follicular-lacunar tonsillitis: the tonsils become large, loose and very hyperemic, covered with plaque in the form of separate small (less often deep) foci. It is accompanied by regional lymphadenitis: the anterior cervical lymph nodes thicken and become painful.

The tongue is initially covered with a dense coating of a grayish-white color. After four or five days, the plaque disappears, and the tongue becomes bright red with a raspberry tint, with enlarged papillae. If the course of the disease is severe, the lips acquire the same color. The secretion of saliva decreases, due to which the mucous membrane of the mouth becomes overdried. begin to weaken, but there are malfunctions in the work of the cardiovascular system - tachycardia occurs, blood pressure rises.

A specific rash is formed in the first or second day of illness. Its peculiarity is its location on a generally reddened skin. The specificity of the rash plays important role when diagnosing. Scarlet rash spreads in a certain sequence: first on the face, neck and upper body, then quickly cover the sides of the chest and abdomen, inner thighs, flexion surfaces of the limbs. In typical cases, the rash looks like small blisters with a cloudy liquid inside. Sometimes they merge, and the skin seems completely reddened.

It is characteristic that the rash, when pressed, disappears for some time in this place, and then appears again (white dermographism).

Scarlet exanthema has important feature: it becomes thicker on the folds of the skin, when the stripes of dark red rashes are located in the armpits, in the places of the elbow and inguinal folds. Typical places for a rash on the face are the cheeks, a little less often - the forehead and temples. The nasolabial triangle remains light and is not affected by rashes. In addition, the skin becomes dry. With an atypical course of the disease, rashes may appear later (on the third or fourth day of illness) or be completely absent.

On the fourth or fifth day after the onset of clinical symptoms of scarlet fever, the child begins to feel better. The body temperature gradually drops, the rash brightens and disappears. After a couple of days, the skin begins to peel off in small scales, on the palms and soles, these scales are larger. In children under two years of age, peeling may not be.

The number of rashes and the duration of their presence on the skin vary greatly. If scarlet fever is mild, the rash is small and does not last long - only a few hours. There is also a direct relationship between the intensity of rashes and the strength of further peeling of the skin. When the rash disappears, no pigmentation remains.

Generally accepted and understandable is the classification clinical forms scarlet fever according to A. A. Koltypin. He proposed to divide it according to the type, severity of the disease and the course of the infectious process.

First of all, typical and atypical forms of scarlet fever are distinguished.

Typical forms are classified according to two criteria.

According to the severity of the disease:

light, transitional moderate(the temperature does not exceed 38 degrees, there is no pronounced intoxication, there is a rash in a typical localization);
moderate, transitional to severe (temperature fluctuates in the range of 38-39 degrees, pronounced intoxication syndrome, profuse rash in typical localization);
severe (toxic, septic, toxic-septic; patients need inpatient treatment in intensive care).

According to the course of the infectious process, scarlet fever is distinguished:

without allergic waves and complications;
with allergic waves;
with allergic complications, purulent complications, septicopyemia;
with an abortive course.

Among the atypical forms of scarlet fever are:

erased;
with increased symptoms (hypertoxic or hemorrhagic);
extrabuccal (burn, wound, postoperative).

The extrabuccal form of the disease is formed when streptococcus enters the body not through the upper respiratory tract, but through damaged skin (for example, surgical incisions or abrasions). In this place, a purulent-necrotic focus occurs, and from it the rash spreads throughout the body of the child (that is, from the point of entry of the pathogen). In this case, lesions of the oropharynx are very rare.

You should not completely relax after the child's recovery: it is quite possible that you will have to go through more “allergic waves”. As a rule, they appear rather unexpectedly, when there are no signs of scarlet fever, and the condition is normal (usually this is the second or third week after the onset of the disease).

Characteristic signs of an allergic wave:

an increase in temperature for a day or two, often insignificant;
recurrence of rashes in the same areas (although the rash itself is not quite similar to scarlet fever: it is pale, it may disappear periodically);
allergic manifestations (a runny nose and cough appear, tears begin to flow, the face becomes puffy, the level of eosinophils in the blood rises);
enlargement of peripheral lymph nodes;
increased heart rate (although a sick child may not feel it);
lowering blood pressure.

There may be more than one allergic wave.

There are sometimes real relapses of scarlet fever. They are characterized by the return of the main symptoms - a specific rash, tonsillitis, temperature. For the most part, true relapses occur a month after the onset of the disease, sometimes they appear a little earlier. Such relapses occur due to re-infection of the body with streptococcus. Usually they are subject to those whose body could not develop (or developed, but not enough) antitoxic immunity. Often weakened children are predisposed to this - for example, those with chronic tonsillitis or rheumatism.