What is scarlet fever and why is it dangerous. Complications after scarlet fever in children - causes, signs and types in boys or girls

Scarlet fever is dangerous for its complications, which can develop in both children and adults. The likelihood of developing complications of scarlet fever is quite high, but if antibiotics are used to treat the infection, then it drops to almost zero. It is the prevention of severe complications that determines the need for antibiotic therapy for scarlet fever.

The whole set of complications can be conditionally divided into immediate and distant. Immediate complications develop directly during the active course of scarlet fever, and remote ones - a few weeks or months after recovery. The mechanism of development of remote and immediate complications is different. The fact is that the next complications develop due to the spread of infection (streptococci, which are the causative agents of scarlet fever) to tissues and organs located next to the tonsils, for example, the ear, sinuses, neck tissue, brain, etc.

Long-term complications are formed on the basis of autoimmune reactions. The fact is that to combat scarlet fever the immune system the body produces a huge amount of antibodies, which are necessary for the destruction of streptococci, which are the causative agents of infection. After recovery, the body remains quite a large number of antibodies that cannot be utilized by the immune system in the bloodstream in a short time, as a result of which they circulate in the blood. These antibodies have an affinity not only for streptococci, but also for the cells of the heart, joints, kidneys and brain, and, therefore, can “attack” these organs when they enter them with the bloodstream. As a result, an excess of antibodies begins to "attack" the cells of any of the four listed organs, since streptococci are no longer in the human body. Under the influence of "attacks" of antibodies in cells, an autoimmune inflammatory process, manifested by a serious violation of the functions of the affected organ.

For the next complications scarlet fever include sinusitis (sinusitis, frontal sinusitis), otitis media, sepsis, neck phlegmon, lymphadenitis, ulcers in the throat. Scarlatinal otitis media is very dangerous because it tends to quickly spread the infection to the brain, which leads to the development of arachnoiditis and meningitis. Neck phlegmon is a purulent fusion of tissues due to the penetration of streptococci between the ligaments and muscles. Phlegmon is a rather dangerous condition, as it can be complicated by sepsis. Lymphadenitis is a purulent inflammation in the lymph nodes and vessels, which goes away on its own or forms an abscess that has to be opened. However, lymphadenitis ends without serious consequences. In principle, all the upcoming complications can be quite dangerous if you do not start in a timely manner. effective treatment antibiotics.

Long-term complications scarlet fever is much more dangerous than the next and includes arthritis, myocarditis, glomerulonephritis and PANDAS syndrome.

Arthritis that develops as a complication of scarlet fever is called "acute rheumatic fever". They usually manifest 1 to 2 weeks after recovery from scarlet fever and are inflammation of any joints. Arthritis is not dangerous, as a rule, it goes away on its own and does not cause negative consequences.

Myocarditis is an inflammation of various tissues of the heart. This complication of scarlet fever is dangerous and entails negative consequences. The fact is that myocarditis is actually considered the beginning of rheumatism. And rheumatism is a long-term disease, during which heart defects are formed. On average, about 20 years pass from the manifestation of rheumatism to the formation of a heart disease.

Glomerulonephritis is a very serious complication of scarlet fever, the essence of which is inflammation of the glomeruli of the kidneys. The outcome of glomerulonephritis can be severe renal failure or death.

PANDAS syndrome (Sydenham's chorea) - This is a set of neurological disorders that occur in a person who has had scarlet fever, due to autoimmune damage to some brain structures responsible for emotions, speech and coordination of movements. Chorea Sydenham develops in 20 - 30% of children suffering from scarlet arthritis. For adults, the development of this complication of scarlet fever is not typical. PANDAS syndrome is manifested by the following symptoms:

• Change in attitude to food (for example, the child eats a lot or refuses food);


• The appearance of unreasonable anxiety, tearfulness and aggressiveness in a child;


• Decreased academic performance;


• Development of nocturnal urinary incontinence;


• The appearance of unnatural movements of the mouth, arms, legs, lips and tongue.

A rash on the body, tonsillitis, fever are symptoms of many childhood diseases, one of which is scarlet fever. The disease is common among babies and can cause serious complications. Adults can also get sick, but childhood pathology occurs more often due to undeveloped immunity and, as a result, poor resistance to infection. Scarlet fever in children has specific symptoms, so it can be suspected even with the manifestation of primary signs, while on early stages the disease is easier to treat.

What is scarlet fever in children

The disease belongs to the category of infectious, caused by excessive susceptibility of the defense systems to the immune complexes of streptococcus. Suffer from the disease mainly integuments, but often affected and internal organs. Because the human body susceptible to streptococci (bacterial pathogens of many pathologies), immunity to protect against them is weak. Damage to organs can lead to their insufficiency, and the pathogen itself develops resistance to antibiotics.

How is it transmitted

Type A streptococci are passed from sick/carriers to healthy children by airborne droplets. Through the top respiratory organs(where the most accessible mucous membrane) the infection enters the body. On a warm, moist surface, the bacterium multiplies, creates colonies and damages the delicate mucosa. Besides, infection spreads along with the products of metabolism outward. Gradually, the infection is transmitted to other organs and systems through the blood.

The blood is a perfect medium that quickly reacts to foreign bacteria and activates specific defense cells, which are lymphocytes. Thus, streptococcus and its toxin are an antigen, and lymphocytes produce antibodies, as a result of which an antigen-antibody immune complex is created. Its circulation stimulates the disruption of the organs and the accompanying symptoms of the spread of infection throughout the body of the child.

A sick baby is a carrier of the infection from the moment the initial signs of streptococcus infection appear. The contagious period can vary in duration in different children and take from several days to a couple of weeks. If the pathology proceeds without complications and therapy was started in a timely manner using antibacterial drugs, after 7-10 days the child ceases to be contagious to others. A dangerous infectious disease is spread by sneezing, coughing, pharynx, so people around the patient are at greater risk.

