Characteristic features of scarlet fever. Scarlet fever in children: symptoms and treatment (17 photos). Etiology and types of spread of infection

Children aged 2-10 years are most often affected.

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. 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(when sneezing, with kisses, 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 influence, in all organs, including the skin and mucous membranes, they expand small vessels, 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. Important sign scarlet fever - 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, elbow bends. 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 tonsils and a crimson tongue with sharply enlarged papillae. Doctors characterize this condition of the throat with the expression “flaming throat.”

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 (ear inflammation);
allergic kidney disease - glomerulonephritis,
joint inflammation - arthritis, synovitis;
heart damage - allergic myocarditis;
pneumonia (pneumonia).

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

After scarlet fever, lifelong immunity is usually maintained. However, re-infection with 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 child’s well-being, the color of the urine (with glomerulonephritis, the urine becomes the color of “meat slop”, which is associated with the release of blood), and 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 the patient and have not previously had scarlet fever are allowed to enter preschool or the first two grades of school after seven days of 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.

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 about 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 called acute infection, the causative agents of which are 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 clothing and belongings

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. Most often, the incubation period in children lasts two to three days. Sometimes it is reduced to one day or even several hours. In rare cases, the incubation period can be extended 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?

Scarlet fever is most often diagnosed in children aged 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. Recurrent disease is possible with reduced immunity in adults.

An adult who has never had scarlet fever before can get it from a child

If an adult has not previously had scarlet fever, he can become infected by airborne droplets from a sick child. However, the severity of scarlet fever in adulthood can vary. 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 beginning clinical manifestations turns 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 represented mainly by the face area (on the cheeks), groin area, flexor surfaces of the limbs, as well as the lateral areas of the torso.

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

Nasolabial triangle with scarlet fever, it does not become covered with a rash, but on the contrary, it 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 of the initial stage of 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.

Severity of the disease

Depending on the age, state of immunity and clinical picture of scarlet fever, a child may have:

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. Decrease in temperature and disappearance acute symptoms celebrated by the seventh or eighth day of illness.
Heavy. Nowadays, 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. At 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 their life. 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 had scarlet fever to the baby after birth causes the rarity of cases of scarlet fever in newborns. The child is protected from such infection by maternal immunity for 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. Besides, in acute phase It is important to adhere to a diet and increase your drinking regime. Food is given to the child in semi-liquid or liquid form, and protein products limit. A child suffering from scarlet fever should drink a lot. It is best to give a warm drink, such as tea.

Drug therapy

Drug treatment for 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, it is recommended infusion therapy(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 auxiliary methods, but only after consultation with 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, sensitization of the child’s body (its increased allergic sensitivity to erythrotoxin) is of great importance.

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, so after just a few 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(kidney and heart damage).
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 timely appointment antimicrobial agents sometimes streptococci die in children's body very quickly, but 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 moderate to severe scarlet fever for one month. If, 3 weeks after recovery, examination of the child, blood and urine tests do not show any abnormalities, dispensary observation stop. Having identified any alarming symptoms in a child who has had scarlet fever, he is referred 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 are talking about primary classes) or to kindergarten.

Symptoms and treatment

Scarlet fever (lat. Scarlatina) - it's spicy infection, characterized by general intoxication, sore throat (see Sore throat), pinpoint rash and a tendency to complications.

Scarlet fever - causes (etiology)

The causative agents of scarlet fever are toxigenic β-hemolytic streptococci of group A. Scarlet fever epidemics are characterized by a wave-like course. Periodic increases in incidence occur after 5-7 years. This disease occurs in children of all ages, but children aged 3 to 10 years are most susceptible to scarlet fever.

When cultured on blood agar it causes hemolysis. Serological classification carried out according to the antigenic properties of the C-polysaccharide. Group A streptococci, to which the causative agent of scarlet fever belongs, includes more than 80 serotypes; group A β-hemolytic streptococcus is resistant to external environment. Withstands boiling for 15 minutes, resistant to many disinfectants(sublimate, chloramine, carbolic acid).

