Scarlet fever in children

Scarlet fever is an acute infectious disease with symptoms of general intoxication, sore throat and rashes on the skin.

Scarlet fever in adults has its own distinctive features.

[1], [2], [3]

Causes of the scarlet fever in a child

Scarlet fever is caused by group A streptococci, which produce exotoxins, but antitoxic immunity plays a decisive role in the occurrence of scarlet fever. If there is no antitoxic immunity at the time of infection, scarlet fever occurs, in the presence of antitoxic immunity, other forms of the disease: angina, pharyngitis.

[4], [5]

Pathogenesis

The development of the clinical picture of scarlet fever is associated with the toxic, septic and allergic effects of streptococcus.

• The toxic line is manifested by symptoms of general intoxication: fever, rash, headache, vomiting.
• The septic pathogenesis line is manifested by purulent and necrotic changes at the site of the entrance gates and purulent complications.
• The allergic pathogenesis line is caused by the sensitization of the body to beta-hemolytic streptococcus.

[6], [7], [8], [9]

Symptoms of the scarlet fever in a child

The incubation period of scarlet fever is 2-7 days. Scarlet fever symptoms start to appear sharply, with rising body temperature, there is pain in the throat when swallowing, headache, there is a single vomiting. A few hours after the onset of the disease symptoms of scarlet fever appear on the face, trunk, limbs, there are symptoms of pinkish pinpoint rash against the background of hyperemic skin. On the face the rash is located on the cheeks, but the nasolabial triangle is free from the rash. The appearance of the patient is typical: the eyes are shiny, the face is bright, slightly edematous, the flaring cheeks are in stark contrast to the pale nasolabial triangle (Filatov's triangle). In the natural folds of the skin, on the lateral surfaces of the trunk, the rash is more saturated, especially in the lower abdomen, on the flexor surface of the extremities, in the armpits, elbows and groin areas. There are often dark red bands as a result of the concentration of rash and hemorrhagic impregnation (a symptom of Pastia).

Individual elements of the rash can be miliary, in the form of small, with pinheaded bubbles with a clear or unclear fluid. In more severe cases, the rash may take a cyanotic shade, and dermographism is intermittent and mild. With scarlet fever, the permeability of the capillaries is increased, which can easily be detected by the application of a tourniquet. The rash usually lasts 3-7 days and, disappearing, does not leave pigmentation.

After the disappearance of the rash at the end of the 1 st - the beginning of the 2 nd week of the disease, peeling begins. On the face, the skin is peeling in the form of tender scales. On the trunk, neck, ear shells, peeling is otrigious. It is more abundant after a miliary rash. For scarlet fever is typical lamellar peeling on the palms and soles. It manifests itself first as cracks in the skin at the free edge of the nail and then spreads from the fingertips to the palm and sole. The skin on the extremities exfoliates the layers. Currently, with scarlet fever, the scaling is less pronounced.

One of the permanent and cardinal symptoms of scarlet fever is a change in the oropharynx. Bright delimited hyperemia of the tonsils, arches, tongue does not extend to the mucous membrane of the hard palate. On the first day of the disease, it is often possible to see a point enanthem, which can become hemorrhagic. Changes in the oropharynx are so pronounced that they are designated, according to NF. Filatova, as a "fire in the throat", "glowing sore throat".

Angina with scarlet fever is catarrhal, follicular, lacunar, but is especially characteristic of this disease necrotizing angina. Depending on the severity of necrosis can be superficial, in the form of separate islets, or deep, completely covering the surface of the tonsils. They can spread and beyond the tonsils: the arch, tongue, the mucous membrane of the nose and throat. Necrosis is often dirty gray or greenish. They disappear slowly, within 7-10 days. Catarrh and follicular angina occurs after 4-5 days.

In accordance with the severity of the oropharynx, regional lymph nodes are involved in the process. They become dense, painful on palpation. Tonsillar and anterolateral lymph nodes are first of all increased.

The tongue is dryish at the beginning of the disease, densely coated with a grayish-brown coating, begins to clear from the tip and sides from 2-3 days, becomes bright red, with prominent swollen papillae, which gives him a resemblance to a raspberry: "crimson", "papillary" , "Scarlet fever" language. This symptom is clearly detected between the 3rd and 5th day, then the brightness of the tongue decreases, but for a long time (2-3 weeks) it is possible to see enlarged papillae.

Typically, intoxication is manifested by an increase in body temperature, lethargy, headache, repeated vomiting. In severe cases, the body temperature rises to 40 ° C, there is a severe headache, repeated vomiting, lethargy, sometimes arousal, delirium, convulsions, meningeal symptoms. Modern scarlet fever is often not accompanied by intoxication at normal body temperature.

White dermographism with scarlet fever in the beginning of the disease has an elongated latent (10-12 min) and shortened (1-1.5 min) apparent period (in a healthy person the latent period lasts 7-8 min, and the apparent period is 2.5-3 min) . In the future, the latent period is shortened, the obvious becomes more persistent.

In the peripheral blood, neutrophilic leukocytosis is noted with a shift to the left; ESR is enhanced.

Forms

Scarlet fever is divided by type, severity and flow. By type distinguish between typical and atypical scarlet fever.

• For a typical attribute forms with all the characteristic scarlet fever symptoms: intoxication, sore throat and rash.

