Nasal scarlatina

Scarlet fever is an acute infectious disease caused by beta-hemolytic streptococcus group A - Str. pyogenes, occurring cyclically with intoxication, sore throat, and small-point rash on the skin. According to classical concepts, "scarlet fever does not like the upper respiratory tract, preferring the digestive tract, in particular the throat." However, nasal localization of this infection is quite common, 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 of the nose. There are several forms of scarlet fever of the nose.

Early scarlet fever purulent rhinitis is characterized by abundant rhinorrhea; discharge at the beginning of the disease is serous, then becomes purulent with a foul odor and hemorrhagic. Soon, acute purulent rhinitis is accompanied by skin lesions in the form of dermatitis of the entrance to the nose and upper lip. These phenomena are accompanied by obstruction of the nasal passages and often catarrhal conjunctivitis. Often, simultaneously or 1-2 days later, inflammation of the mucous membrane of the pharynx and palatine tonsils joins scarlet fever of the nose. The above signs of scarlet fever of the nose develop against the background of a severe general clinical picture of diphtheria, manifested by high body temperature, cardiopulmonary insufficiency of toxic genesis, general severe condition of the body, progressing to a comatose and soporous state, which after 4-5 days ends in death. In cases where the latter can be prevented, purulent rhinitis becomes protracted and ends with an atrophic state of the nasal mucosa as a result of desolation of the endonasal vascular and lymphatic systems, as well as atrophy of the autonomic nerve fibers.

Late scarlet fever purulent rhinitis occurs mainly in the peeling stage at the sites of rash occurrence, when all general clinical symptoms subside. The appearance of this form of rhinitis coincides with the occurrence of complications of the disease. Local manifestations are abundant mucopurulent discharge from the nose, pronounced obstruction of the nasal passages, inflammatory infiltrate in the area of the nasal vestibule and its pyramid, spreading to the upper lip.

Pseudomembranous scarlet fever purulent rhinitis is similar in clinical manifestations to the previous form, however, during its evolution, pseudomembranous plaques in the form of characteristic thin films of a whitish-yellow color appear additionally on the affected areas of the mucous membrane, blocking the nasal passages, easily removed, but quickly reappearing.

Complications arising from scarlet fever of the nose are basically the same as those arising from measles and diphtheria, with the same features observed in scarlet fever. All of them are mainly purulent in nature, caused by streptococcal infection. The spread of the process to the larynx can cause stridor, edema of the subglottic space, up to stenosis of the larynx and asphyxia. Complications from the parenchymatous organs, and in particular scarlet fever nephritis, often occur. Late complications include various cicatricial stenosis of the nasal passages and other areas of the upper respiratory tract, in which there were pathomorphological manifestations of scarlet fever infection. For example, in scarlet fever otitis, extensive destruction is observed in the middle ear and a mixed form of profound hearing loss.

The diagnosis of nasal scarlet fever is not difficult with typical general and dermatological signs of scarlet fever and is based on the symptoms of nasal scarlet fever described above and its specific general clinical manifestations. Scarlet fever of the nose should be differentiated from various forms of nasal diphtheria. Diagnosis is especially difficult when both of these forms are combined.

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

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