Despite the exceptional interest in the problem of streptococcal infections and a huge number of solid works in this area, it is still not possible to obtain a clear answer to the question about the specific properties of types of streptococci A that can cause scarlet fever.

It is known that the pathogen produces an erythrogenic (scarlet fever) toxin.

Scarlet fever - mechanism of occurrence and development (pathogenesis)

The main source of infection in scarlet fever is the patient. Infection can occur throughout the illness, but in the acute period the infectivity is highest. Mild and atypical cases, the number of which has now greatly increased, pose a great danger from an epidemiological point of view. The causative agent of scarlet fever is found mainly in the mucus of the throat and nasopharynx and is transmitted by droplets, as well as by direct contact. Transmission of the pathogen through healthy bacteria carriers is of limited importance. They don't give it either of great importance the spread of scarlet fever through objects, since the pathogen does not remain on them for very long.

The pathogenesis of scarlet fever is a sequential development of three stages (lines) associated with the toxic, septic and allergic effects of streptococcus. These lines of pathogenesis are interconnected.

At the site of penetration on the mucous membrane of the oropharynx, respiratory, genital tract or on damaged skin (burns, wounds), streptococcus causes inflammatory changes. With scarlet fever, the palatine tonsils are most often the portal of entry. From the site of introduction it can spread through the lymphatic tract to regional The lymph nodes, but to superficial vessels, intracanalicularly or upon contact - to nearby tissues. In this case, toxic substances of β-hemolytic streptococcus appear in the blood, which affect the cardiovascular, nervous and endocrine system. The body develops a complex pathological process, which is represented by toxic, septic and allergic syndromes.

Toxic syndrome (toxic line of pathogenesis) develops under the influence of the thermolabile fraction of exotoxin and is characterized by the development of fever, intoxication (headache, vomiting), sympathetic manifestation of vascular changes (in the sympathetic phase) in the form of increased blood pressure (see Blood pressure), muffled heart sounds , tachycardia, persistent white dermographism and the appearance of pinpoint rash.

In more severe cases, hemodynamic disorders may develop, hemorrhagic syndrome up to hemorrhage in the adrenal cortex, cerebral edema, dystrophic changes in the myocardium, autonomic disorders up to sympathicoparesis.

The septic line of pathogenesis is caused by the influence of microbial factors of GABHS and is manifested by purulent and necrotic changes inflammatory reaction at the entrance gate and complications of a similar nature. The septic component may be the leading one in the clinical picture from the first days of the disease or manifest itself as complications in a later period of infection. More frequent complications are sinusitis, otitis, lymphadenitis, adenophlegmon, osteomyelitis. With necrotizing otitis, the process can progress to bone tissue, hard meninges, venous sinuses.

The allergic line of pathogenesis develops as a result of sensitization by the thermostable fraction of the exotoxin and antigens of damaged tissues. Allergic syndrome can manifest itself already in the first days of the disease and reaches its greatest severity at 2-3 weeks infectious process in the form of allergic complications (various rashes, unmotivated low-grade fever, glomerulonephritis, myocarditis (see Myocarditis), synovitis, lymphadenitis, arthritis, etc.).

In the pathogenesis of scarlet fever, there is a change in phases of autonomic nervous activity: at the beginning of the disease, there is an increase in the tone of the sympathetic part of the autonomic nervous system (“sympathetic phase”), which in the 2nd week is replaced by a predominance of the tone of the parasympathetic part of the nervous system (“vagal phase”).

Antitoxic immunity after scarlet fever is persistent, repeated cases of the disease are observed in 4-6% of children. Early use of penicillin prevents the formation of intense antitoxic immunity.

Scarlet fever - pathological anatomy

According to the severity of the course, scarlet fever is classified into mild, moderate and severe. The mild form can be characterized by only the most minor changes in the pharynx, such as catarrhal tonsillitis. Moderate to severe scarlet fever is divided into toxic, tocoseptic and septic.

