Scarlet fever: symptoms

Scarlet fever, the symptoms of which have been known to mankind for many centuries, is a dangerous disease caused by streptococci - Streptococcus pyogenes, which belong to the group of hemolytic streptococci. This kind of bacterium is also capable of provoking chronic tonsillitis, turning into rheumatic diseases, streptoderma, glomerulonephritis. Unlike viral infections - measles, rubella, scarlet fever - is a disease of bacterial etiology, accordingly it has quite a specific symptomatology. For a long time scarlet fever was not differentiated from similar diseases accompanied by a rash, and only at the end of the XVIIth century the disease was thoroughly studied and described. Due to the characteristic symptom - the bright red color of the tongue and the oral mucosa, the purple color of the small-scale rash was called scarlet fever (purple fever).

Scarlatina symptoms are fairly typical, but they can vary depending on the mechanism of transmission of bacterial infection.

[1], [2], [3], [4], [5], [6], [7],

Ways of infection with scarlet fever, the mechanism of disease development

With scarlet fever infection, streptococcus occurs in two ways - airborne and household, so the disease can spread extremely fast. The source of infection is only a person who can be a hidden carrier of streptococci and release bacteria into the environment for a long time without showing any obvious clinical symptoms of the disease. According to statistics, more than 15% of people with chronic tonsillitis may be potential carriers of scarlet fever. Also common is the contact-household way - food, through toys, household items, dirty hands. The insidiousness of scarlet fever lies in the fact that after recovery the person does not acquire a stable immune response to infection, so relapses are possible provided that another form of streptococcus is infected. It is believed that the incubation of scarlet fever does not exceed ten days, of which the first two days are the most dangerous in terms of the spread of the infection.

Classification of the disease

Scarlet fever is usually differentiated in form, severity of the disease. This classification was adopted more than twenty years ago and helps to more accurately determine the nature of the disease in order to effectively control it and minimize possible complications. 

The form: 

• A typical form of the disease. 
• Atypical form of the disease, which can be without skin manifestations (rash), can have a hemorrhagic form, an extra-buccal form (infection outside the nasopharynx) is also possible. 

The severity of the disease can be as follows: 

• Light degree of severity. 
• The average severity, gravitating to a more serious form. 
• Severe form, hypertoxic, accompanied by sepsis.

Scarlet fever develops and proceeds also in different ways and can be this: 

• Acute form of the disease. 
• A prolonged, chronic form of the disease. 
• Scarlet fever, which has no complications and is not accompanied by allergic reactions. 
• Scarlet fever, the symptoms of which indicate complications and allergic reactions.

Complications can be as follows: 

• Allergic forms of complications - myocarditis, kidney pathologies (nephritis), lymphadenitis, synovitis (inflammatory process in the joints). 
• Purulent pathologies. 
• Sepsis and bacterial embolism - septicopyemia. 
• Combination of several pathologies developing after scarlet fever.

Clinical manifestations of scarlet fever are grouped according to the forms of the disease and severity. There are typical signs of the disease, there are also described types of manifestations of scarlet fever, the symptoms of which vary depending on the localization of the infectious process.

Scarlet fever symptoms is as follows: 

• Rapid development of the disease, acute form.
• Hyperthermia - increase in temperature to 39-40 degrees.
• Intoxication of the body, accompanied by nausea and vomiting (toxic form). 
• Angina, severe sore throat. 
• Bright red, purple-colored tongue. 
• Characteristic white color of the skin in the nasolabial triangle on the background of facial exanthema. 
• Inflammation of the lymph nodes is lymphadenitis. 
• A characteristic rash on the first or second day. 
• Scaly skin of the palms and feet.