Symptoms of scarlet fever in children

It is important for parents to be aware of specific symptoms in children that indicate the development of an acute infection. The main signs of scarlet fever in a child:

1. Symptoms of intoxication of the body with streptococcal toxins. Pathology is manifested by fever, aching joints / muscles, tachycardia, vomiting, general malaise.
2. A characteristic rash with scarlet fever in children appears on the 1-3 day of pathology. The rashes look like dots of bright pink or red color and are localized, as a rule, in the face, groin, flexion zones of the limbs, on the sides of the body. In this case, the clinical symptom has a maximum intensity under the armpits, on the bends of the elbows and knees: the rash forms dark red stripes. There are no skin rashes in the area of ​​the nasolabial triangle, while the covers in these places look pale.
3. Severe angina is also characteristic symptom scarlet fever. The causative agent, when it enters the mucous membranes of the nasopharynx, begins to produce streptococcal toxins, which cause the development of purulent foci of infection and inflammation of the tonsils. The child's throat becomes bright red.
4. Changing the color of the language. Raspberry color can be seen on the 2-4th day of the development of pathology. The tongue shows graininess due to the enlargement of the papillae.
5. Characteristic peeling of the skin. The symptom develops 1-2 days after the initial signs of the disease (peeling is replaced by a specific rash). On the palms and feet, the skin flakes more strongly, on the body, neck, ears - weaker. The symptom is especially pronounced on the hands: the epidermis is removed from the fingertips in large areas. After the rash, pigmentation does not remain.

First signs

Scarlet fever in a child begins to appear approximately 3-7 days after the moment of infection - this time is called the incubation stage of the disease. In some cases, this period is reduced to 1 day or even several hours, even more rarely, the incubation of the disease is extended to 12 days. Initial signs illnesses in a child are observed, as a rule, during the first few days. The occurrence of the disease can be guessed by the following signs:

• body temperature rises to 38-40 degrees;
• there are sore throats, white plaque;
• some babies have febrile seizures due to fever.

The reasons

The infection is caused by group A streptococcus, a resistant bacterium that produces a toxin that subsequently spreads throughout the body through the bloodstream. This is the direct cause of the disease, but in addition to it, there are other predisposing factors:

• atopic dermatitis - a disease that increases the reactivity of the child's body to streptococcus;
• chronic tonsillitis (frequent lesions of the tonsils, throat diseases);
• undernourishment, malnutrition, low body weight relative to the age of the child forms a low resistance to diseases, including scarlet fever;
• immune skin pathologies, including diathesis;
• diabetes mellitus, endocrine diseases;
• immunodeficiency states (HIV, AIDS, acclimatization);
• hormonal instability, pathology of the adrenal glands;
• systematic use of immunosuppressants, for example, steroid hormones, which are often prescribed to children with stenosis, allergies, obstruction).

Features of the course in children of different ages

The time during which scarlet fever lasts and the severity of the disease are determined by the work of the child's immune system. In babies up to a year, pathology is diagnosed extremely rarely due to the protective properties that a newborn's body acquires from its mother through milk. If the infection affects the baby, then the pathology will be extremely difficult: such children are hospitalized with round-the-clock medical supervision. The stages of development of the disease in very young crumbs do not differ from older children.

In childhood, the incidence of scarlet fever is at its peak. In this case, the course of the disease is moderate, and the prognosis is usually favorable. The periods of pathology are relatively mild, but have an increased duration. In adolescents from the age of 14, the disease can cause complications, since its course is more severe, and the immune system is in a state of restructuring, and the body's resistance to infections decreases. After suffering from scarlet fever, which was adequately treated, the prognosis for a teenager is favorable.

What is dangerous scarlet fever

The danger of the disease is explained by the characteristics of the bacterium (causative agent). A streptococcal infection can affect the throat, and the resulting complications can lead to kidney, liver or heart failure. The disease in children is dangerous because an incompletely cured infection can affect the listed organs in a matter of hours. Therapy of complications takes years and not in all cases gives a positive result.

Complications

Doctors deny the greater danger of the disease for boys than for girls. The only difference in their course of the disease is that the former have a higher risk of complications, manifested by glomerulonephritis. The early negative consequences of scarlet fever, which develop as a result of the spread of infection to internal organs / tissues, are:

• otitis;
• lymphadenitis;
• sinusitis.

A common complication of the pathology is malnutrition, which occurs due to severe pain in the larynx and difficulty swallowing. Late allergic complications and other negative consequences of the disease are observed, as a rule, in children who have been treated incorrectly. These include:

• arthritis;
• glomerulonephritis;
• rheumatism;
• carditis.

Diagnostics

An important condition for preventing complications is to see a doctor if you suspect scarlet fever. The pediatrician will examine, listen to the baby to determine the specifics of the pathology. If the diagnosis is confirmed, the doctor may advise you to visit the infectious diseases hospital, where they will provide full assistance to the baby, take tests, etc. The doctor will definitely interrogate the baby and parents not only about the current disease, but also find out whether it was a re-infection or primary, what infections were previously whether the child was vaccinated, whether there were contacts with patients.

After collecting an anamnesis, the following tests are prescribed:

• smear on the microflora of the pharynx (to determine the pathogen and the number of bacteria);
• general blood analysis;
• analysis of the sensitivity of streptococcus to the main drugs (Azithromycin, Flemoxin);
• analysis of venous peripheral blood to determine the titer of antibodies to streptococcus type A.

Laboratory diagnostics more informative during the first day of pathology, while the activity and concentration of bacteria is maximum. It is not necessary for parents to know the decoding of the test results: if an infection is detected, laboratory / polyclinic workers will contact them. All analyzes, as a rule, are monitored in the dynamics of the disease (during the entire period of its development). Diagnostic methods, Besides laboratory research, can serve as an ultrasound of the heart, kidneys, ECG.

Treatment of scarlet fever in children

Therapy is carried out at home, while hospitalization is required only in case of a severe form of the disease, in case of complications, or if there are other children under 10 years of age in the family who have not previously suffered from scarlet fever. acute infection you need to treat with an antibiotic, any drugs are prescribed by a doctor. While the temperature is kept, the baby is shown bed rest. Who is this, in the acute phase of the disease, it is important to strengthen the drinking regimen and stick to a diet.