These forms differ from each other in the intensity of intoxication and the depth of purulent-necrotic processes in the pharynx, tonsils and lymph nodes of the neck. Of course, the duration of the evolution of all these processes will be longer, the more widespread they are. But in general they end by the end of the 3rd week of illness.

The second period of scarlet fever is not a necessary expression of the disease and cannot be foreseen. The onset of the second period does not depend on the severity of the first. In this regard, persons who have had the disease for 3 weeks, despite the absence of clinical manifestations, are observed for another 2 weeks and, if everything goes well, they talk about full recovery from scarlet fever.

The second period of scarlet fever is expressed by the occurrence of minor catarrhal phenomena in the pharynx. However, the most significant changes should be considered in the kidneys, where acute diffuse glomerulonephritis develops with a pronounced hemorrhagic component. Clinically, hematuria and hypertension appear. Nephritis in rare cases takes a chronic course and ends with secondary shrinkage of the kidneys. In addition, in the second period, vasculitis, warty endocarditis, and serous arthritis may be observed.

Scarlet fever - symptoms (clinical picture)

The incubation period in most cases ranges from 3 to 7 days, rarely up to 11 days. A shorter incubation (1-3 days) is observed with extrabuccal scarlet fever.

When determining the form of scarlet fever, the classification of A. A. Koltypin is most often used, which is based on the differentiation of the disease by type, severity and course. In typical forms, all the main signs of scarlet fever are clearly expressed; with atypical ones, one of the cardinal signs is absent (rash or sore throat) or all symptoms are weakly expressed (erased form). Atypical forms include hypertoxic forms and extrabuccal scarlet fever. When assessing severity, the severity of general intoxication and the intensity of the local process in the pharynx, nasopharynx and regional lymph nodes are taken into account. Forms in which manifestations of general severe intoxication predominate are classified as toxic, and if a severe local process predominates, they are classified as septic. When determining the course, the presence or absence of complications, or wave-like outbreaks of the process and their nature are taken into account.

The typical mild form is characterized by slight intoxication, there may be a slight and short-term increase in temperature, there is no vomiting or it happens once. Sore throat is catarrhal, with limited hyperemia and a brighter color of the small tongue, the tonsils are slightly enlarged and somewhat painful. A pinpoint rash against a background of erythema can be quite common, with the middle of the face, lips, nose and chin free of rash (Filatov’s white triangle), but often the rash can only be in skin folds, on the inner surfaces of the thighs, and in the lower abdomen.

All symptoms quickly reverse, and by the 5-6th day of illness a period of convalescence begins.

Currently time is easy the form is predominant, accounting for 80-85% of all cases. It must be remembered that with this form late complications are possible, including nephritis.

In the moderate form of scarlet fever, high temperature, moderate intoxication, repeated vomiting, profuse, uniform rash with distinct white dermographism, sore throat with necrosis, crimson tongue, and enlarged regional lymph nodes are observed. Complications with this form are more common than with mild ones and are more varied in nature.

Severe forms of scarlet fever in modern conditions are rare (less than 1%), among them there are toxic, septic and toxic-septic.

With toxic scarlet fever, there is a violent onset, high fever, uncontrollable vomiting, frequent loose stool, anxiety, delirium, convulsions, adynamia, injection of scleral vessels, acrocyanosis, cold extremities, frequent weak pulse, weakened heart sounds. The rash is scanty, uneven, cyanotic, and sometimes there may be hemorrhages. Changes in the pharynx and regional lymph nodes are insignificant. These forms occur mainly in children over 3 years of age.

The septic form of scarlet fever is now extremely rare. It is characterized by deep and extensive necrotic changes in the pharynx and nasopharynx, inflammation of the lymph nodes of the neck with rapid involvement of the surrounding tissue in the process.

Atypical forms include erased scarlet fever, in which all symptoms are very mild or one of the main symptoms, most often a rash, disappears. A mild rash lasts for several hours and can easily go undetected.

