Scarlet fever in children: symptoms, forms, treatment, difference from other diseases. Scarlet fever clinic: causes, symptoms, disease diagnosis, treatment and prevention Scarlet fever infectious diseases

Rash on the skin of the body, sore throat and heat are symptoms of many childhood infections. One of these infectious diseases is scarlet fever. It is very common in childhood and can cause serious complications. And therefore, many parents are concerned with questions - how a child becomes infected with scarlet fever and what the rash looks like with this disease, how scarlet fever occurs in children and how such an infection is dangerous, and many others.

What it is

Scarlet fever is an acute infection caused by hemolytic streptococci belonging to group A. Such bacteria can have a toxic and septic, as well as allergic effect on the human body due to the production of a special toxic substance- erythrotoxin.


Scarlet fever is transmitted not only by airborne droplets, but also through clothes and things

It is this toxin that causes all the symptoms characteristic of scarlet fever. Due to the dilation of small blood vessels, children develop a rash, and the death of the epidermis caused by exposure to erythrotoxin causes severe peeling of the skin.

How is it transmitted

Group A streptococci are transmitted from carriers and patients to healthy children mainly by airborne droplets. Bacteria are spread by sneezing or coughing, so people who are close to a sick child are especially at risk of becoming infected. Transmission of the pathogen is also possible through clothing, contaminated toys or food.

Who can you get infected from?

Streptococci can cause scarlet fever if they enter a child’s body from:

  • A person suffering from scarlet fever, who is especially contagious in the first days of the infection.
  • A person suffering from pharyngitis or tonsillitis, if these diseases are caused by group A streptococci.
  • A recently recovered person, because bacteria continue to be released into the environment for up to three weeks after the condition improves.
  • A carrier of hemolytic streptococcus who has no symptoms of the disease. Bacteria can live on the mucous membrane of the nose and throat, and at the same time not cause scarlet fever in its carrier, but be dangerous for other people.


A carrier of streptococcus may never get scarlet fever, but a child infected from it may become seriously ill

Incubation period

The first symptoms of the disease appear on average 3-7 days after infection. The most common incubation period in children is two to three days. Sometimes it is reduced to one day or even several hours. In rare cases, the incubation period can be extended up to twelve days.

How many days is a child contagious

A sick child begins to release the scarlet fever pathogen into the environment from the moment the infection first appears. The contagious period can vary in length - several days or several weeks. If scarlet fever proceeds without complications and the child is treated with antibiotics, then after 7-10 days he ceases to be infectious to others.

Can an adult become infected from a child?

Most often, scarlet fever is diagnosed in children from 2 to 10 years. The disease in most cases causes lifelong immunity, therefore, if an adult had such an infection in childhood, scarlet fever often does not develop after contact with a sick child. Re-infection is possible with reduced immunity of an adult.


An adult who has not had scarlet fever before can become infected from a child

If an adult has not previously had scarlet fever, he can become infected by airborne droplets from a sick child. At the same time, the severity of scarlet fever in adulthood can be different. There are both erased forms and toxic scarlet fever with a very severe course.

Symptoms

initial stage Scarlet fever in most children is short and lasts less than a day. The disease begins acutely with an increase in body temperature and the appearance of a sore throat. The main signs of a typical form of scarlet fever in children are presented:

  • Symptoms of general intoxication. The disease is manifested by headaches, fever, general malaise, agitation (less often lethargy), vomiting, aching muscles and joints, and tachycardia.
  • A pinpoint rash that appears on the first or third day of the disease.
  • A sore throat, the course of which may be more severe than with ordinary sore throats.
  • A change in the language that causes it to be called "raspberry". The tongue with scarlet fever is initially covered with a whitish coating, but on the second to fourth day from the onset of clinical manifestations it becomes bright red. It shows graininess as the papillae increase in size.
  • Peeling of the skin, which appears approximately 1-2 weeks after the initial manifestations of the disease (it replaces the rash). On the feet and palms, the skin peels off in large parts, and on the torso, ears and neck, small peeling occurs, called pityriasis.


You can learn more about the symptoms that accompany the disease in the following video.

What does the rash look like?

The rash appears as numerous red or bright pink dots. The localization of the rash is mainly represented by the face area (on the cheeks), the groin area, the flexor surfaces of the limbs, as well as the lateral parts of the body.


At the same time, in the area of ​​the elbows, under the arms, and also under the knees, the rash thickens, forming dark red stripes (this is called Pastia's symptom). In the area called the “nasolabial triangle” there is no rash with scarlet fever, and the skin of this part of the face will be pale (this is how Filatov’s symptom manifests itself).

The rash begins to disappear on days 3-7 of illness

The nasolabial triangle with scarlet fever does not become covered with a rash, but on the contrary, becomes pale

If you press moderately on a scarlet fever rash with a spatula, the color of the spots becomes clearer, but with strong pressure with your palm, the rash disappears and the skin looks yellowish (this manifestation is called the “palm symptom”). A baby's skin with a rash feels like sandpaper to the touch.

3-7 days after the appearance, the rash begins to disappear, leaving behind peeling. Peeling is especially pronounced on the hands - the skin is removed from the fingertips in large areas, like gloves. There is no pigmentation left after such a rash.


When the rash goes away, the baby's skin begins to peel and peel.

How does a sore throat manifest?

Streptococcus that gets on the mucous membranes of the nasopharynx settles on the tonsils and begins to secrete a toxin, which is the cause of sore throat in scarlet fever. The child's throat becomes bright red (due to severe inflammation this picture is called a “flaming pharynx”), and the tonsils become covered with purulent plaque.

Here are a few photos of a child’s throat with scarlet fever:

Tonsils with scarlet fever acquire a purulent coating

The throat becomes bright red with scarlet fever

How long does the temperature last

Fever is one of the most common symptoms initial stage scarlet fever. The temperature rises sharply to 38-40°C. Some children experience febrile seizures due to this rise in temperature. A decrease in temperature in most children is noted from the third to fifth day of illness.

Disease severity

Depending on age, immune status and clinical picture Scarlet fever in a child occurs:

  • Easy. Symptoms of intoxication in this course are mild, the fever does not exceed +38.5°C, the tonsils may be without plaque, and the rash is less bright and profuse. The mild form progresses faster - by the fourth or fifth day the temperature returns to normal and all acute symptoms disappear. Nowadays, this form is diagnosed in children more often than others.
  • Medium-heavy. The disease begins acutely, the temperature rises to +40°C, the child complains of headaches, weakness, vomiting, and rapid pulse. The rash in this form is quite abundant, its color is bright, and the pharynx and tonsils are covered with a purulent coating. A decrease in temperature and disappearance of acute symptoms are noted by the seventh or eighth day of illness.
  • Heavy. IN present time this form rarely develops. Due to severe intoxication, such scarlet fever is called septic or toxic. In addition, a severe form of scarlet fever is necrotic if the child develops necrotic inflammation of the tonsils, and the lymph nodes become inflamed and suppurate. In severe forms, children must be hospitalized.


