Scarlet fever represents a sharp infection with primary defeat of the rotoglotka expressed by intoxication and characteristic ekzantemy. The causative agent of scarlet fever is the group A streptococcus which is transferred from the patient with a contact or airborne way. The clinic of scarlet fever includes the general intoxication and fever, skarlatinozny quinsy, regionarny lymphadenitis, crimson language, melkotochechny rash with the subsequent melkocheshuychaty peeling on skin. Diagnosis of scarlet fever is performed on the basis of existence of typical clinical symptoms.
Scarlet fever represents a sharp infection with primary defeat of the rotoglotka expressed by intoxication and characteristic ekzantemy.
Characteristic of the activator
Scarlet fever is caused by the beta and hemolytic streptococcus of group A relating to a sort grampolozhitelny, facultative and aerobic, an ovoidny form of bacteria Streptococcus. The tank and a source of the causative agent of scarlet fever, as well as in case of all streptococcal infections, is the person: patient or carrier. Patients with scarlet fever constitute the greatest danger in the first few days diseases, the probability of transmission of infection completely disappears three weeks later after expansion of clinical symptomatology. The considerable percent of the population (15-20%) belongs to asymptomatic carriers of an infection, sometimes people are an infection source for months and years.
The streptococcus is transferred on the aerosol mechanism (the patient allocates the activator at cough, sneezing, at a conversation) in the airborne or contact way. At hit of the activator on foodstuff, realization of an alimentary way of transfer is possible. Infection is most probable at close communication with the sick person.
The natural susceptibility of the person to scarlet fever quite high, a disease develops at the persons infected with the beta and hemolytic streptococcus (emitting erythrogene toxin) in the absence of anti-toxic immunity. The immunity which is formed after the postponed infection is type-specific and does not interfere with infection with other type of a streptococcus. There is some seasonal dependence: incidence increases during the autumn and winter period; and also communication with other respiratory streptococcal infections (quinsy, streptococcal pneumonia).
Pathogenesis of scarlet fever
As entrance gate for the causative agent of scarlet fever serves the mucous membrane of a pharynx, a nasopharynx, sometimes (extremely seldom) genitals. Happens that bacteria get into an organism through damages of an integument. In the field of introduction of the activator the local center of an infection with the characteristic necrotic phenomena is formed. The microorganisms breeding in the center emit the toxins promoting development of infectious intoxication in blood. Presence of toxin at the general blood-groove stimulates expansion of small vessels in various bodies and, in particular, integuments that is shown in the form of specific rash.
Anti-toxic immunity is gradually formed that promotes subsiding of symptoms of intoxication and disappearance of rash. Sometimes there is a hit in blood directly of activators that leads to defeat by microorganisms of other bodies and fabrics (lymph nodes, brain covers, tissues of a temporal bone, the hearing aid, etc.), causing is purulent - a necrotic inflammation.
Scarlet fever symptoms
The incubatory period can last from days to ten days. The disease begins sharply, there is a sharp temperature increase which is followed by symptoms of the accruing intoxication: a headache, an ache in muscles, weakness, tachycardia. High fever of the first days quite often is followed by the increased mobility, euphoria, or on the contrary: apathy, drowsiness and slackness. Considerable intoxication can provoke vomiting. Recently even more often note the course of scarlet fever with the moderate hyperthermia which is not reaching high figures.
When swallowing morbidity in a throat is noted, survey of a pharynx reveals the expressed hyperaemia of almonds (much more intensive, than at quinsy), handles of a uvula, a back wall of a throat, a soft palate (the so-called "the flaring pharynx"). At the same time hyperaemia of a mucous membrane is accurately limited to the place of transition of a soft palate to firm. Sometimes the clinical picture of folikulyarno-lacunary quinsy develops: intensively hyperemic mucous almonds becomes covered by the centers (more often small, but sometimes large and deep) a raid, mucopurulent, fibrinozny or necrotic character.
The inflammation of regionarny (perednesheyny) lymph nodes develops in too time: they increase in a size a little, become dense to the touch and painful. The language which is originally covered with a grayish-white raid in the subsequent (for 4-5 days of a disease) gets saturated scarlet and crimson coloring, the hypertrophy of nipples takes place. At a heavy current lips are painted in the same color. As a rule, subsiding of symptoms of quinsy begins at this time. Raids of necrotic character regress much more slowly.
Characteristic melkotochechny rash arises in the first or second day of a disease. Against the background of the general hyperaemia, on integuments of the person and the top part of a trunk (and in the subsequent and on the sgibatelny surfaces of hands, sides, the internal surface of hips) there are more dark points, being condensed on skin folds and in places of natural bends (the elbow bend, smelled, an axillary pole) and forming dark red strips (a symptom of Pastia).