Extrabuccal scarlet fever in children is most often observed after a burn. The incubation period is short (1-2 days), the rash begins at the site of the burn. There is no sore throat in the first days of the disease or it is mild. The course of this form of scarlet fever is mostly mild.

From the 4-5th day, with uncomplicated scarlet fever, the reverse development of all symptoms begins. Manifestations of general intoxication weaken, the temperature becomes normal, mild sore throats disappear in 5-7 days, necrotic ones last 9-10 days, the rash disappears, leaving no pigmentation behind.

Peeling usually begins at the end of the 2nd week. The earliest pityriasis peeling appears on the neck, earlobes, axillary, and pubic areas; Larger scales form on the body, and large layers separate on the fingers and toes, palms and soles. In infants, peeling is usually mild.

It must be emphasized that in recent years there has been an increase in the number of erased forms of scarlet fever and a softening of its main initial symptoms. The temperature does not reach high numbers, the febrile period has become shorter, the rash is low-intensity and does not last long, sore throat is almost always catarrhal, the reaction from the regional lymph nodes is moderate. Complications have become less common and less varied.

The second period of scarlet fever is characterized by peculiar changes in the cardiovascular system. The pulse becomes slow, arrhythmic, the heart sounds are weakened, a functional systolic murmur may appear, a bifurcation of the second sound on the pulmonary artery may appear, the boundaries of the heart expand somewhat, and blood pressure drops. This is the so-called scarlet fever, its manifestations last on average 2-4 weeks. These disorders are changeable, unstable and almost do not aggravate the general condition of the patient; they are caused by a violation nervous regulation activity of the cardiovascular system.

There are septic and allergic complications, according to the time of occurrence - early and late.

Septic complications include lymphadenitis, otitis media, and sinusitis. Most a common complication is lymphadenitis, the group of anterior cervical lymph nodes is most often affected with reverse development after 2-5-9 days. Currently, purulent lymphadenitis is extremely rare, the frequency of inflammation of the middle ear has noticeably decreased and in the vast majority of cases otitis is catarrhal, sinusitis (ethmoiditis, frontal sinusitis) is less common, which is mild, with less severe symptoms and is not always recognized.

Allergic complications include synovitis and nephritis. Synovitis is a benign short-term inflammation of predominantly small joints, most often appearing on the 4-7th day of illness in children over 5 years of age.

Kidney damage in scarlet fever can be varied - from toxic nephrosis to diffuse glomerulonephritis. In recent years, pronounced nephritis has been observed very rarely. Considering the possibility of asymptomatic forms of nephritis, it is necessary to conduct urine tests over a period of 3-4 weeks.

Scarlet fever - treatment

Patients with scarlet fever are hospitalized in a hospital according to clinical and epidemiological indications. It is necessary to fill the wards or department simultaneously (within 1-3 days). Communication between patients from different wards should not be allowed. Children who develop complications must be isolated from other patients. The department must not be overloaded with patients. It is necessary to strictly ensure that the department is systematically ventilated. It is very important to ensure compliance with the correct regimen and especially long sleep for sick children in the acute period of the disease.

When treating at home, a sick child must be isolated in a separate room and measures must be taken to prevent the transmission of infection by the person caring for the patient.

Since objects that patients come into contact with can be a source of infection for others, ongoing disinfection of dishes, towels, handkerchiefs, toys and other personal items of the patient should be carefully carried out.

In the acute period of the disease, even with a mild form of scarlet fever, the child should be on bed rest. At the end of the acute period (from the 6-7th day) at normal temperature, the child’s satisfactory condition and the absence of pronounced changes in the cardiovascular system, he can be allowed to get out of bed. It is necessary to take care of increasing the child’s emotional tone (toys, books, drawing, etc.).

It is necessary to measure body temperature 2 times a day and systematically do urine tests.

Food should be complete and rich in vitamins. In the presence of necrosis and sore throat, food should be mechanically and chemically gentle. It is necessary to ensure that in the acute period the child receives sufficient quantity liquids (at least 1 l).