Scarlet fever in a child can be mild, severe and moderately severe.

Atypical scarlet fever

In some children, the infection occurs atypically (a latent form develops). Doctors distinguish the following forms of scarlet fever in addition to the typical one:

  • Erased. With it, intoxication is mild, the sore throat is catarrhal, and the rash is pale, scanty and disappears quite quickly.
  • Extrabuccal. With such scarlet fever, streptococci enter the child's body through the affected skin.
  • Scarlet fever without rash. With such an infection, all the symptoms of scarlet fever are present, but there are no rashes on the skin.

How many times do they get sick

In most cases, after suffering from scarlet fever, a person develops immunity to the erythrotoxin produced by streptococci, so children often suffer from such an infection once in a lifetime. However, although very rare, cases of recurrent disease do occur.


Most people get scarlet fever only once in a lifetime.

The transfer of antitoxic immunity from a mother who has recovered from scarlet fever to an infant after birth determines the rarity of cases of scarlet fever in newborns. The child is protected from such infection by maternal immunity within six months after birth.

Treatment

Most children with scarlet fever are treated at home. Hospitalization is required only in case of a severe form or complications, as well as in some other situations (for example, if a child from a boarding school falls ill or in the family of the sick child there are people who work with children, but it is not possible to isolate them).

Mode

Until the temperature drops, the child should stay in bed. In addition, during the acute phase, it is important to adhere to a diet and increase drinking regimen. The child is given food in semi-liquid or liquid form, and protein foods are limited. A child suffering from scarlet fever should drink a lot. It's best to give warm drink, for example, tea.

Drug therapy

Drug treatment scarlet fever certainly includes antibiotics. Children are often prescribed medications penicillin series in tablet form or syrup, for example, amoxicillin, augmentin, amoxiclav, retarpen. The duration of use and dosage is determined by the doctor, but usually the course of antibiotic therapy lasts 7-10 days.

Additionally, the child is given vitamin supplements and antiallergic drugs, and if intoxication is severe, infusion therapy is recommended (glucose and other drugs are administered intravenously). For gargling, use chamomile infusion, furatsilin solution, soda solution, calendula infusion and other antiseptics.


Children with scarlet fever are prescribed antibiotics

Homeopathy and folk remedies can be used in the treatment of scarlet fever, as helper methods, but only after consulting a doctor.

Is it possible to bathe a child

Washing during scarlet fever is not prohibited. On the contrary, children should be bathed, as this will reduce itching of the skin and prevent scratching of the rash. However, it is important to follow some rules:

  • The water in the bath should not be too hot or very cool.
  • If the child has a fever, the bath is replaced by wiping.
  • The skin should not be rubbed with a washcloth or sponge.
  • To wash off soap suds, instead of taking a shower, it is better to douse with a ladle.
  • It is not recommended to dry your child with a towel after bathing. It is better to blot the water by wrapping the baby in a sheet or diaper.

Complications


The risk of complications is significantly reduced with timely antibiotic therapy. In the development of damage to the heart, joints and kidneys great importance has sensitization of the child’s body (its increased allergic sensitivity to erythrotoxin).

Komarovsky's opinion

The famous pediatrician quite often encountered scarlet fever in his practice. Komarovsky focuses the attention of parents on the following nuances:

  • Streptococci are highly sensitive to penicillin antibiotics, therefore, after several doses of the drug, the condition of children with scarlet fever clearly improves.
  • If a child is intolerant to penicillin, this will not be a problem either, since streptococci are sensitive to many other antimicrobial drugs.
  • Scarlet fever can be called a disease in which timely administration of antibiotics ensures a successful outcome. If such an infection is not treated, it is possible severe complications(damage to the kidneys and heart).
  • Treatment should not be stopped as soon as the child's condition improves. It is important to complete the course antimicrobial drug prescribed by a doctor.
  • Due to the timely administration of antimicrobial agents, sometimes streptococci die in the child’s body very quickly, and immunity to their toxins does not have time to develop. This is the cause of repeated diseases, which, according to Komarovsky, are easier than the first infection.
  • Streptococcus can enter a child’s body not only through the throat. There are cases of infection through wounds on the skin. In this case, the child develops all the signs of scarlet fever (only a sore throat will not occur). Treatment is the same as for regular scarlet fever.
  • A child who has had scarlet fever should not have contact with other people for some time after the illness, since repeated exposure to streptococcus can lead to allergies and other complications. Komarovsky recommends starting to attend school or kindergarten after scarlet fever no earlier than 3 weeks.

Mild forms and most moderate forms of scarlet fever in children can be safely treated at home. The kids are isolated for 10 days, after which, if their condition is satisfactory, they are allowed to go for walks.

Consequences

Nowadays, the prognosis for a child with scarlet fever is in most cases favorable. When the child has recovered, it is important to monitor his well-being in order to promptly identify possible complications. Close attention should be paid to the color of urine (it changes with kidney damage, becoming similar to “meat slop”) and complaints of joint pain.

Doctors should monitor the condition after moderate or severe scarlet fever for one month. If 3 weeks after recovery, the examination of the child, blood and urine tests do not show abnormalities, dispensary observation is stopped. Having identified any alarming symptoms in a child who has had scarlet fever, he is sent for examination to a nephrologist or rheumatologist.

Prevention

It is known that there are no vaccines that protect against scarlet fever. Children and adults who have not been sick before can be protected from infection by the following measures:

  • To prevent infection of family members, it is important to carry out regular ventilation and wet cleaning in the room where a sick child is.
  • A child with scarlet fever should be cared for by one person, who is recommended to use specially designated clothing and a gauze mask.
  • A sick child should be given a separate towel, his own dishes, a handkerchief, toys and other items that healthy family members should not come into contact with.


If a child has been in contact with a person with scarlet fever and has not previously had such an infection, he should be isolated from the children's group for 7 days. After a week's stay at home, such a child can return to school ( we're talking about O primary school) or to kindergarten.

  • Symptoms and treatment

Scarlet fever- spicy infection. It manifests itself as a small rash, intoxication and sore throat. It most often affects children, but adults can also become victims of this disease. All signs and symptoms of scarlet fever are caused by erythrotoxin (from Greek “red toxin”).

This is a poisonous substance that produces this type streptococcus. Having had scarlet fever once, a person develops immunity to beta-hemolytic streptococcus. Therefore, it is no longer possible to become infected with scarlet fever again.

What is the cause of scarlet fever?

Scarlet fever 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 secretes Dick's toxin, which causes intoxication (poisoning of the body with toxins) and a small rash (exanthema). Settles on human mucous membranes. They most often reproduce in the nasopharynx, but can live on the skin, intestines and vagina. To protect themselves, bacteria can create a capsule around themselves and are prone to forming clusters - colonies.

In some people, streptococcus A may be part of the microflora. That is, it peacefully coexists with the human body without causing disease. But after stress, hypothermia, when immunity drops, streptococci begin to actively multiply. At the same time, they poison the body with their toxins.

