Overview
scarlet fever disease (scarlatina) is found everywhere, but proceeds more rapidly in cold countries. Sick children usually between the ages of 2 and 12 years. Pathogen scarlet fever transmitted by contact with a sick child (predominates airborne transmission path), as well as through a variety of items and toys.
The transmission mechanism of the disease - the aerosol path - airborne. Most often, infection occurs by close long-term association with a carrier or sick. Possible pin (via contaminated utensils or hands) or nutritional (food) infection way.
From the first days of illness the child becomes dangerous for the children. Scarlet fever symptoms appear after one or two days after exposure. The peak incidence occurs in the fall and spring. Immunity unstable.
Scarlet fever is characterized by the connection with the previous respiratory manifestations of streptococcal infection, which are not uncommon for kindergartens, especially for a short time after their formation. The highest
incidence observed in the autumn-winter-spring period. Thus scarlet fever different recurring ups and downs. Along with intervals of 2-4 years marked a pause with larger time intervals (up to fifty years old) with a significant increase in the number of cases.Causes
Development of scarlet fever bacterium provokes - B-hemolytic streptococcus. The causative agent belongs to the Gram-positive cocci - bacteria of spherical shape, having strong and complex in their cell wall structure. Their pathological effect is on the red blood cells and can promote their hemolysis.
Normally, the human organism is resistant to this microorganism. Infectious process is started as a result of hypothermia, Reduction of protective functions of the mucosa of the respiratory tract, general weakness and wasting of the body. Aggravating factors and symptoms of scarlet fever may also be prolonged use of antibiotics, chronic diseases of the respiratory tract.
Mechanism of Action:
- Eritrotoksin. The major metabolite of bacteria. It provokes the development of acute febrile syndrome, rash when it gets into the bloodstream (rash due to haemolysis of red blood cells and vascular lesions).
- Endotoxins. They are specific for the pathogen and cause leakage of the infectious process and its features.
Against the background of Streptococcus activity observed following signs of illness:
- toxic factor. It determines the initial clinical symptoms and signs. Due to the release of toxins and getting into the bloodstream seen the development of severe redness and plethora of bodies. Provokes hyperemia and swelling of the skin vessels, which leads to subsequent rejection surface layer (stratum), occurrence of peeling and light depigmentation. In addition, toxins action causes the development of lesions and other internal organs (most often suffer from heart, brain, blood vessels).
- Allergic reaction. It appears after 4-5 days of onset. It provokes the formation of immune complexes that can cause visceral cells. Especially susceptible thereto kidney (glomeruli capillary), and liver. It develops due to the activation of immune responses to the fallen in the systemic circulation and metabolism products streptococcus decay. Often accompanied by increased levels of antibodies can provoke the development of vaskulitopodobnyh states.
- septic factor It causes the spread of streptococcus in the body and settling with the development of secondary foci infection in other organs (most often suffers from lymphatic system with lymph node, spleen and liver).
symptoms
- acute onset with increasing temperature;
- skin rash and subsequent peeling;
- acute laryngitis.
Temperature rise usually the debut symptom of scarlet fever. It can rise to 40⁰S, causing increased patient activity. ill Children are usually excited, poorly perceived instructions from relatives. High temperature, stored for a long time, can lead to seizures. At night are frequent awakening, feverish delirium.
After one or two days of scarlet fever have seen the development of hyperemia throat. The process usually involves all tonsil pharyngeal ring, although it is possible and selective of their defeat. Pharynx becomes intensely red tint (described as "flaming" or "burning" throat). In the background is sometimes possible to observe development melkotochechnye submucosal hemorrhage (Enantemy). Symptoms of scarlet fever also include flushing language ("crimson" language It is an important diagnostic criterion for the disease).
Swallowing occur sore throat. On examination, patients have severe diffuse redness of the tonsils, Uvula, arches, the rear wall of the pharynx and the soft palate. Hyperemia is more intensive than ordinary catarrhal sore throat, it is substantially limited in the transition region of the mucous on the hard palate.
Perhaps the development of follicular tonsillitis, lacunar, when loosened greatly enlarged tonsils are formed mucopurulent, sometimes necrotizing fibrinous or strikes a common deep or shallow individual foci. At the same time there is a development of regional lymphadenitis, which is characterized by painful and dense perednesheynye lymph nodes. On language initially appears patina gray-white color. A few days later language purified and becomes crimson hue with hypertrophied papillae. In severe scarlet fever - the same crimson color is also observed on the lips. By the time symptoms of angina regressed, necrotic raids go slowly. Against the backdrop of moderate growth of blood pressure in the cardiovascular system is determined tachycardia.