For scarlet fever, antibiotics are prescribed. The most widely used is penicillin (for 6-8 days). In case of intolerance or resistance to penicillin, drugs of the tetracycline group are prescribed. According to most authors, antibiotics must be administered even in the mildest cases of scarlet fever.

Attention should be paid symptomatic therapy, drinking plenty of fluids, desensitizing agents. In the treatment of septic complications, the leading place is occupied by antibiotic therapy for 6-8-10 days. Scarlet fever nephritis is treated according to the principle of acute glomerulonephritis therapy.

Synovitis has a favorable course and goes away without any special treatment. For scarlet heart, no other therapeutic measures are required other than rest.

Scarlet fever - prevention

Anti-epidemic measures in the fight against scarlet fever currently come down to timely diagnosis, early isolation of patients, compliance with quarantine periods and the fight against the introduction of infection into children's groups.

Discharged from the hospital after the 10th day of illness, provided wellness sick, normal temperature for 5 days, in the absence of complications, a calm state of the pharynx and nasopharynx, normalization of blood composition and ESR. When treating at home, communication with the patient is allowed no earlier than the 10th day from the onset of the disease. For children attending preschool institutions and the first 2 grades of school, additional separation from the team is established for 12 days after discharge from the hospital or isolation at home.

When a patient is hospitalized, quarantine is imposed only on children who have not had scarlet fever, live in the same room with the patient and attend preschool institutions and the first 2 grades of school. The quarantine period is 7 days from the moment the patient is isolated. If the patient remains at home, then quarantine is imposed on children who have been in contact with him for 7 days from the end of the acute period, i.e. after the 10th day.

Adults serving children's institutions, surgical departments, maternity, food and dairy production, are subject to medical supervision for 7 days.

Scarlet fever- acute infectious disease. 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:

A patient with scarlet fever, tonsillitis or streptococcal pharyngitis. Such a person is especially dangerous for others in the first days of illness.
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.
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 the summer, the number of cases decreases.

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 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 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 and feels severe weakness, 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. 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.

According to 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 the 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 more and thinner skin. 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, skin peeling begins	At first, in those places where the rash was more intense - in the folds of the body. On the face the peeling is fine, on the arms and legs it is lamellar. This is due to the death of skin cells and the separation of the top layer - the epidermis.
The skin on the palms and soles peels off in layers	Because of close connection between 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 symptoms 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 occur 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 unnoticed and insignificant, and 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 explained by the fact that small blood vessels dilate under the influence of toxins secreted by bacteria. Also arise:

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

In adults, symptoms of general intoxication quickly increase - poisoning with streptococcal 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 a small allergic rash. The skin becomes dry, rough, and itching appears. The rashes have the same features as in children:

the first rash appears on the face
the area below the nose to the chin is without rash and very pale
Most roseola are 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 take on a bluish tint. 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 bacteria have settled. Lymph nodes near the affected area become enlarged and painful. This is because they are trying to delay the spread of 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. Special attention pay attention to the 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, medical institutions and in the field of nutrition. 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 the spread of the 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 walls 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

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

Heart valve damage- 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. Manifested by shortness of breath and aching chest pain.
Synovitis- serous inflammation of the joints - the result of allergization, occurs in the second week of the disease. Are affected small joints fingers and feet. It manifests itself as swelling and pain. Goes away on its own without treatment.
Rheumatism- damage to 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.
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.
Chorea- brain damage that occurs 2-3 weeks after recovery. 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 the impaired function, in others, inconsistency of movements remains for life.

Late complications after scarlet fever most often occur if the infectious disease was treated independently without antibiotics or the diagnosis was made incorrectly.

Prevention of complications - correct and timely treatment scarlet fever. At the first signs of illness, you should consult a doctor. Taking antibiotics, antiallergic drugs and drinking plenty of fluids is reliable protection against complications.

Is scarlet fever contagious, and how is it transmitted?