Source of infection spread with scarlet fever is a person. It could be:

  1. A patient with scarlet fever, tonsillitis or streptococcal pharyngitis. Such a person is especially dangerous for others in the first days of illness.
  2. Convalescent is a person who has recovered from an illness. He can still secrete streptococci for some time. Such carriage can last up to three weeks.
  3. A healthy carrier is a person who has no signs of disease, but group A streptococci live on the mucous membrane of his nasopharynx and are released into the environment. There are quite a lot of such people, up to 15% of the total population.

Main route of transmission scarlet fever - airborne. When talking, coughing or sneezing, bacteria are released along with droplets of saliva and mucus. They enter the mucous membrane of the upper respiratory tract healthy person. Streptococci can find a new host in another way. For example, through toys, bed linen and towels, poorly washed dishes, food. There have been cases when infection occurred in women giving birth through the birth canal.

Epidemiology of scarlet fever.

Today, this disease is considered a childhood infection. Most patients are under 12 years of age. But the disease can also occur in adults. But babies up to one year old practically do not get sick. This is due to the fact that they inherited maternal immunity.

The patient is considered infectious from the first to the 22nd day of illness. There is an opinion that he can infect others a day before the first symptoms appear. This is due to the fact that during this period streptococci are already in large quantities in the nasopharynx and are released during conversation. But the body’s immune cells still keep the situation under control, so signs of the disease are not noticeable.

Peaks of the disease are observed in September-October and in the winter, when children return from vacation to school or kindergarten. IN summer time the number of sick people is decreasing.

Due to the greater population density, the incidence is higher in cities. Urban children experience this disease in preschool and early school age and acquire immunity. And in rural areas Adults also often get scarlet fever if they have been in contact with someone with scarlet fever.

Scarlet fever epidemics occur every 3-5 years. In recent decades, scarlet fever has become a much milder disease. If earlier the mortality 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 to treat scarlet fever, reducing the toxicity of staphylococcus. However, some researchers claim that epidemics of “malignant” scarlet fever occur every 40-50 years. When complications and mortality rates increase to 40%.

What are the signs and symptoms of scarlet fever in children?

Scarlet fever in children causes severe poisoning with erythrogenic streptococcal toxin. 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 very weak, headache and nausea. This is often accompanied by repeated vomiting. By evening, a characteristic rash begins to appear. Its features will be discussed below.

Children complain of a sore throat, especially when swallowing. The palate becomes red, the tonsils become greatly enlarged and become covered with a whitish coating. This is due to the fact that streptococci A colonize the tonsils and multiply there intensively. Therefore, streptococcal tonsillitis almost always develops with scarlet fever.

Lymph nodes that are located at the level of the corners lower jaw, enlarge and hurt. With the flow of lymph, toxins and bacteria from the nasopharynx enter them, causing inflammation.

If a wound or cut serves as the entry point for infection, then a sore throat does not develop. Other symptoms characteristic of scarlet fever persist.

What does a child with scarlet fever look like (photo)?

General state resembles a cold (fever, weakness)
The first hours of scarlet fever are similar to the flu or other acute illness.

Skin rash
But after about a day, a specific rash and other external symptoms appear. The rash associated with scarlet fever is called exanthema. 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. The 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, over 2-3 days, elements of the rash spread throughout the body. The rash lasts from several hours to five days. Then peeling appears in its place. This is the release of epidermal cells affected by streptococcal toxin.

Symptoms on the face
The baby's face becomes puffy and swollen. When you first look at a child, the pale area around the lips attracts attention. It contrasts sharply with red cheeks and crimson lips. The eyes shine feverishly.

What does the tongue look like with scarlet fever?


What does a skin rash look like with scarlet fever?

Exposure to group A streptococcal toxin causes all small blood vessels to dilate. In this case, lymph containing the toxin leaks through the walls of the capillaries. Swelling and inflammation of the skin occurs, and a rash appears.

Symptom name Description what does it look like?
Skin rash Rash in the form of pimples, roseolas are very small and have a bright pink color, with a brighter center. Size 1-2 mm.
Pimples They rise above the surface of the skin. This is almost unnoticeable, but the skin feels rough to the touch, like sandpaper. This phenomenon is called “shagreen skin”.
Dry and itchy skin Characteristic of scarlet fever. There is redness around the pimples. This is because the skin is inflamed. The elements are very small and arranged so densely that they practically merge.
Rash on body skin more pronounced on the sides of the body, in the inguinal, axillary and buttock folds, on the back and lower abdomen. This is explained by the fact that the elements of the rash appear where sweating is stronger and the skin is thinner. Beta-hemolytic streptococcus toxins are eliminated through skin pores.
Darkening in skin folds In the folds of the skin(neck, elbow and knee bends) dark stripes are found that do not disappear when pressed. This is due to the fact that the vessels become more fragile and small hemorrhages form.
White dermographism White trail is formed if you press on the rash or rub it with a blunt object. This is important diagnostic sign, which is called “white dermographism”.
Pale nasolabial triangle Against the background of rashes on the skin of the entire face, a “clean”, rash-free area of ​​the nasolabial triangle
Individual roseolas are not visible on the face The rash is so fine that the cheeks appear uniformly red.
The rash lasts for 3-5 days Sometimes only a few hours. Then it disappears without leaving dark pigment spots.
After 7-14 days, peeling of the skin begins At first, in those places where the rash was more intense - in the folds of the body. Peeling is fine on the face, lamellar on the arms and legs. This is due to the death of skin cells and the separation of the upper layer - the epidermis.
The skin on the palms and feet comes off in layers Because of the close connection between the epithelial cells in these areas. Peeling begins from the free edge of the nail, then moves to the fingertips and covers the entire palm.
The disappearance of the rash and recovery is due to the accumulation of antibodies in the body. They bind toxins and relieve the manifestations of toxicosis.

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 outbreaks of the disease also occur among adults. Especially often in close, closed groups: in student dormitories, among military personnel.

Currently, severe epidemics among adults are not common. In most cases, they proceed in the form of streptococcal pharyngitis without a rash.

Signs of scarlet fever in adults may not be as clear as in children. Often the rash on the body is imperceptible and insignificant, disappears in a few hours. This makes it difficult to make a diagnosis.

Scarlet fever in adults begins acutely and has much in common with sore throat. Changes in the nasopharynx are caused by the fact that beta-hemolytic streptococcus multiplies most intensively in this area. It causes destruction of the mucous membrane. The intense red color of the palate and tongue is due to the fact that under the influence of toxins released by bacteria, small vessels expand. Also occur:


  • severe sore throat that gets worse when swallowing
  • a whitish-yellow coating appears on the tonsils, purulent foci and sores may occur
  • submandibular lymph nodes become enlarged and inflamed

In adults, the symptoms of general intoxication are rapidly growing - poisoning with streptococcus toxin:

  • high temperature, often up to 40°
  • weakness and severe headache
  • nausea and repeated vomiting in the first hours of illness

They are caused by Dick toxin entering the bloodstream and spreading the infection throughout the body. This causes minor allergic rash. The skin becomes dry, rough, and itching appears. Rashes have the same features as in children:

  • the first rashes appear on the face
  • the area below the nose to the chin without rash and sharply pale
  • most of all, roseola is found in the folds of the body and above the pubis
  • dermographism is observed - a white mark after pressing, which is noticeable for 15-20 seconds
  • in severe cases, the rash may become bluish in color. This is due to small hemorrhages under the skin.