It is better to give food to the patient in a liquid or semi-liquid form (light soups, various cereals, vegetable stew, etc.), and protein products limit. The baby should drink a lot, while it is better to give him warm drinks - tea, herbal decoctions. How to treat scarlet fever in children at home:

• the crumbs are allocated separate dishes and household items for the duration of treatment;
• it is highly desirable to isolate the patient in a separate room;
• the room should be cleaned daily using disinfectants;
• the baby should adhere to bed rest for at least 7-10 days.

Medical treatment

For a quick clinical recovery, the doctor prescribes antibiotics penicillin series. Streptococcus is not sensitive to other types of antibacterial drugs. It is important to strictly follow the course of treatment prescribed by the doctor, otherwise the risk of complications is high. For the treatment of scarlet fever often use:

1. Flemoxin. Main active substance medication - amoxicillin, due to which the agent provides a wide spectrum of action. For children 1-3 years old, the daily dosage is 0.25 mg of the drug twice a day, for patients 3-6 years old, the antibiotic is taken once. The course of treatment is carried out for 10 days. The advantage of Flemoxin lies in its speed of action: active ingredient absorbed immediately after entering the stomach, and the maximum concentration of amoxicillin in the blood is reached after an hour. The disadvantage of the drug is its ability to disrupt the digestive process.
2. Augmentin. The remedy for scarlet fever in children is available in the form of tablets, drops, syrup and suspension. The advantage of Augmentin is the ability to choose the most suitable type of medication that will be easier for the baby to take. The dosage depends on the form of the drug, so you should follow the one prescribed by the doctor. The disadvantage of Augmentin is that even with a slight overdose, it can cause many side effects.
3. Erythromycin. An antibiotic from the macrolide group is prescribed somewhat less frequently than the agents described above. Its advantage in a variety of forms of release: for the smallest crumbs are optimal rectal suppositories, for older patients, suspension or tablets are suitable. The disadvantage of the tool is its ability to cause allergic reactions and digestive disorders.

In addition to antibiotic therapy, babies should be given probiotics, which will support intestinal microflora. Paracetamol is allowed to reduce fever, and Ibuprofen should be avoided if possible, as it has a strong effect on the kidneys and liver. In addition, symptomatic therapy is carried out, which involves local anesthesia and treatment of the throat (scarlet fever is always accompanied by a sore throat, due to which a purulent plaque develops on the mucous membrane of the throat) with sprays, rinses, etc.

Effects

The impact of childhood infection on girls and boys is about the same. The causative agent of scarlet fever does not have a negative effect on reproductive system. Purulent-inflammatory processes characteristic of the disease are caused by lymphogenous and hematogenous dissemination of streptococcus, while clinical manifestations pathologies are diverse and depend on the foci of inflammation. Possible side effects of scarlet fever include:

• phlegmon;
• boils;
• abscesses.

The maximum danger of pathology for girls and boys is a late allergic complication, the complete cure of which is not always possible. The most common negative consequences after scarlet fever are:

1. Rheumatic changes. They are observed in large joints - wrist, knee, elbow. At the same time, the baby has a change in configuration, swelling, and a decrease in the amplitude of movements. With prolonged scarlet fever and the absence of treatment, the joints lose their mobility.
2. Damage to the heart valve, organ failure. In extreme cases, this complication leads to death.
3. Glomerulonephritis. After the illness, chronic kidney failure, which poses a danger to the life of the crumbs.
4. Chorea Sidengami. The complication does not pose a threat to the life of the child, however, its clinical manifestations in the form of tremor, changes in character and gait greatly affect the development of the baby and the quality of life of parents.

Prevention

Not all children can become infected with scarlet fever: only 3 out of 10 people are susceptible to pathology after contact with the carrier of the infection. Vaccinations from this disease does not exist, but there is no need for such a vaccination, since the child's body is able to cope with the infection on its own. Prevention of scarlet fever in children involves timely treatment any ENT diseases and stimulation of immunity.

When infected with an infection, the child is not allowed to attend classes, he is hospitalized or isolated at home. During the quarantine caused by the epidemic, the wards with babies are filled simultaneously for 1-2 days, and contacts of recovering patients with patients in the acute period are excluded. The first ones are discharged from the hospital on the 10th day of treatment in the absence of complications.

The child is admitted to school or preschool groups on the second day after recovery. Children who have been in contact with the patient and have not previously had scarlet fever can be allowed to attend classes only after a week of isolation at home. This rule applies exclusively to children of preschool age, as well as students in the first and second grades.

Photo of a rash with scarlet fever

Video

Scarlet fever is an acute infectious disease, manifested by a small punctate rash, general intoxication of the body, fever, tonsillitis. The causative agent of the disease is group A streptococcus.

The disease is very contagious, and is transmitted from patients and carriers by airborne droplets (when sneezing, coughing, talking), and through household items (toys, dishes, underwear). At the same time, it is almost impossible to prevent infection.

Scarlet fever: causes of the disease

The causative agent of the disease, as already mentioned, is group A streptococcus, which is also the cause of other streptococcal infections - tonsillitis, chronic tonsillitis, rheumatism, acute glomerulonephritis, streptoderma, erysipelas and other equally dangerous diseases.

How does scarlet fever work?

Toxigenic group A beta-hemolytic streptococcus usually colonizes the nasopharynx, sometimes the skin, provoking local inflammatory changes (tonsillitis, regional lymphadenitis). The exotoxin produced by it causes symptoms of general intoxication (poisoning) and exanthema in the body.

At favorable conditions for the growth and reproduction of microbes, streptococcus causes a septic component, which is manifested by otitis media, lymphadenitis, septicemia. An important role in the development of pathologies of the disease is played by allergic mechanisms that are involved in the occurrence and development of complications that manifest themselves in the late period of the disease. Often, the development of scarlet fever complications is directly related to reinfection or streptococcal superinfection.

Where is the source of infection?

The "reservoir", the source of infection is a person who is sick with tonsillitis, scarlet fever or other clinical forms of streptococcal respiratory infection. And, besides, scarlet fever, the reasons for its spread are "healthy" carriers of the infection - group A streptococci.