Typical forms are divided into light, medium and heavy. The severity is determined by the severity of the symptoms of intussication and local inflammatory changes in the oropharynx. In recent years, scarlet fever in most cases occurs in mild form, less often - in the middle-aged. Heavy forms are practically not observed.

• By atypical include erased lightest form with mild clinical manifestations, as well as ekstrafaringealnuyu form (the burn, wound and postpartum) with a primary focus is the oropharynx. With extrafaryngeal scarlet fever, the rash appears and is more intense at the entrance gate, there are symptoms of intoxication: fever, vomiting. Angina is absent, but there may be mild hyperemia of the mucous membrane of the oropharynx. Regional lymphadenitis occurs in the region of the entrance gates and is less pronounced than with typical scarlet fever.
• To atypical one can include the most severe forms - hemorrhagic and hypertoxic.

[10], [11], [12], [13], [14], [15]

Diagnostics of the scarlet fever in a child

In typical cases, the diagnosis of scarlet fever in a child is not difficult. Sudden acute onset of the disease, fever, vomiting, sore throat when swallowing, delimited hyperemia of the arches, tonsils, tongue, pink small rash on the hyperemia of the skin, pale nasolabial triangle, enlarged regional lymph nodes of the neck give grounds for clinical diagnosis of scarlet fever. An auxiliary method can serve as a picture of peripheral blood: neutrophilic leukocytosis with a slight shift to the left and an increase in ESR.

Difficulties in the diagnosis of scarlet fever occur with erased forms and late admission of the patient to a hospital.

With the erased forms of scarlet fever, the limited hyperemia of the oropharynx, the phenomena of lymphadenitis, white dermographism and the picture of peripheral blood have diagnostic significance.

With the late admission of the patient, the long-lasting symptoms are diagnostically important: a "crimson" tongue with hypertrophied papillae of the tongue, petechiae, dryness and peeling of the skin. Very important in such cases are epidemiological data - contact of the child with the patient with other forms of streptococcal infection.

For laboratory confirmation of the diagnosis of scarlet fever, it is important to isolate beta-hemolytic streptococcus in the mucus from the oropharynx, as well as determine the titer of antistreptolysin-0, other enzymes and streptococcus antitoxins. Scarlet fever is differentiated from pseudotuberculosis, iersiniosis, staphylococcal infection, accompanied by a scarlatina-like syndrome, toxicoallergic condition, measles, meningococcemia, enterovirus exanthema, etc.

[16], [17], [18]

Treatment of the scarlet fever in a child

Patients with scarlet fever are hospitalized for clinical and epidemiological indications.

• Hospitalization is mandatory in severe forms of scarlet fever and when at home it is impossible to isolate the patient and create conditions for his treatment. Patients with scarlet fever are placed in boxes or wards for 2-4 people, filling them simultaneously. It is impossible to allow contacts between newly arrived patients and convalescents. The discharge from the hospital is made according to clinical indications after the end of the course of antibiotic therapy, usually on the 7th-10th day from the onset of the disease.
• Patients with mild and moderate forms are treated at home. When treating at home, you need to isolate the patient in a separate room and observe sanitary and hygienic rules when caring for the patient (current disinfection, individual dishes, household items, etc.). It is necessary to monitor the observance of bed rest during the acute period of the disease. The diet should be full, with enough vitamins, mechanically sparing, especially in the early days of the disease.

With scarlet fever, treatment with antibiotics is indicated. In the absence of contraindications, the antibiotic of choice is still penicillin. The duration of the course of antibiotic therapy is 5-7 days.

Specific bactericidal action against gram-positive cocci is possessed by tomicide. The drug is used externally to rinse the throat 10-15 ml 5-6 times a day.

In the treatment of scarlet fever in a child at home give phenoxymethylpenicillin inside from the calculation of 50 000 IU / kg per day in 4 receptions. In a hospital it is more expedient to administer penicillin intramuscularly into 2 doses. In severe forms, the daily dose of penicillin is increased to 100 mg / kg and more or transferred to treatment with third generation cephalosporins. Simultaneously with the antibiotic prescribe probiotics (acipol, etc.).

Prevention

Specific prophylaxis of scarlet fever is not developed. Preventive measures include early detection and isolation of patients with scarlet fever and any other streptococcal infection. According to the instructions given by people with scarlet fever, they are isolated for 7-10 days from the onset of clinical manifestations, but they are allowed to be sent to a children's institution after 22 days from the onset of the disease due to the possibility of various complications. Patients with other forms of streptococcal infection (angina, pharyngitis, streptodermia, etc.) in the focus of scarlet fever are also isolated for 22 days.

For the specific prevention of scarlet fever and other respiratory streptococcal infections among contact persons, application of thymicide is indicated. Tomicide is used in the form of rinses (or irrigation) of the throat. For one rinse use 10-15 ml of the drug or 5-10 ml for irrigation of the throat. The drug is used after meals 4-5 times a day for 5-7 days.

Since scarlet fever currently occurs almost exclusively in an easy form and does not cause complications, especially when treated with antibacterial drugs and compliance with the regime, these decreed periods of isolation of patients with scarlet fever can be reduced. In our opinion, patients with scarlet fever should be isolated no more than 10-12 days from the onset of the disease, after which they can be admitted to the organized team.

[19]

Forecast

The prognosis is favorable for rationally administered therapy (early penicillin therapy in conditions that exclude reinfection), the course of the disease is smooth, complications are rare.

[20], [21], [22],