Streptococcus A can enter the body through cuts and burns. In this case, the rash is more pronounced near the wound where the bacteria have settled. Lymph nodes near the affected area become enlarged and painful. This is because they are trying to delay the spread of the infection. In them, like in filters, microorganisms and their decay products accumulate.

What is the incubation period for scarlet fever?

The incubation period is the time from the moment beta-hemolytic streptococcus enters the body until the first manifestations of the disease. This period of the disease is also called latent. A person is already infected, but the number of bacteria is not yet 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. The duration depends on the state of immunity and the number of streptococci that have entered the body.

During this period, streptococci settle on the mucous membrane of the upper respiratory tract and multiply there intensively. The body's immune cells try to destroy them, and at first they cope with their task. The body begins to produce special antibodies to fight the disease.

But then a moment comes when there are too many streptococci and they intensively release toxins, undermining the body’s strength. The human immune system is not able to cope with them on its own and treatment is required.

How to prevent scarlet fever?

In order to protect yourself from scarlet fever, it is necessary to avoid communication 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 through communication, staying in the same room
  • food (nutritional)- staphylococci end up on foods that a healthy person then consumes
  • contact- transmission of bacteria from a sick person to a healthy person through household items, toys, clothes

Scarlet fever is not as contagious as other infectious diseases, such as chickenpox. You can be in the same room as someone who is sick and not get infected. Susceptibility to disease depends on immunity.

Main preventive measures: identification and isolation of patients. The team where the patient was located is quarantined for a period of 7 days. If the child went to kindergarten, then those children who have not been in contact with the sick person are not accepted into the group. They are temporarily transferred to other groups.

During this period, a daily examination of all children or adults who were in contact is carried out. In children's groups, the temperature is taken daily and the throat and skin are examined. This is necessary in order to promptly identify newly infected people. Pay special attention to signs respiratory infection and sore throats. Since this may be the first symptoms of scarlet fever.

Children who had contact with the sick person are not allowed into kindergartens and the first two grades of 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 from the onset of the disease or 12 days after clinical recovery.

Everyone who interacted with the patient is prescribed Tomicide. The drug must be gargled or sprayed 4 times a day after meals for 5 days. This helps prevent the development of the disease and get rid of streptococci that may have entered the nasopharynx.

Most often, treatment is carried out at home. Patients with a severe course of the disease and in cases where it is necessary to prevent infection of small children or workers of decreed professions are sent to the hospital. These are the people who work with children, in medical institutions and in the nutrition sector. They are hospitalized for at least 10 days. For another 12 days after recovery, such people are not allowed into the team.

If a child in the family gets sick, the following rules must be followed:

  • exclude communication with other children
  • place the patient in a separate room
  • One family member must care for the child
  • Do not wash your child’s clothes with the laundry of other family members
  • provide separate dishes, bed linen, towels, hygiene products
  • thoroughly treat toys with a disinfectant solution, and then rinse with running water

The room where the patient is located is disinfected. This is wet cleaning with a 0.5% chloramine solution. You also need to regularly boil the clothes and dishes of the sick person. Such measures will help prevent the spread of streptococcus and infection of others.

Dispensary registration

In order to prevent 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 carried out. If necessary, a cardiogram is performed. If the tests do not reveal bacteria, the person is removed from the dispensary register.

What are the possible consequences of scarlet fever?

All complications of scarlet fever are explained by the characteristics of the bacterium 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 disrupted
  • allergic- proteins that are formed as a result of the breakdown of bacteria cause an allergic reaction. This factor is considered the most dangerous
  • septic- spreads throughout the body with the bloodstream and causes purulent foci of inflammation in various organs.

According to statistics, complications occur in 5% of patients. Of this number, almost 10% are heart lesions (endocarditis, myocarditis). In second place, 6% - pyelonephritis (inflammation of the kidneys). In third place is sinusitis (inflammation of the sinuses).

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.

Consequences associated with distribution infectious process and the spread of beta-hemolytic streptococcus.

There may be:

  • necrotizing tonsillitis - destruction caused by streptococcus can lead to the death of areas of mucous membrane on the tonsils
  • paraamygdala 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 pharynx
  • sinusitis- inflammation of the paranasal sinuses
  • purulent foci(abscesses) in the liver and kidneys
  • sepsis- blood poisoning

Toxic. Streptococcal toxin causes abnormalities in the heart tissues called toxic heart. Its walls swell, soften, and the heart increases in size. The pulse slows down, the pressure drops. Shortness of breath and chest pain occur. These phenomena are short-term and disappear after a sufficient amount of antibodies that bind the toxin has accumulated in the body.

Allergic. The body's allergic reaction to the bacterium and its toxins causes temporary kidney damage. Its severity depends on the individual reaction of the body and on whether it has encountered this bacterium before.
Allergy manifestations include vascular damage. They become brittle and internal bleeding occurs. Of these, cerebral hemorrhage is especially dangerous.

Late complications of scarlet fever

Later consequences the most dangerous and are associated with sensitization of the body - allergies. As a result, immune system cells attack own fabrics and organs. The most serious allergic complications:

  1. Heart valve disease- the valves that ensure blood flow in the right direction thicken. At the same time, the tissue becomes brittle and breaks. Blood circulation in the heart is disrupted, and heart failure develops. Presents with shortness of breath and aching pain in the chest.
  2. Synovitis- serous inflammation joints - the result of allergization, occurs in the second week of the disease. The small joints of the fingers and feet are affected. It manifests itself as swelling and pain. Goes away on its own without treatment.
  3. Rheumatism- defeat large joints, occurs at 3-5 weeks. In addition to pain in the limbs, complications from the heart may also appear. Rheumatism c reads as the most common and unpleasant complication of scarlet fever.
  4. Glomerulonephritis- kidney damage. After recovery, the temperature rises to 39°. Swelling and pain appear in the lower back. Urine becomes cloudy and its quantity decreases. In most cases streptococcal glomerulonephritis treatable and goes away without a trace. But if measures are not taken in time, kidney failure may develop.
  5. Chorea- brain damage that occurs 2-3 weeks after recovery. The first manifestations: laughter and crying for no reason, restless sleep, absent-mindedness and forgetfulness. Later, uncontrolled movements in the limbs appear. They are fast and messy. Coordination, gait, and speech are impaired. In some cases, the brain manages to compensate for impaired function, in others, incoordination of movements remains for life.