Draining of dot elements of rash in one big eritema is in certain cases noted. Localization on cheeks, temples, a forehead is characteristic of rash on a face. In a nasolabial triangle of a rash are absent, the pobledneniye of integuments (Filatov's symptom) is noted here. Rashes when pressing on them temporarily disappear. Due to the fragility of vessels, on skin, in the places which are exposed to friction or squeezing small hemorrhages can be noted. Sometimes besides skarlatinozny rash small papules, makula and vesicles are noted. Besides display of rash (for 3-4 day of a disease) or its absence is later.
As a rule, for 3-5 days from the beginning of a disease there is an improvement of a condition of the patient, and the symptomatology gradually abates, rash turns pale and, by the end of the first - the beginning of the second week, completely disappears, leaving a melkocheshuychaty peeling on skin (on palms and feet – krupnocheshuychaty). Expressiveness of rash and speed of its disappearance differ depending on weight of a course of a disease. Intensity of a peeling directly depends on abundance and duration of existence of rash.
The Ekstrabukkalny form of scarlet fever arises when introduction of the activator happened through the damaged integuments (in places of grazes, wounds, an operational wound). At the same time in the field of damage it is formed it is purulent - the necrotic center, rash extends from the place of introduction, defeats in area of a pharynx are not observed.
At adults the erased form of a course of scarlet fever which is characterized by insignificant intoxication, a moderate catarrhal inflammation of a pharynx and poor, pale, short-term rash is sometimes noted. In rare instances (also at adults) scarlet fever proceeds extremely hard with probability of development of toksiko-septic shock: lightning progressing of intoxication, the expressed fever, development of cardiovascular insufficiency. On skin gemorragiya often appear. Such form of scarlet fever is fraught with dangerous complications.
Scarlet fever complications
Most often pyoinflammatory complications of scarlet fever (lymphadenitis, otitis) and late complications connected with an infectious alergicheskimi mechanisms (carditises, arthritises, nephrites of autoimmune genesis) meet.
Diagnosis of scarlet fever
High degree of specificity of a clinical picture allows to make sure diagnostics at poll and fizikalny survey. Laboratory diagnostics: the general blood test - notes symptoms of a bacterial infection: neytrofilny , shift of a leykotsitarny formula to the left, increase in SOE. As specific express diagnostics do RKA, do not make allocation of the activator in view of irrationality.
At development of complications from cardiovascular system the patient needs consultation of the cardiologist, carrying out the ECG and ultrasonography of heart. When developing otitis survey of the otolaryngologist and an otoskopiya is necessary. For assessment of a condition of an urinary system carry out ultrasonography of kidneys.
Treatment of scarlet fever
Treatment of scarlet fever is usually made at home, patients with severe forms of a current are subject to the room in a hospital. To patients appoint a bed rest to 7-10 days, recommend the sparing diet (food of a semi-fluid consistence) for the expressed anginozny symptoms, without forgetting about the balanced vitamin structure of a diet.
Choice medicine for etiotropny treatment of scarlet fever is penicillin which is appointed a course within 10 days. As medicines of a reserve apply macroleads and tsefalosporina of the first generation (in particular: erythromycin and cefazolin). In case of the available contraindications to use of the above-stated medicines purpose of synthetic penicillin or linkozamid is possible. In complex therapy the antibiotic combination to anti-toxic serum is successfully applied.
Make rinsings of a throat with Furacilin solution in cultivation 1:5000 for sanitation of the center of an infection, infusions of officinal herbs (a camomile, an eucalyptus, a calendula). At heavy intoxication make infusion of solutions of glucose or salts, violations of warm activity correct the corresponding cardiological medicines (, ephedrine, camphor).
The forecast at scarlet fever
The modern medicine allows to suppress successfully streptococcal infections including scarlet fever, thanks to application of antibiotics on early terms of a disease. In most cases the disease has the favorable forecast. Exceptional cases of a heavy current with development of a toksiko-septic form of a disease can cause complications. Now the disease, as a rule, proceeds favorably though it is occasionally possible to meet the cases of toxic or septic scarlet fever proceeding usually hard. The repeated disease meets in 2-3% of cases.
Prevention of scarlet fever
General measures of prevention of scarlet fever timely identification of patients and carriers of an infection, their due isolation (at home or in a hospital) mean, implementation of quarantine actions (in particular at detection of scarlet fever in kindergartens, schools, medical institutions). The extract of patients from hospitals is made not earlier than on 10y day after the beginning of a disease then they are on house treatment of 12 more days. Patients can come back to collective not earlier than for the 22nd days on condition of a negative bacteriological research to existence of the activator.
The children who did not have earlier scarlet fever and coming into contact with patients are not let in kindergarten or school of 7 days after contact, adult contact persons are within 7 days under observation, but without restrictions in work.