For others, the patient is most dangerous in the early days of the disease. Contact with him becomes relatively safe most often after 3 weeks from the onset of the disease - that is, all 3 weeks, he is contagious to others. As for carriers of group A streptococci, this is a widespread phenomenon among the population (according to statistics, 15-20% of the average healthy population are carriers). Many of the carriers, without even suspecting it, are able to isolate the causative agent of infection over a very long time period - months and even years, being carriers.

Mechanism of distribution of scarlet fever.

The mechanism of infection transmission is aerosol, airborne. As a rule, infection occurs in the case of prolonged close contact with a carrier or a patient. Infection is also possible by contact (through household items and contaminated hands) and by the alimentary route of infection (through food).

Scarlet fever has a high prevalence, because the natural susceptibility of people to this infection is very high. Scarlet fever occurs in people who do not have antitoxic immunity when they “catch” toxigenic strains of bacteria that secrete erythrogenic toxins such as types A, B and C. After an infection, type-specific immunity is produced in the body, that is, a person is no longer re-infected get infected. However, if there is an infection with group A streptococci, but a slightly different serovar, as they say, re-infection is possible.

The main epidemiological signs of scarlet fever.

The disease is ubiquitous, but most common in regions where the climate is temperate and cold, that is, in our latitudes. Basically, the overall level of the disease and its dynamics, assessing the long-term and monthly incidence rates of scarlet fever, determines exactly scarlet fever in preschool children who attend organized groups: kindergartens, educational groups, circles, etc. Annually, scarlet fever in children attending children's institutions occurs more often 3-4 times than in children who are brought up at home. This difference is most pronounced in children of the first 2 years of their lives - the level of the disease is 6-15 times higher, and already among children of 3-6 years of age it is less noticeable. In the same age groups, the highest indicators of the so-called "healthy" bacteriocarrier are observed.

Characteristic of scarlet fever is the connection with diseases preceding it, in particular, with tonsillitis and other respiratory streptococcal infections. The highest incidence occurs in the autumn-winter-spring period.

What happens when you get infected with scarlet fever

Through the mucous membranes of the nasopharynx and pharynx, this pathogen enters the human body, in rare cases, infection occurs through damaged skin or mucous membranes of the genital organs.

An inflammatory-necrotic focus is formed at the site of bacteria colonization. Infectious intoxication (poisoning) develops primarily due to the entry into the blood of erythrogenic streptococcal toxin (in medicine - Dick's toxin), and the action of cell wall peptidoglycan. Subsequently, this leads to an expansion in all organs of small vessels, including mucous membranes and skin, resulting in a characteristic rash.

In the future, the body synthesizes and accumulates antitoxic antibodies that bind the toxins of the infection, and the manifestations of toxicosis decrease, and the rash gradually disappears. In places of the rash, the skin becomes horny, a crust forms, and after the extinction of the scarlatinal rash, the skin peels off. The connection of keratinized cells in the thick layers of the skin is quite strong, so the peeling on the palms and soles has a large-lamellar character.

Scarlet fever in adults and children: possible complications of the disease

Most frequent complications scarlet fever is necrotic and purulent lymphadenitis, purulent otitis media, and in addition, infectious and allergic complications that often occur when scarlet fever in adult patients, in the form of diffuse glomerulonephritis, myocarditis. Possible further inflammation paranasal sinuses nose, middle ear, rheumatism.

Scarlet fever in adults and children, as a result, often provokes the development of hypersensitivity, fixation and formation of immune complexes, autoimmune reactions, disorders of the hemostasis system. In most cases, these manifestations are the cause of the development of arteritis, glomerulonephritis, endocarditis and other immunopathological complications.

From the lymphatic formations located in the mucous membrane of the oropharynx, streptococcal pathogens enter the lymphatic vessels to regional The lymph nodes. There they accumulate, accompanying their reproduction with inflammatory reactions with necrotic foci and foci of leukocyte infiltration. If you do not stop the development of the disease at this stage, later in some cases this may lead to the penetration of pathogens into various organs and systems of the body, to the formation of purulent-necrotic processes in them. All this can eventually result in purulent lymphadenitis, otitis, in lesions of bone tissue in the area of ​​the temples, temporal sinuses, dura mater, etc.

Scarlet fever: symptoms of caring

The incubation period of scarlet fever can last from 1 to 10 days. The typical symptoms of scarlet fever are an acute onset of the disease, sometimes in the very first hours of the illness, an increase in body temperature occurs to high numbers, up to 40 degrees. Accompanying signs of scarlet fever are malaise, headache, weakness, tachycardia, and sometimes abdominal pain. In the case of high fever in the first days of illness, patients are overly excited, mobile and euphoric, or, on the contrary, incredibly lethargic, drowsy and apathetic. Due to severe intoxication of the body, vomiting often occurs. However, it should be emphasized that the modern course of scarlet fever may differ in the absence high temperature body.

Scarlet fever: symptoms of inflammation of the larynx.

Very quickly there is a pain in the throat when swallowing. Pronounced signs of scarlet fever, which do not allow to confuse it with a sore throat and other diseases similar in symptoms, are a bright diffuse hyperemia of the tonsils, arches, soft palate, uvula and posterior pharyngeal wall, the so-called “flaming pharynx”, which cannot be overlooked during examination sick. Hyperemia is much more intense in scarlet fever in children and adults than in cases of ordinary catarrhal angina, while it is sharply limited where the mucous membranes pass to the hard palate.

It is also possible to form follicular-lacunar tonsillitis: on enlarged, highly loosened and hyperemic tonsils, mucopurulent, sometimes fibrinous deposits or even necrotic, are formed in the form of separate and widespread foci. At the same time, regional lymphadenitis develops; on palpation, the anterior cervical lymph nodes are dense and painful.

Diagnosis of scarlet fever does not pose any difficulties by the 4-5th day of illness. Since the tongue, which was first coated with a grayish-white coating, by this time is cleared, becoming bright red, rather even raspberry, with hypertrophied papillae. That is, the most striking symptom of scarlet fever is the “crimson tongue”. In cases of severe course of scarlet fever, such a "raspberry" color is also noted on the patient's lips. By the same period of time, the signs of angina begin to regress, although the disappearance of necrotic raids occurs much more slowly.