Late complications after scarlet fever most often occur if the infectious disease was treated on its own without antibiotics or the diagnosis was incorrect.

Prevention of complications - correct and timely treatment of scarlet fever. At the first signs of illness, you should consult a doctor. Taking antibiotics, antiallergic drugs and taking a large amount of liquid is a reliable protection against the occurrence of complications.

Is scarlet fever contagious, and how is it transmitted?

Scarlet fever is a contagious disease. In order to get sick with it, you need to communicate with a patient with a sore throat, scarlet fever, or a carrier of a streptococcal infection. Also dangerous are people from the environment of the patient who have acute tonsillitis, nasopharyngitis, bronchitis. Most often, they also secrete hemolytic streptococcus.

There are four mechanisms of infection:

  1. Airborne- infection occurs through contact with a patient or carrier. The disease spreads quickly in children's groups. When coughing, talking in the air, an aerosol is formed from small drops of saliva containing the pathogen. When it enters the mucous membrane of the upper respiratory tract of a healthy person, bacteria primarily colonize tonsils(tongs) and begin to produce a toxin. Over time, they spread to surrounding tissues and regional The lymph nodes.
  2. Domestic- through household items used by the patient. Toys, dishes, linen can become a source of infection if they get saliva or mucous secretions of a sick person. Although streptococcus loses its dangerous properties V environment, it can cause infection. This happens if a microorganism from things with dust enters the mouth or nose of a healthy person. The bacterium, once in favorable conditions, attach to the nasopharyngeal mucosa, begin to actively multiply and produce toxins. Therefore, it is so important to carry out ongoing disinfection in the room where he is and not to allow the sharing of his things.
  3. Food (nutritional)- if bacteria got on it during cooking, then such a dish can become a breeding ground for them and a breeding ground. Especially dangerous in this respect are dairy products that are not boiled and various jellies. When eating such food, it immediately enters the body a large number of microorganisms. They linger on the nasopharyngeal mucosa and cause disease. That is why so much attention is paid to testing cooks and other kitchen workers for bacterial carriage.
  4. Through damaged skin- wounds, burns, damaged mucous membranes of the genital organs, the inner lining of the uterus after childbirth - can become an entry point for infection. Staphylococcus in this case does not multiply in the tonsils, but on the damaged tissue. This causes the rash to concentrate around the wound and inflame the nearby lymph nodes.

Do I need to use antibiotics for scarlet fever?

Scarlet fever is 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. Within a day after the start of treatment, it is possible to stop the spread of infection throughout the body. The bacteria die and stop producing toxins. The patient feels much better. Therefore, antibiotics are mandatory for scarlet fever. The choice of drug depends on the severity of the disease:

  • in mild cases, penicillins and macrolides are prescribed in tablets or suspensions for children: Erythromycin, Azimed, Azithromycin. Treatment period - 10 days
  • for moderate forms - penicillin in the form of intramuscular injections: Oxacillin for 10 days
  • in severe forms - I-II generation cephalosporins: Clindamycin, Vancomycin for 10-14 days. Administered intravenously

Thanks to antibacterial therapy managed to transform scarlet fever from a deadly infection into a disease that is relatively mild. Antibiotics for scarlet fever make it possible to avoid life-threatening complications. In addition, they make a person safe for others from an epidemic point of view. He ceases to be contagious.


How to treat scarlet fever?

If you have scarlet fever, you must stay in bed for 3-7 days. Its duration depends on the patient’s condition and the characteristics of the disease.

In most cases, treatment occurs at home. They are sent to the hospital in the following cases:

  • at severe course disease
  • children from orphanages and boarding schools
  • patients from families where there are persons who work in preschool institutions, hospitals, trade workers and Catering, as well as other representatives of decreed professions
  • patients from families with children under 10 years of age who have not had scarlet fever
  • if it is not possible to isolate the patient and organize care for him

Treatment of scarlet fever is based on antibiotics. But for a speedy recovery, an integrated approach is required.

Other drugs are also prescribed in parallel:

  1. Antiallergic (antihistamine) drugs - to eliminate manifestations of allergies and complications that may arise due to allergization of the body: Loratadine, Cetrin;
  2. Antipyretics - to normalize temperature and relieve headaches: Paracetamol, Ibuprofen;
  3. Strengthening the wall of blood vessels - to eliminate the effect of the toxin on the blood capillaries: Ascorutin, Galascorbin;
  4. Local sanitation means - preparations for cleansing the nasopharynx from bacteria: rinsing with Chlorophyllipt, Furacilin;
  5. At serious condition the patient is administered intravenously saline solutions and glucose. This is necessary to maintain water-salt balance and speedy removal of toxins.

In order to quickly cure a sore throat with scarlet fever and clear the tonsils of streptococcus, physiotherapy is prescribed.

  1. Irradiation of tonsils with UV rays - they destroy bacterial proteins and cause their death.
  2. Centimeter wave (CW) tonsil therapy - treatment of tonsils with microwaves.
  3. Magnetic laser therapy improves blood circulation and ensures increased activity of immune cells.
  4. UHF therapy has an anti-inflammatory effect and accelerates healing.
  5. KUF therapy - kills microorganisms, cleanses the tonsils of plaque.

Diet for scarlet fever

The nutrition of the patient should be aimed at maintaining the strength of the body, increasing the resistance to infection and reducing allergization. Food should be easy to digest. It must also be remembered that the sore throat is aggravated by swallowing. Therefore, the dishes should be semi-liquid and mashed. Doctors recommend therapeutic diet No. 13, which is prescribed for infectious diseases. You need to eat often - 4-5 times a day, but the portions should be small.

Recommended Products Prohibited Products
Dried white bread Fresh bread, baked goods
Low-fat meat and fish broths, vegetable soups, mucous decoctions of cereals Fatty broths, soups, borscht;
Low-fat varieties poultry, meat, fish Fatty varieties meat, poultry, fish
Cottage cheese and lactic acid drinks Smoked meats, sausage, salted fish, canned food
Puree porridge from buckwheat, rice, semolina Whole milk and cream, full-fat sour cream, hard cheeses
Potatoes, carrots, beets, cauliflower, ripe tomatoes White cabbage, radish, radish, onion, garlic, cucumbers, legumes
Ripe soft fruits and berries Pasta, millet, barley and barley groats
Fruit compotes, rosehip broth, diluted juices Chocolate, cakes, cocoa
Sugar, honey, jam, marmalade

If there are no complications from the kidneys, it is necessary to drink 2-2.5 liters of fluid per day. This will help flush out the toxin from the body in the urine.

Phytotherapy and folk remedies will help alleviate the condition with scarlet fever. We offer some of the best effective recipes.