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

There are four mechanisms of infection:

Airborne- infection occurs through contact with a patient or carrier. The disease spreads quickly in children's groups. When you cough or talk, an aerosol is formed in the air from small droplets of saliva containing the pathogen. When the bacteria enter the mucous membrane of the upper respiratory tract of a healthy person, they first colonize the palatine tonsils (tonsils) and begin to produce a toxin. Over time, they spread to surrounding tissues and regional lymph nodes.
Domestic- through household items used by the patient. Toys, dishes, and linen can become a source of infection if saliva or mucous secretions of a sick person come into contact with them. Although streptococcus loses its dangerous properties in the environment, it can cause infection. This happens if a microorganism from dusty items enters the mouth or nose of a healthy person. The bacteria, once in favorable conditions, attach to the mucous membrane of the nasopharynx, begin to actively multiply and produce toxins. Therefore, it is so important to carry out ongoing disinfection in the room where he is and to prevent the sharing of his things.
Food (nutritional)- if bacteria get on it during cooking, then such a dish can become dangerous for them nutrient medium and breeding site. Particularly dangerous in this regard are dairy products that are not boiled and various jellies. When eating such food, a large number of microorganisms immediately enter the body. They linger on the nasopharyngeal mucosa and cause illness. That is why so much attention is paid to testing cooks and other kitchen workers for bacterial carriage.
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. In this case, staphylococcus multiplies not in the tonsils, but on 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 cases - cephalosporins I-II generations: Clindamycin, Vancomycin for 10-14 days. Administered intravenously

Thanks to antibacterial therapy managed to turn scarlet fever from fatal dangerous 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:

in severe cases of illness
children from orphanages and boarding schools
patients from families where there are persons who work in preschool institutions, hospitals, trade and catering workers, 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:

Antiallergic (antihistamine) drugs - to eliminate manifestations of allergies and complications that may arise due to allergization of the body: Loratadine, Cetrin;
Antipyretics - to normalize temperature and relieve headaches: Paracetamol, Ibuprofen;
Strengthening the wall of blood vessels - to eliminate the effect of the toxin on the blood capillaries: Ascorutin, Galascorbin;
Local sanitation means - preparations for cleansing the nasopharynx from bacteria: rinsing with Chlorophyllipt, Furacilin;
If the patient's condition is serious, he 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.

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

Diet for scarlet fever

The patient’s nutrition should be aimed at maintaining the body’s strength, increasing resistance to infection and reducing allergenicity. Food should be easy to digest. It is also necessary to remember that a sore throat worsens when swallowing. Therefore, dishes should be semi-liquid and pureed. 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, salty 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, pearl barley and barley cereal
Fruit compotes, rosehip decoction, diluted juices	Chocolate, cakes, cocoa
Sugar, honey, jam, jam, marmalade

If there are no kidney complications, you need to drink 2-2.5 liters of fluid per day. This will help remove the toxin from the body through urine.

Herbal medicine and folk remedies will help alleviate the condition of scarlet fever. We offer several of the most effective recipes.

Gargle with herbal decoctions. 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.
Wash the horseradish root and grate it. Pour a liter of hot boiled water and leave for three hours. Use for rinsing 5-6 times a day.
Take half a glass of freshly squeezed beet juice, add a teaspoon of honey and apple cider vinegar and half a glass warm water. Use to rinse every two hours.
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.
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.
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.
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.
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.
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 is great amount variants of these microorganisms. Pharmaceutical companies 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.

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 sore throat or pharyngitis. The pathogen is quite stable in the external environment and can persist in food products for a long time.

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 of the pharyngeal tonsil or the 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.

Constant symptom Scarlet fever is a sore throat - 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 testing of blood and urine on the 10th and 21st days of the disease. An electrocardiogram is performed 2-3 weeks after clinical recovery.

IN acute period illness, 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 Tomicide 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 are resorted to. Treatment of complications is carried out according to generally accepted regimens.

Prevention. Immunoprophylaxis for the disease has not been developed. For specific prevention use of scarlet fever among contact persons is indicated 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).

Events 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.