Scarlet fever also appears on the cardiovascular system, accompanied by tachycardia against the background of a moderately increased blood pressure.

Symptoms of scarlet fever: scarlatinal exanthema.

Scarlet exanthema, as doctors call it, or simply a rash, appears on the 1-2nd day of illness. Rash is very important diagnostic feature scarlet fever. First, small-pointed elements appear on the skin of the face, neck, and also the upper body, after which the rash rapidly spreads to all surfaces of the folds of the limbs, to the inner surface of the thighs, to the sides of the abdomen and chest. In most cases, white dermographism is clearly visible.

A characteristic feature of scarlet fever is a thickening of the rash in places of natural folds on the folds of the skin in the form of dark red stripes, for example, in the elbows, armpits, inguinal folds (Pastia's symptom). In places, finely punctate abundant elements can merge completely, creating a picture of continuous erythema.

The rash on the face is usually located on the cheeks, and to a much lesser extent - on the temples and forehead. At the same time, the nasolabial triangle is absolutely free from rash and is characterized by pallor (Filatov's symptom).

A characteristic sign of scarlet fever is also a “symptom of the palm” - when pressed with the palm of the hand on the skin, the rash temporarily disappears in this place.

As a result of increased fragility of blood vessels, small pinpoint hemorrhages are possible on the skin in places of articular folds, and friction or squeezing of the skin by clothing. For scarlet fever, the symptoms of gum and tourniquet (Konchalovsky-Rumpel-Leede) are also characteristic. In some cases, the typical scarlet fever rash may be filled with small vesicles and maculo-papular elements.

Among other things, the rash may appear late, only on the 3-4th day of illness, or not appear at all.

As a rule, by the 3-5th day the patient's state of health improves significantly, the body temperature gradually begins to decrease. The rash turns pale, gradually disappearing and changing by the end of the first week, the beginning of the 2nd, finely scaly peeling of the skin (large-lamellar peeling on the soles and palms).

The intensity of the rash and the timing of its disappearance vary. Sometimes, in cases of a mild course of the disease, a scanty rash disappears just a few hours after its appearance. As for the severity of skin peeling and its duration, it directly depends on the abundance of the preceding rash.

"Special" forms of scarlet fever

There are three main forms of scarlet fever, which differ in foci, symptoms and course of the disease, from a common disease.

Extrabuccal scarlet fever.

Currently, this form of the disease is quite rare. The gates of infection in this case are the places of skin lesions - wounds, burns, foci of streptoderma, and so on. The rash spreads throughout the body from the place where the pathogen has taken root. Another feature of this form of the disease is the absence of inflammatory changes in the oropharynx and cervical lymph nodes.

Erased forms of scarlet fever.

Such scarlet fever in adults is most common. Erased forms of the disease are characterized by mild general toxic symptoms, changes in the oropharynx of a catarrhal nature, a scanty, pale and quickly disappearing rash. At the same time, scarlet fever in adults can sometimes take place in a very severe form, the so-called toxic-septic.

Toxic-septic scarlet fever.

This form of the disease rarely develops, fortunately, and, as a rule, it is scarlet fever in adults. It is characterized by a rapid onset with hyperthermia, the rapid development of vascular insufficiency (threaded pulse, drop in blood pressure, muffled heart sounds, cold extremities), often with the appearance of hemorrhages on the skin. In the following days, infectious-allergic complications (damage to the heart, kidneys, joints) or septic complications (otitis media, lymphadenitis, necrotic tonsillitis, etc.) join these symptoms.

Scarlet fever and pregnancy

During pregnancy, a woman can just as well become infected with scarlet fever, as in any other period of her life, because contact with a carrier or patients with scarlet fever is quite likely. Scarlet fever during pregnancy threatens any woman who does not have specific immunity for this infection.

Scarlet fever and pregnancy: symptoms.

As for the question "scarlet fever and pregnancy, symptoms", they are the same as in all other cases. And they depend on the degree, complexity of infection and the course of a particular form of the disease. That is:

• 1. fever, fever;
• 2. malaise, headache, weakness, tachycardia;
• 3. intoxication of the body (scarlet fever during pregnancy is often marked by vomiting);
• 4. sore throat, "flaming throat";
• 5. development of symptoms of purulent tonsillitis;
• 6. "crimson tongue";
• 7. characteristic rash.

Effect of scarlet fever on pregnancy.

Scarlet fever during pregnancy is an unpleasant and unsafe phenomenon. First of all, because scarlet fever is treated mainly with antibiotics, which is completely unacceptable during pregnancy, especially in the first trimester. During the formation of the fetus, antibiotics are strictly contraindicated, since pathological deviations are possible in the development of the organs of the future man.

The effect of scarlet fever on pregnancy in its early stages often results in spontaneous abortion or simply miscarriage. Scarlet fever during pregnancy for more later dates proceeds with more optimistic forecasts. In the second trimester, antibiotics are already allowed, but one way or another, after the recovery of the potential mother, additional fetal ultrasound and tests will be required.

The negative impact of scarlet fever on pregnancy can result in problems such as premature pregnancy, intrauterine fetal hypoxia, complications during childbirth, and pneumonia in the newborn.

However, sensitivity to this pathogen, that is, the risk of getting sick, decreases significantly after 20 years. In addition, immunity after scarlet fever once suffered is quite persistent, which means that if a woman was once sick with scarlet fever, then there is, in fact, nothing to be afraid of - the same pathogen will not take her a second time.

Scarlet fever and pregnancy: treatment.

Treatment of scarlet fever is carried out with antibiotics of the penicillin series, erythromycin, which are not contraindicated in pregnant women after a 12-week period.

As a rule, the treatment of scarlet fever during pregnancy consists of strict bed rest in the first week of illness and a sparing diet. It is imperative to drink plenty of water so that toxins are removed from the body as soon as possible. Also for the treatment of scarlet fever during pregnancy is prescribed local therapy in the form of gargles with a solution of furacilin, calendula, decoction of chamomile, eucalyptus and other natural substances.

If necessary, treatment of scarlet fever during pregnancy with antibiotics is prescribed, the safest for use during pregnancy. In addition, the obligatory intake of vitamin and restorative preparations is recommended.