  1. Gargle with decoctions of herbs. Chamomile, calendula, sage and eucalyptus are perfect for this purpose. Brew 2 tablespoons of one of the products with a glass of boiling water, let cool, strain.
  2. Wash the horseradish root and chop on a grater. Pour a liter of hot boiled water and leave for three hours. Apply for rinsing 5-6 times a day.
  3. Take half a glass of freshly squeezed beetroot juice, add a teaspoon of honey and apple cider vinegar and half a glass of warm water. Use to rinse every two hours.
  4. Pour half a glass of calendula flowers with hot water and simmer in a water bath for 30 minutes. Allow to cool and apply as a lotion to areas of rash.
  5. Ginger powder and licorice. Mix in a one to one ratio. Pour a tablespoon of the mixture into a glass of boiling water and leave to steep for half an hour. Strain and drink in one go.
  6. Grind a teaspoon of propolis and mix with a glass of milk. Warm in a water bath for 15 minutes. Drink at night, after rinsing your throat.
  7. Prepare a solution of citric acid. Dilute a spoonful of the product in a glass of warm water and gargle every 1.5-2 hours and after meals. Citric acid inhibits streptococcus and speeds up recovery. You can also suck on lemon slices throughout the day.
  8. Wash the parsley root well and grate or finely chop. Pour one tablespoon of boiling water and leave for 20 minutes. Strain and drink 2-3 tablespoons 4 times a day.
  9. Sour fruit and berry juices: lemon, cranberry, lingonberry - perfectly strengthen the body and kill bacteria. You need to drink 2-3 glasses of juice or fruit drink a day. Drink warm in small sips after meals.

Should you get vaccinated against scarlet fever?

Today there is no specific vaccine against scarlet fever and other diseases caused by group A streptococcus. This is due to the fact that there are a huge number of variants of these microorganisms. Pharmaceutical companies They are trying to develop a vaccine against scarlet fever. Today it is passing clinical trials, but it is not on sale yet.

The following is sometimes used as a vaccine against scarlet fever:

  • Intravenous polyspecific immunoglobulin G. This remedy is made from the blood of donors and is given to people whose bodies do not produce enough antibodies. This ensures passive immunity: proteins for protection against bacteria and toxins are not produced independently, but are introduced in ready-made form.
  • Streptococcal toxoid. The drug is prepared from a weakened, neutralized Dick toxin. The product causes the body to produce antibodies to staphylococci and their toxins. Increases the body's ability to fight infection and reduce intoxication during illness. Injected subcutaneously into the scapula area if there has been contact with the patient.
  • Pyobacteriophage polyvalent/sextophage. Take orally 3 times a day for 1-2 weeks or use as compresses. It helps boost immunity and dissolves streptococci and other bacteria.

However, these drugs do not provide a 100% guarantee that infection will not occur. In addition, they have a fairly short period of action - from several weeks to one year. A contraindication to the use of these drugs may be hypersensitivity to their components. They can cause general allergic reactions, the most severe of which is anaphylactic shock. Therefore, it is necessary that the person remains under medical supervision for an hour after administration of the drug.

The main role in the prevention of scarlet fever remains the general strengthening of the immune system. Nutritious food, rich in protein foods and vitamins, physical activity and hardening of the body. These measures will protect the body from streptococcal infections and other diseases.

The content of the article

Scarlet fever- an acute infectious disease, which is caused by hemolytic streptococcus, transmitted by airborne droplets, characterized by fever, tachycardia, acute tonsillitis (tonsillitis) with regional lymphadenitis, ruby ​​rosacea (punctate) rash, vomiting.

Historical data of scarlet fever

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

Etiology of scarlet fever

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

Epidemiology of scarlet fever

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

Pathogenesis and pathomorphology of scarlet fever

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

Scarlet fever clinic

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

Standard forms

The mild form is more common and is characterized by subfebrile body temperature, minor violation general condition, catarrhal sore throat, thin pale rash. Clinical manifestations observed within 3-4 days.
In the moderate form, all the above symptoms are more clear: body temperature 38-39 ° C, lacunar tonsillitis. By the 7-8th day of illness, the body temperature decreases, the initial symptoms disappear. The severe toxic form is characterized by a violent onset, repeated vomiting, a thick rash with a cyanotic tint, sometimes with a hemorrhagic component, severe symptoms of damage to the central nervous system, vascular insufficiency syndrome.
In the case of a severe septic form, necrotic tonsillitis is observed, necrosis can spread to the palate, arches, soft palate, and pharynx. It turns out to be significant inflammatory response from the regional lymph nodes and surrounding tissue, the development of purulent lymphadenitis and adenophlegmon. Purulent complications are common. Hepatosplenomegaly appears. Last time severe forms Scarlet fever is observed very rarely.

Atypical forms

Scarlet fever without rash is observed mainly in adults. It is characterized by all clinical signs with the exception of the rash, which goes unnoticed due to the short duration and indistinctness. In the erased (rudimentary) form, all the symptoms of scarlet fever are mild. The extrapharyngeal form (wound, burn, postoperative) is rarely observed. It is characterized by a shortened (up to a day) incubation period, the absence of angina or its mild symptoms, the rash appears intense and expressive at the entrance gate of the infection, and regional lymphadenitis also appears there. The infectiousness of such patients is insignificant due to the impossibility of the airborne transmission mechanism.
In infants, scarlet fever is very rare, characterized by a slight toxic syndrome, catarrhal angina, not big amount and the pallor of the rash, the absence in most cases of the crimson tongue symptom and peeling. The severity of the disease is associated with a large number of septic complications, when purulent foci appear already on the 1st-2nd day of illness.
Complications. There are early and late purulent complications, which are usually the result of streptococcal reinfection or superinfection. These include purulent lymphadenitis, adenophlegmon, otitis media, mastoiditis, purulent arthritis, etc.
Allergic complications (lymphadenitis, synovitis, glomerulonephritis, myocarditis) develop in the second - fourth week of illness, more often in older children.
In the second or third week of illness, after all manifestations of the initial period have disappeared, allergic waves are sometimes observed. The patient's body temperature rises for 1-3 days or longer, a variety of ephemeral rashes appear (drybnoplasticity, urticaria or anularia), a moderate increase in all peripheral lymph nodes, leukopenia, lymphocytosis, and eosinophilia appear. Sometimes the symptoms resemble a serum sickness clinic. Allergic waves may recur.
Recurrences of scarlet fever develop in 1-4% of cases, most often in the 3-4th week of illness, mainly from reinfection. Allergization of the body and inferior immunity play a certain role.
Relapse is characterized by a repetition of the main symptoms of the initial period of the disease. When differentiating true and pseudo-relapses, i.e. allergic waves, it must be borne in mind that with the first, the same vascular changes are observed as at the beginning of scarlet fever, in the blood - leukocytosis, neutrophilia.
Recently, the features of scarlet fever are its mild course, the absence of purulent complications, the rapid release of the body from hemolytic streptococcus, but recurrent scarlet fever is more often observed.
The prognosis is favorable thanks to wide application antibiotics.