Depending on the duration of the incubation, the manifestations of scarlet fever can be erased in a clinical sense, but can be very obvious. If scarlet fever does not manifest symptoms or proceeds in a mild, worn out form, the first signs of malaise can be severe fatigue, decreased appetite, less often headache and slight chills. Much more often scarlet fever symptoms show suddenly and in an acute form. In such cases, in addition to a sharp rise in body temperature, vomiting, joint aches, severe headache and sometimes delirious conditions join the symptoms. During the first 12 hours of the rapid development of the disease, there is already noticeable hyperemia of the tongue of the palate, strong reddening of the tonsils, enlargement of the lymph nodes, plaque in the tongue. The cheeks are hyperemic, often within the first day there is a typical scarlet fever, which begins to cover the skin with small dotted eruptions, gradually merging into reddish purple spots. Characteristic of the way the rash spreads - from the upper zone of the neck down the chest throughout the body. The patient's face acquires a red color with a "classic" white triangle in the nasolabial triangle. This sign was first described and introduced into clinical diagnostic practice by the great doctor, pediatrician Nil Fedorovich Filatov, whose name was the triangle - a symptom of Filatov. In addition, it was Filatov who pointed to a typical combination of inflammation of the tonsils and scarlet fever, when he said: "Scarlet fever without angina hardly occurs, so diagnosing it with one rash is very risky." Developing, the infection is accompanied by a general intoxication of the body, which manifests itself in constant nausea, sometimes vomiting, while the tongue is covered with a characteristic grayish coating that descends on the fifth day of the disease. After 4-5 days of scarlet fever, the symptoms are more pronounced: the tongue acquires a scarlet color, the lymph nodes increase in size, lymphadenitis often extends to the submandibular region and the occiput. The red color of the tongue persists for 15-20 days. The blood test, taken in the first days of the disease, shows an increase in the number of white blood cells, which is explained by the primary response of the immune system to infection. Then the white blood cells return to normal, the level of eosinophils increases as a response to allergic intoxication. If scarlet fever is not accompanied by purulent complications, a week later the blood test shows relatively normal indices. Gradually, the rash disappears, the body temperature also returns to normal and the following signs of scarlet fever occur: skin peeling, which is localized first on the palms, less often on the feet (soles) of the legs. Shivering palms - this is a typical sign of infection with streptococci, causing scarlet fever. It is for this symptom that the diagnosis of the disease, sometimes symptomatic similar to classical tonsillitis, when scarlet fever occurs in an erased, asymptomatic form, is sometimes specified. Peeling can be intense or quite insignificant, it depends on the prevalence of exanthema (rash).

[8], [9], [10],

Other types of scarlet fever

Scarlet fever, the symptoms of which can depend on the form of the disease, affects not only yawns, tonsils. The forms and symptoms of scarlet fever can be as follows: 

• Scarlet fever, developing outside the nasopharynx - extra-buccal. This form of the disease is characterized by infection of damaged skin (burn wounds, traumatic wounds of eczema, streptoderma). The signs of extra-buccal scarlet fever differ little from the typical picture of the disease, with only one difference - the localization of the rash, which begins to spread from the source of infection (from the site of skin damage). Cervical lymph nodes do not increase, yawns, tonsils remain unchanged. 
• The erased form of the disease is characteristic of adult patients. Scarlet fever, the symptoms of which are poorly expressed, are accompanied by a pale exanthema (rash) rapidly disappearing. Despite undeveloped symptoms, this type of disease is dangerous for its latent course, which can suddenly develop into a toxic form. The main diagnostic criterion can serve as scaly palms in combination with weak signs of ductal angina and small hyperemic areas of the skin. 

Scarlet fever, the symptoms of which are expressed as toxic, are the most severe form of the disease, fortunately, it is very rare at present. The toxic-septic appearance of scarlet fever, as a rule, is characteristic for adult patients. This form of the disease begins rapidly, body temperature steadily rises within 8-10 hours, heart failure develops with a sharp drop in blood pressure, a decrease in the pulse rate. Scarlet fever in this form is characterized by its abundant hemorrhagic eruptions, signs of catarrhal tonsillitis, indomitable vomiting, diarrhea and delusional condition. In especially severe cases, convulsive syndromes are possible. If you do not provide urgent medical help in a timely manner, the patient may die within 24 hours from a general extensive intoxication and cardiac arrest. The toxic-septic form can be a consequence of a septic form, not diagnosed, not recognized in time. With septic form of scarlet fever, the symptoms are as follows: 

• A strong increase in the tonsils. 
• White coating on tonsils and tongue. 
• The characteristic purulent smell of their nasopharynx. 
• Mucous discharge with pus from the nose. 
• Difficulty breathing, constantly open mouth. 
• Strong puffiness in the upper facial area. 
• Enlargement of the lymph nodes of the neck, sometimes to the tumor. 
• Purulent discharge from the ears.

Scarlet fever, the symptoms of which are sufficiently well studied, is dangerous and as an independent disease, which sometimes is very difficult, scarlet fever is also dangerous, and its complications in the form of jade, purulent otitis, cardiopathology, lymphadenitis, arthritis. Early diagnosis is the main way of timely relief of acute symptoms, reducing the risk of transition to severe disease and minimizing the menacing complications of scarlet fever.