Scarlet fever of nose

Scarlet fever is an acute infectious disease caused by beta-hemolytic streptococcus of group A-Str. Pyogenes, flowing cyclically with intoxication, sore throat, small-scale rash on the skin. According to the classical ideas, "scarlet fever does not like the upper respiratory tract, prefers digestive, in particular the pharynx." However, nasal localization of this infection occurs quite often, especially in adolescents, with severe forms of the disease, provoked by a particularly virulent streptococcal infection and manifested by ulcerative-membranous or gangrenous forms of rhinitis.

Clinical forms of scarlet fever. There are several forms of scarlet fever.

Early scarlet fever purulent rhinitis is characterized by abundant rhinorrhea; discharge in the beginning of the disease is serous, then become purulent with fetid odor and hemorrhagic. Soon, acute purulent rhinitis is associated with skin lesions in the form of dermatitis in the nose and upper lip. These phenomena are accompanied by obstruction of the nasal passages and often with catarrhal conjunctivitis. Often simultaneously or 1-2 days later, scarlet fever of the nose is accompanied by inflammation of the mucous membrane of the pharynx and palatine tonsils. These symptoms of nasal scarlatina develop against the background of a severe general clinical picture of diphtheria, manifested by a high body temperature, cardiopulmonary insufficiency of toxic origin, a general severe state of the body, progressing into a coma and a co-morbid state, which ends in 4-5 days of death. In cases where the latter can be prevented, purulent rhinitis takes a protracted character and ends with an atrophic condition of the nasal mucosa as a result of the desolation of endonasal vascular and lymphatic systems, as well as atrophy of nerve vegetative fibers.

Late scarlet fever purulent rhinitis occurs mainly in the stage of peeling in places where the rash occurs, when all general clinical symptoms are declining. The appearance of this form of rhinitis coincides with the occurrence of complications of the disease. Local manifestations are plentiful mucopurulent discharge from the nose, pronounced obstruction of the nasal passages, an inflammatory infiltration in the area of the nasal vestibule and its pyramids extending to the upper lip.

Pseudomembranous scarlet fever purulent rhinitis is similar to the previous form in clinical manifestations; however, in its evolution, pseudomembranous plaques appear in the affected parts of the mucous membrane in the form of characteristic thin whitish-yellow films that block the nasal passages, which easily disappear but quickly reappear.

The complications arising from scarlet fever of the nose are basically the same as in measles and diphtheria with those features that are observed in scarlet fever. All of them are mostly purulent, caused by streptococcal infection. Spreading the process into the larynx can cause the phenomenon of stridor, swelling of the lining space, up to laryngeal stenosis and asphyxia phenomena. Often there are complications from the parenchymal organs, and in particular scarlet fever. Late complications include various cicatricial stenoses of nasal passages and other areas of the upper respiratory tract, in which there were pathomorphological manifestations of scarlet fever infection. For example, with scarlet fever, extensive destruction is observed in the middle ear region and a mixed form of deep hearing loss.

Diagnosis of scarlet fever of the nose does not cause difficulties with typical general and dermatological signs of scarlet fever and is based on the symptoms described above of scarlet fever and specific general clinical manifestations of it. Differentiate the scarlet fever of the nose follows from various forms of diphtheria of the nose. Diagnosis is particularly difficult when both forms are combined.

Treatment of scarlet fever is common and local. The general is based on the long-term use of appropriate antibiotics. Local treatment is carried out on the same principles as with other purulent-inflammatory diseases of the nasal cavity. If there is a complication in the form of scarlet fever, then emergency measures should be taken to prevent the laryngeal edema, up to the intubation of the trachea and tracheotomy.

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