Scarlet fever diagnosis

Supporting symptoms clinical diagnostics scarlet fever is a sore throat with a clear border of bright hyperemia of the soft palate (flaming pharynx), vomiting, tachycardia (scarlet fever triad), the presence already on the first day of the disease of a bright pinpoint roseolous rash against the background of hyperemic skin with predominant localization on the flexor surfaces of the limbs and accumulation in places of natural folds , symptoms of Filatov, Pastia, Rosenberg, later - crimson tongue, lamellar peeling, lymphadenitis, eosinophilia. Important for the retrospective diagnosis of scarlet fever are the symptoms of Pastia, crimson tongue, large plates and peeling on the palms and soles, late complications diseases (streptoderma, lymphadenitis, arthritis, etc.).

Specific diagnosis of scarlet fever

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

Differential diagnosis of scarlet fever

Scarlet fever should be differentiated from measles, rubella, Far Eastern scarlet-like fever (pseudotuberculosis), staphylococcal infection, rash after ingestion medicines, prickly heat similar.
Diagnostic signs of measles - progressively increasing catarrhal manifestations, Belsky-Filatov-Koplik symptoms, timing of the onset of maculopapular rash and pigmentation after it; rubella - absence acute tonsillitis and hyperemic skin background, the presence of a rash in the area of ​​the nasolabial triangle, enlargement and soreness of the occipital lymph nodes.
Staphylococcal infection with scarlet fever-like syndrome is characterized by the presence of a purulent focus, a rash around it, and the absence of a sore throat. With pseudotuberculosis there is no real sore throat, hyperemia of the mucous membrane of the pharynx, bradycardia, pain in the joints and muscles of the extremities are detected, sharp pain on the right iliac region, dyspeptic manifestations, hyperemia and swelling of the hands and feet, the rash is larger than with scarlet fever, is localized around the joints and often becomes hemorrhagic in nature. The rash after taking medications is located on an unchanged skin background, has a varied character without localization typical for scarlet fever, and covers the nasolabial triangle. Miliaria appears in children under one year of age on the neck and chest when overheated. When cooled, it decreases.

Treatment of scarlet fever

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

Prevention of scarlet fever

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

Scarlet fever is an acute infectious disease characterized by symptoms of general intoxication, sore throat and pinpoint rash on the skin.

Etiology. The causative agent of the disease is group A β-hemolytic streptococcus. Its peculiarity is the ability to produce exotoxin. The decisive role in the occurrence of the disease belongs to the level of antitoxic immunity. If it is low or absent, the introduction of streptococcus causes the development of scarlet fever. With intense antitoxic immunity streptococcal infection occurs in the form of a sore throat or pharyngitis. The pathogen is quite stable in external environment, can persist for a long time in food products.

Epidemiology. The source of infection is a patient with scarlet fever or other streptococcal disease, a carrier (β-hemolytic streptococcus.

The main mechanism of infection transmission is airborne droplets. A contact-household mechanism of transmission or a food route, realized mainly through milk, dairy products, and creams, is possible.

Children of preschool and primary school age often suffer from scarlet fever. In the 1st year of life, the disease is rare due to the high titer of antitoxic immunity received from the mother.

The contagious index is about 40%. After an infection, strong antitoxic immunity remains.

Pathogenesis. The entrance gate for the pathogen is the palatine tonsils, in young children due to their underdevelopment pharyngeal tonsil or mucous membrane of the upper respiratory tract. In rare cases, streptococcus can enter the body through a wound or burn surface of the skin. The development of the disease is associated with toxic, septic (inflammatory) and allergic effects of the pathogen. An inflammatory focus is formed at the site of streptococcus invasion. Through the lymphatic and blood vessels, the pathogen penetrates into the regional lymph nodes and causes their damage. The entry of exotoxin into the blood leads to the development of symptoms of intoxication. The pathogen is characterized by selective damage to the smallest peripheral vessels of the skin, autonomic nervous and cardiovascular systems.

Clinical picture. The incubation period lasts from 2 to 12 days. The disease begins acutely: body temperature rises, general weakness, malaise, sore throat, and often vomiting occur. During the first day, less often at the beginning of the second, a rash appears on the skin, which quickly spreads to the face, neck, torso and limbs (Fig. 71 on color incl.). Scarlet fever rash has the appearance of small pinpoint elements located close to each other on a hyperemic background of the skin. The rash is more intense on the side of the body, in the lower abdomen, on the flexor surfaces of the limbs, and in natural folds of the skin. The skin is dry, rough to the touch, and persistent white dermographism appears with light pressure. The patient’s cheeks are hyperemic; against the background of the bright coloring of the cheeks, the pale, not covered with rash, nasolabial triangle, described by Filatov, clearly stands out.



A constant symptom of scarlet fever is tonsillitis - catarrhal, follicular, lacunar. Typical bright hyperemia of the tonsils, uvula, arches (“flaming throat”). Regional lymph nodes are involved in the process. They enlarge and become painful on palpation. In the first days of the disease, the tongue is thickly covered with a white coating; from the 2-3rd day it begins to clear, becomes bright red, grainy, reminiscent of ripe raspberries (“raspberry tongue”). The severity of general intoxication corresponds to the severity of the disease.

Symptoms are often observed "scarlet fever": tachycardia alternating with bradycardia, muffled heart sounds, systolic murmur, and sometimes expansion of the boundaries of the heart.

The acute period of the disease lasts 4-5 days, then the condition of the patients improves. Along with the disappearance of the rash and a decrease in temperature, the sore throat gradually disappears. At the 2nd week of the disease, lamellar peeling appears on the palms, fingers and toes, and pityriasis-like peeling appears on the body. In infants, peeling is not pronounced.

On the blood side, leukocytosis, neutrophilia, eosinophilia, and increased ESR are noted.

In addition to the typical forms, there may be atypical forms diseases. Erased form proceeds without fever, the sore throat is catarrhal, dull, the rash is mild, scanty, often located only on the folds.

At extrapharyngeal form(burn, wound and postpartum scarlet fever) the rash appears in the primary focus and is most pronounced in these places. There is no sore throat, mild hyperemia of the oropharynx may be noted. Regional lymphadenitis occurs in the area of ​​the entrance gate, but is less pronounced than with typical scarlet fever.

Hypertoxic And hemorrhagic form Currently they are practically not found.

Complications. There are early (bacterial) and late (allergic) complications. The first group includes purulent cervical lymphadenitis, otitis, sinusitis, mastoiditis, osteomyelitis. Allergic complications occur in the 2nd week of illness and are accompanied by damage to the joints (synovitis), kidneys (diffuse glomerulonephritis), and heart (myocarditis).

Laboratory diagnostics. For laboratory confirmation of the diagnosis, it is important to isolate β-hemolytic streptococcus in cultures of mucus from the oropharynx, determine the titer of antistreptolysin-O, other enzymes and antitoxins of streptococcus, and test blood for RPHA with yersinia diagnosticum (paired serum). Blood is taken V at the beginning of the disease - no later than the 3rd day of the rash, then again after 7-9 days. The diagnosis is confirmed by an increase in the titer of specific antibodies by the 10-14th day of illness by 4 times or more. IN general analysis blood there is neutrophilic leukocytosis with a shift to the left, increased ESR.