Scarlet fever itself does not affect the condition of the fetus, moreover, the disease mild form, does not threaten anything and the condition of a pregnant woman, too.

Thus, for the health of a woman and a baby, in the vast majority of cases, the prognosis is favorable. However, the obligatory supervision of a specialist and the determination of the tactics of therapy and management of pregnancy in the future are required.

Diagnosis of scarlet fever

It is important to distinguish scarlet fever from measles, rubella, medicinal dermatitis, pseudotuberculosis. In rare cases, it is necessary to differentiate the development of fibrinous deposits, especially when they go beyond the tonsils, from diphtheria.

Medical checkup.

The main distinguishing features of scarlet fever for medical examination- this is:

• 1. "flaming pharynx" (diffuse bright hyperemia of the oropharynx), which has a sharp limitation in the place where the mucous membrane passes to the hard palate;
• 2. "crimson tongue" - bright red, even crimson tongue with hypertrophied papillae;
• 3. elements of the rash are small-pointed, thickening of the rash in the places of folds and on skin folds in the form of dark red stripes;
• 4. pronounced distinctly white dermographism;
• 5. "symptom of the palm" - when pressing the palm on the skin, the rash disappears for a while, positive endothelial symptoms;
• 6. pallor of the nasolabial triangle;
• 7. after the disappearance of the rash, in its place appears finely scaly skin peeling or large-lamellar on the soles and palms.

Laboratory diagnosis of scarlet fever.

Diagnosis of scarlet fever in the laboratory is carried out using a blood test. Changes in the hemogram are noted, which are typical of a bacterial infection: leukocytosis, increase in ESR, neutrophilia with a shift to the left of the leukocyte formula.

Direct isolation of the pathogen is extremely rare, since the clinical picture of the disease is very characteristic and remarkable, and the spread of bacteria in healthy people and patients with other forms of streptococcal infection is very wide. For express diagnosis of scarlet fever, RCA is used, which detects streptococcal antigens.

Scarlet fever treatment

Treatment is carried out mainly at home, in the same way as with angina. You can learn in detail about the methods of treating scarlet fever in the article:.

Only patients who have a severe and moderate form of the disease are subject to hospitalization. Those who have children from 3 months to 7 years of age and elementary schoolchildren who have not previously had scarlet fever are also hospitalized. This is done in order to prevent and prevent infection with scarlet fever in the family.

A patient with scarlet fever must be isolated in a separate room from the rest of the family. He should have separate tableware, towels, etc.

Isolation of the patient can be stopped after recovery, but not earlier than 10 days from the onset of the disease. As for visiting children who have had scarlet fever, pre-school and primary school institutions, it is allowed only after additional isolation of the child at home for 12 days after recovery.

Children who were in contact with the patient, but did not themselves suffer from scarlet fever, are not allowed into the team for a week after contact, and if they stayed with the patient for the entire period of illness, then isolation from the team should last up to 17 days.

A little more about scarlet fever in children:

“Extremely insignificant, barely requiring mention of suffering” - this is how the famous 17th-century English physician Thomas Sydenham spoke of scarlet fever.

But when, two years later, he encountered an epidemic of this disease, he already compared it with the plague. "Purple fever" is what doctors of the 21st century call scarlet fever.

Scarlet fever is a childhood disease

Scarlet fever is not a new disease. She was known in antiquity. Translated from Latin, “scarlet” means bright red. The disease is so named for the typicality of its manifestation.

This disease is quite common. Pediatricians and infectious disease specialists deal with sick children aged 1 to 9 years.

Scarlet fever is a very serious infectious disease. If left untreated, the outcome can be tragic.

This is a childhood disease. It occurs predominantly in preschool children. Rarely, younger schoolchildren and adolescents get sick with scarlet fever. If the baby is on breastfeeding, then along with the mother's milk, antitoxic immunity is transmitted to him.

Children infancy in such cases, scarlet fever does not get sick.

In recent years, the incidence rate has risen. But in the adult population older than 30 years, cases of scarlet fever are not observed.

The disease has a seasonality - autumn-winter period. Risk factors for scarlet fever are also:

• accumulation of children in children's institutions;
• overwork;
• excessive physical activity;
• vitamin deficiency;
• iron deficiency.

Scarlet fever is a disease caused by group A beta-hemolytic streptococcus. Getting on the mucous membrane, it causes significant inflammatory changes. Microbes produce large amounts of erythrotoxin, which is highly toxic. In the blood, the toxin destroys and causes intoxication, that is, poisoning of the entire child's body.

Ways of transmission of scarlet fever

Beta-hemolytic streptococcus is very stable in the external environment. He can long time persist in the secretions of the patient - saliva, mucus, pus.

You can get an infection in different ways:

• airborne;
• contact-household - through household items, toys, door handles;
• food - through products susceptible to streptococcus.

Scarlet fever is the so-called "ward" isolated infection. Transmission of the pathogen, unlike measles, does not occur from room to room.

Streptococcus, which causes scarlet fever, is not only a dangerous pathogen, it remains frozen and dried for a long time. Getting on the mucous membranes of the tonsils, it multiplies there, progresses and produces toxins.

By this, it causes a certain symptom complex in the form of fever (catarrhal, lacunar), lymphodermatitis and punctate rash.

Erythrogenic toxin enters the bloodstream and violently affects:

• cardiovascular system;
• endocrine system.

The action of the toxin leads to extensive clinical picture. The disease is accompanied by fever, intoxication syndrome, skin rashes, tonsillitis and lymphodermatitis.

Every adult has heard about the childhood illness of scarlet fever. But in practice, only a few can recognize the symptoms of this infection. It is often mistaken for a sore throat and treated incorrectly. This leads to severe complications of the heart, kidneys and joints.

Parents are required to know what scarlet fever is and how it manifests itself in children. This will help them, if a child has symptoms of an infectious disease, to immediately identify them and take the necessary measures. Foci of scarlet fever often occur in children's institutions in the autumn-winter period.

The most important thing for a streptococcal infection is to correctly diagnose and start treatment in a timely manner. And for this you need to know all the symptoms of the disease.