Scarlet fever symptoms manifest punctate red rash, without going beyond the skin. It appears primarily on the surfaces of foldable body, and in places where the skin is the most delicate and thin (interdigital spaces, inner thighs, the skin of genitals).
The rash may be localized on the face, without hitting the nasolabial triangle (in clinical medicine is called symptom Filatov).
Characteristic of the rash, "a symptom of the palm" - with pressure on the skin rash seen her disappearance. On the surface of the skin as it is handprint, which disappears after a while with a consistent manifestation of the rash.
The rash begins to disappear after 4-5 days from the date of its occurrence. In its place are formed portions of the plate surface peeling (which may be used for diagnosis in the later stages).
Classification
The disease is classified according to severity:
- Mild form occurs with a slight fever and a primary lesion of the pharynx. The internal organs are not affected.
- The average degree of severity qualifies at 38-39oS, expressed intoxication syndrome. The rash is present for 6-7 days. There are changes in the blood and urine tests.
- Severe form occurs with a substantial rise in temperature above 40 ° C, the phenomenon of septic lesions, CNS depression and significant inflammatory changes in blood and urine.
Adults are often found erased forms of scarlet fever, characterized by mild general toxic symptoms, pale, lean and fast disappearing rash, changes in the oropharynx. It should be noted that the scarlet fever in adults also sometimes takes place in severe toxic-septic form.
Diagnostics
Diagnosis of scarlet fever is to collect a thorough history, adjustment of contact with other children or their clothes and toys.
Be sure to find out the time of occurrence of disturbing symptoms, how long they are taking place, what treatment is undertaken.
Laboratory diagnosis of scarlet fever is study of blood and urine tests. In the blood, there is a pronouncedleukocytosis with a predominance of neutrophils and a shift leukocyte left. The urine may cause protein trace, identifying cylinders or erythrocytes.
Suffice it to a highly sensitive and specific research is the identification of B-hemolytic Streptococcus in crops or microscopy
Treatment
Patients with mild to moderate severity can undergo a course of treatment of scarlet fever as an outpatient or in specialized units.
scarlet fever Treatment involves bed rest child, receiving a hearty hot drinks and high-calorie food rich in fruits and vegetables. Treatment is carried out since the first detection of disturbing symptoms, and for several weeks after recovery.
Pathogenetic treatment of scarlet fever held the appointment of antibiotics. The most effective drugs in the defeat of B-hemolytic streptococcus are antibacterials penicillins. Use them preferably with the creation of tissue intramuscular depot preparation. Antibiotic treatment is carried out for 7-8 days, then adjust the therapeutic regimen, if necessary (if the antibiotic does not give effect to the need to replace it for two days).
The symptoms and treatment of scarlet fever may include the use of local antiseptics for the mucous membrane of the pharynx, using different lozenge.
Vitamins are appointed by the child during the recovery period.
In severe forms of the development of scarlet fever should be treated in infectious wards or OARIT. In this case the patient shows massive fluid therapy using highly effective antibiotics.
prevention
Prevention of scarlet fever is not carried out. It is strongly recommended isolation of sick child or an adult in a separate room. The patient will also need to allocate a separate towel utensils. Insulation stops not before 10 days from the beginning of infection, the best option - after complete recovery. Visiting children recover from preschool, first and second grade of primary school It is permitted only after an additional "home" isolation for at least 12 days from the date recovery.
In identifying the sick child in junior high school and kindergartens during the treatment of scarlet fever shows the dissolution of the team, in which there was a sick child, To quarantine.
The child is allowed to contact with the children after a full clinical recovery, the negative crop from the nasopharynx to the pathogen, as well as normalization of laboratory parameters.
If a child is treated on an outpatient basis, it is obligatory to conduct current and final disinfection after consulting a pediatrician or an infectious disease epidemiologist.
forecasts
The prognosis for early detection of scarlet fever and begun treatment favorable. If there had been no appropriate treatment, may later develop immune destruction of internal organs. In addition, the possible death in complicated scarlet fever and late onset of drug and intensive care support.
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