Treatment. Patients with scarlet fever can be treated at home. Hospitalization is carried out in case of severe course of the disease, with the development of complications or By epidemiological indications.

Treatment at home requires careful medical supervision with mandatory laboratory research blood and urine on the 10th and 21st days of the disease. An electrocardiogram is performed 2-3 weeks after clinical recovery.

During the acute period of the disease, bed rest is prescribed. The diet should be appropriate for the child’s age and should include dairy and plant products. Drinking plenty of fortified drinks is recommended.

Regardless of the severity of the disease, antibiotics are prescribed, mainly penicillin ( amoxicillin, ampicillin, phenoxymethylpenicillin) at an age dose of 5-7 days.

If you are intolerant to penicillins, antibiotics from the macrolide group are used ( erythromycin, roxithromycin, midecamycin, sumamed) or 1st generation cephalosporins ( cephalexin, cefazolin, cefadroxil) in age-related doses. After the end of antibiotic therapy, it is administered intramuscularly once bicillin-5 at a dose of 20,000 units/kg.

Has a specific bactericidal effect against gram-positive cocci tomicid. It is used externally to gargle or irrigate the throat. For one rinse, 10-15 ml of solution is used or 5-10 ml for irrigation. Rinse after meals 5-6 times a day. Can be used for rinsing furatsilin solution(1: 5000) or other disinfectant solutions.

To improve the effectiveness of antibiotic therapy, it is recommended to prescribe Wobenzym - a multienzyme drug with immunomodulatory and detoxifying effects. Good effect observed when using bacterial lysates, especially imudon.

Care. When caring, great attention should be paid to regular ventilation of the room and systematic wet cleaning. Caring for the oral mucosa is important. Due to the fact that peeling may cause itching of the skin, the child should cut his nails short to avoid scratching. Given the possibility of developing nephritis, the nurse needs to monitor the volume of urination and the nature of the patient’s urine.

In severe cases of the disease, detoxification and symptomatic therapy. Treatment of complications is carried out according to generally accepted regimens.

Prevention. Immunoprophylaxis for the disease has not been developed. For specific prevention of scarlet fever among contact persons, the use of tomicide in the form of gargling or irrigating the throat 4-5 times a day for 5-7 days.

To prevent the spread of infection, patients are isolated for 10 days from the moment of illness. Convalescents attending preschool institutions and the first two grades of school, due to the possibility of complications arising during the recovery period, are allowed into the children's group after additional isolation for 12 days (not earlier than the 22nd day from the onset of the disease).

Activities in the hearth. Children who have been in contact with a person with scarlet fever, attending preschool institutions and the first two grades of school, are subject to separation for 7 days. They are placed under medical supervision with daily thermometry and examination of the skin and mucous membranes. Older children are subject to medical supervision for 7 days after isolation of the patient. If the child is being treated at home, contact children and adults (working in the dairy industry, nursing home, surgical and obstetric hospitals) are subject to medical supervision for 17 days. The fireplace is ventilated and wet cleaned using a soap-soda solution.

Most often, children 2-10 years old get sick.

The causative agent of scarlet fever is group A streptococcus, which can also cause kidney damage (glomerulunophritis), sore throat, chronic tonsillitis, rheumatism and other diseases. Scarlet fever occurs if, at the time of infection with streptococcus, there is no immunity to it.

Source of infection- a patient with scarlet fever, tonsillitis or a “healthy” carrier of stereptococci. The incubation period usually lasts from 1 to 10 days. A child is considered contagious the day before the first symptoms appear and for the next 2–3 weeks.

The infection is transmitted by airborne droplets (by sneezing, kissing, etc.). In addition, you can become infected with scarlet fever through food, shared utensils, clothing, or simply by holding the door handle, which was previously opened by a completely healthy-looking carrier of the infection.

What's happening?

Once on the mucous membrane, streptococcus causes inflammatory changes in the nasopharynx. The microbe produces a large amount of a toxic substance - erythrotoxin. Once in the blood, this toxin destroys red blood cells and causes intoxication (poisoning of the entire body). Under its action, small vessels dilate in all organs, including the skin and mucous membranes, which leads to the appearance of a characteristic rash. Erythrotoxin causes the death of the outer layer of the skin - the epidermis, which leads to severe peeling of the skin.

By the end of the first week of illness, immunity to streptococcus begins to develop. The synthesis and accumulation of antibodies, their binding of toxins leads to a reduction and elimination of the manifestations of toxicosis and the gradual disappearance of the rash.

How does it manifest?

Scarlet fever begins acutely: with a sharp rise in temperature to 39º C. The child complains of headache, nausea, severe malaise, and severe pain when swallowing.

At the end of the first and beginning of the second day, a small, itchy rash appears, which covers almost the entire body within a few hours. An important sign of scarlet fever is thickening of the rash in the form of dark red stripes on the skin folds in places of natural folds - in the groin folds, armpits, elbows. The skin feels very dry and feels like sandpaper.

If you look into the patient’s mouth, you can see bright red inflamed mucous membrane, purulent deposits on the palatine tonsils and a crimson tongue with sharply enlarged papillae. Doctors characterize this condition of the throat with the expression "flaming pharynx."

On the face, the rash is located on the cheeks, and to a lesser extent on the forehead and temples, while the nasolabial triangle remains pale and free of rash elements ( characteristic feature scarlet fever).

After 3-5 days, the skin turns pale and severe peeling begins, especially pronounced on the child’s palms: the skin is removed from them like gloves.

Complications :

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

The likelihood of complications is significantly reduced when taking full course antibiotics.

After scarlet fever, lifelong immunity is usually maintained. Nevertheless, reinfection scarlet fever still happens. Doctors are convinced that this is the fault of too active therapy - the disease is neutralized so quickly that immunity does not have time to form.

Diagnosis and treatment

The diagnosis is made on the basis of contact with a patient with scarlet fever, tonsillitis, in the presence of a characteristic rash and throat lesions.

Treatment is usually carried out at home. Children with severe and complicated forms of scarlet fever are hospitalized.

Bed rest must be observed for 7-10 days. To suppress the growth of streptococcus, antibiotics are used for a 10-day course. In addition, gargling with a solution of furacillin, infusions of chamomile, calendula, and eucalyptus is prescribed. Antiallergic drugs and vitamins are also used.

The prognosis is favorable.

After recovery, it is necessary to carefully monitor the well-being of the child, the color of urine (with glomerulonephritis, urine becomes the color of "meat slops", which is associated with the release of blood), pay attention to the appearance of pain in the joints. This will allow timely identification and treatment of complications of scarlet fever.

Prevention

Children who have been in contact with a sick person and have not previously suffered from scarlet fever are admitted to preschool or the first two grades of school after a seven-day isolation at home. In the apartment where the patient is located, regular wet cleaning and ventilation of the premises are carried out.

There is no vaccine for scarlet fever.