Symptoms of scarlet fever

scarlet fever - acute illness. This is the first meeting of a child's organism with a streptococcal infection. Against the background of absolute health, the child's temperature suddenly rises and signs of intoxication develop, that is, weakness, headache, nausea, and sometimes vomiting on the first day. Further, signs typical of scarlet fever appear.

How to understand that the child is ill with this particular viral infection. Initially, there is a prodromal period. The kid will be lethargic, refuse to eat, act up. The next day, he will have specific rashes on a hyperemic background: the child will be covered with a small-dotted rash of a bright pink color. The main centers of its distribution are:

• face;
• upper and lower limbs;
• chest and back.

The features of the manifestation of the rash should be noted the pallor of the nasolabial triangle.

A characteristic symptom of scarlet fever is angina.

- this is an increase in the tonsils, covered with a purulent coating. The disease practically does not proceed without it. In the medical literature, hyperemic tonsils with scarlet fever are called "flaming pharynx."

The tonsils are hypertrophied, the lacunae contain pus. In mild forms of the disease, angina is catarrhal, the tonsils are brightly hyperemic. With moderate and severe scarlet fever, grayish-yellowish deposits are visible on the tonsils - necrosis.

Language changes are very typical. In the first two days of illness, he is covered with a thick white coating. Then the tongue is cleaned, starting from the tip. By the fourth day of the disease, it becomes bright red with sharply enlarged papillae, which vaguely resemble raspberries in shape and color.

This is scarlet fever, the so-called "crimson tongue" (the photo in children clearly demonstrates this).

By the end of the first - the beginning of the second week, hyperemia persists, the papillae begin to atrophy. The tongue looks smooth, polished - "varnish tongue". After 10 days, it becomes normal.

There is also a reaction of regional lymph nodes. Basically it is okolomandibular. They are multiple, painful, especially when swallowing.

Signs of scarlet fever at all children are different. Streptococcus secretes a poisonous toxin into the blood, which causes the symptoms of the disease. They are:

• high body temperature, sometimes reaching 40 degrees;
• increase in palatine tonsils;
• sore throat when swallowing;
• weakness.

The nature of the rash with scarlet fever

All these symptoms are very similar to angina. But unlike her, by the end of the first day of illness, a profuse purple rash appears on the neck, upper body, which quickly (within 2 hours) spreads throughout the body.

It is best expressed on the lower part of the body, the flexor surface of the arms, in the axillary regions. (see photo below). Here, in the natural folds of the skin, the rash is especially intense. Often rashes are localized on the inner surface of the thighs and lateral parts of the chest.

Some sick children may have a miliary rash. It consists of small, within 1 mm in diameter, bubbles filled with a cloudy liquid. If you press on them or stretch the skin over it with your fingers, they quickly disappear. Then reappear when released.

The rash tends to be located on the body in the form of dark red stripes. On the stomach, it is barely noticeable and has a pale pink color. On the elbow and inguinal folds, in the perineum, and in boys , and in girls, the rash is pronounced.

The skin of the baby is dry, somewhat reminiscent of sandpaper. If you run your hand over your chest, you can feel goosebumps, as if the child is cold. It is nothing but a papular eruption, very characteristic of scarlet fever.

Changes in the skin on the face are peculiar: the rash is located on the temples, the skin of the forehead and cheeks. nose area, upper lip and chin remain pale, without rashes. This creates a sharp contrast with the purplishness of the cheeks. The rash lasts for 4 days.

It does not disappear without a trace, but leaves behind a peeling, the beginning of which falls on the second week of the disease: large-lamellar and pityriasis. After the disappearance of the rash, stripes of pigmentation may remain on the body. This symptom is called Pastia's symptom. It is highly pathognomonic of scarlet fever.

A characteristic feature of scarlet fever is a sharp contrast between red, brightly glowing cheeks and a pale nasolabial triangle (as in the photo).

Many diseases are similar to scarlet fever and it does not always have a typical clinical picture:

• can flow without temperature;
• not be accompanied by a rash.

Therefore, it is often confused with other infectious diseases.

Parents need to be vigilant and not panic from the first spot that appears on the skin. On the first day of the child's rash, it is necessary to show the pediatrician, who must be called to the house. This will help to more accurately diagnose the disease and prescribe the right treatment.

Diagnosis of scarlet fever

It is possible to identify the disease and make the correct diagnosis, on which the treatment will depend, using several procedures. They include:

• physical examination of a sick child;
• serological method;
• immunofluorescent method;
• bacteriological method.

Scarlet fever treatment

Scarlet fever itself can be completely safe when it is proper treatment. If you follow all the recommendations of the doctor, perform the prescribed procedures, then the child will not face any complications.

For the entire acute period of scarlet fever, the child should have bed rest according to all the rules. In some cases, patients have to be hospitalized. Parents should be prepared for this, and in no case refuse inpatient treatment.

In the first place is antibiotic therapy. Antibiotics are taken in a course of at least 10 days. This kills microbes and prevents the development of complications of this infection. If a child develops dyspeptic symptoms against the background of antibiotic therapy, then the appointment and intake of probiotics will be justified.

For the treatment of scarlet fever prescribed antihistamines. They are suitable for accompanying skin rashes severe itching. They are also prescribed for obvious dryness of the skin.

With severe sore throat, pain and discomfort in the throat, the child needs a warm, plentiful drink. This is much more important than cleaning the oral cavity. Water helps to actively fight the intoxication of the body, which is observed with scarlet fever.

Diet for scarlet fever

The food that is given to the child during the period of illness should be soft and gentle so as not to cause additional irritation of the mucous membranes. But at the same time, it must carry a certain nutritional load. The nutrition of a child with scarlet fever should be:

• homogeneous;
• easy to swallow;
• predominantly dairy and vegetable;
• all food is served mashed and boiled and only warm.

As a drink, warm compotes, berry fruit drinks, kissels are used. Cranberries, cranberries, rose hips are useful. They saturate the body with vitamins and help replenish the energy balance.

convalescence

After 7-10 days, with a moderate course of the disease, a period of convalescence begins:

• body temperature decreases;
• sore throat decreases;
• weakness and lethargy disappear;
• there is an appetite;
• the rash disappears completely.

In the second week, an important retrospective pathognomonic sign of scarlet fever appears - peeling. It occurs as a result of parakeratosis. Where the skin is tender, the peeling is pityriasis, as if the skin is sprinkled with flour. This is observed on the cheeks, neck, armpits.

On the chest, abdomen, the skin is slightly rougher. Peeling in these places is lamellar. At the fingertips, it is large-lamellar.

The signs of scarlet fever in a preschool child are pronounced and unchanged for many years. It refers to general condition organism, oral cavity and skin. At their first manifestations, it is necessary to apply for medical care so that the child emerges victorious in the fight against scarlet fever.

It must be remembered that the child cannot be immediately after recovery given to the children's team - Kindergarten or school. Clinical symptoms pass in 10 - 12 days, full recovery occurs in another week. Therefore, the child can attend childcare facilities:

• 22 days after the onset of the disease;
• 12 days after discharge from the hospital.

Until the doctor gives permission to visit the children's institution, the child must be isolated: in a hospital or under home supervision.

In order for the child to recover from the disease as soon as possible, he needs small physical exercises. Regular tennis balls will help with this. You can also use balls with thorns.

What is dangerous scarlet fever

Scarlet fever is dangerous, first of all, for its complications. She can call:

• lymphadenitis,
• mastoiditis,
• neck abscess.

But there are later severe complications at the level of the immune system. They arise if the child goes early to the children's team and re-encounters with the causative agent of the disease.

Scarlet fever is a bacterial infection caused by streptococci. And they affect the muscles of the heart and kidney tissue. The most formidable complication that is formed with scarlet fever is streptococcal heart disease in the form or chronic illness kidneys.

Timely detection of symptoms of the disease, contacting medical institutions, correct diagnosis and implementation of all prescriptions of the attending physician can avoid dangerous complications.

Currently, scarlet fever occurs in milder forms than it was several decades ago. Complications after it - quite a rare event, usually everything ends well. Do not self-medicate, it is better to give this prerogative to doctors.

After suffering scarlet fever, a strong immunity to this infection usually develops. But it is better to try to protect the child from a dangerous disease.

Prevention of scarlet fever

Scarlet fever is an infection transmitted by airborne droplets. Unfortunately, there are no vaccines for her. Preventive measures against this disease are non-specific. It:

• general improvement of the body;
• hardening and feasible physical activity;
• lack of contact with patients - carriers of streptococcal infection;
• strengthening local immunity from the nasopharynx and throat;
• the use of natural phytoncides (onions and garlic) in the autumn-winter period;
• vitaminization;
• avoiding hypothermia and dampness.

conclusions

During the autumn-winter period, the body of every person, and especially children, is exposed to various infections. In such weather and time of year, doctors recommend giving increased attention children's health and warn of dangerous diseases. Among them is a very unpleasant infectious disease - scarlet fever. In children, symptoms, treatment and prevention have some certainty.

Scarlet fever is referred to infectious diseases transmitted mainly by airborne droplets. It most often affects children aged 5 to 9 years, but it also occurs at a later age. The causative agent of the infection is streptococcus. And many people, although they do not get sick themselves, are its carriers.

Scarlet fever is very similar to angina, but hallmark the disease is minor, both on the face and on other parts of the body. AT last years the incidence in many regions is increased, but the course of the disease occurs in milder forms.

The first symptoms of scarlet fever in a child are the appearance of a small-spotted pink rash on the face, trunk and limbs. Moreover, their expression can be very diverse. Along with the rash, the tonsils are always affected.

In mild cases, the course of scarlet fever is possible without fever.

These signs of the disease should not be ignored and immediately seek help from medical institutions. After all, with refusal or improper treatment, serious complications can occur. Scarlet fever requires antibiotic therapy for 5 to 10 days. Good effect on streptococcus preparations of the penicillin group.

After recovery, immunity to the disease is usually developed, and in practice it happens only once in a lifetime. However, more attention should be paid children's health and do not forget about preventive measures.

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Content

Absence dangerous consequences characteristic only for a mild course of scarlet fever. In other cases, the pathogen causes severe consequences: streptococcus provokes scarlet fever, which affects the lymph nodes, cardiovascular system, joints, immunity, hemostasis, kidneys, liver and other internal organs.

Why Complications Occur

The entrance gates for the penetration of streptococcus into the body are the mucous membrane of the tonsils, oropharynx and damaged skin. Once in the human body, the bacterium causes an infection. The mechanism of its development:

1. Streptococcus is attached to lymphocytes due to lipoteichoic acid in the composition of its cells.
2. Then there is an active release of toxins: streptolysin, peptidoglycan, hyaluronidase, A-polysaccharide, protein M.
3. Toxins inhibit the activity of phagocytes, thereby preventing the capture of pathogenic cells.
4. Erythrogenic toxin causes a rash due to a sharp expansion of capillaries and an acute inflammatory reaction of the skin.
5. Streptolysin provokes hemolysis, cardiohepatotoxin affects the diaphragm, myocardium, liver. This leads to the development of other disorders in children.

Classification of the consequences of scarlet fever

According to one of the classifications, complications after scarlet fever are divided into types depending on the form of the course of this disease. The following groups of consequences are distinguished:

• Infectious. Associated with the spread of streptococcus from the primary focus through the bloodstream throughout the body.
• Toxic. Develop due to the waste products of streptococci.
• Allergic. Arise as a response of the immune system to streptococcus cells in the body.

Complications of scarlet fever in children

Depending on the time of occurrence, all complications after scarlet fever in boys and girls are divided into two groups. In children, the following consequences are distinguished:

• Early. They are formed due to severe intoxication of the body even during the active phase and in the first days after the cure. Early consequences are directly related to the severity of the disease. They are more often detected with severe symptoms of streptococcal infection or its toxic-septic form.
• Late. Their cause is an allergic factor. All streptococci are the strongest provocateur of immunity. Under the influence of this bacterium, the immune system begins to "fight" with its own body. Late consequences are not associated with the form and severity of streptococcal infection.

Early

The early group includes options for the development of the most streptococcal infection in the body. The consequences arise due to the fact that streptococci spread from the primary focus of inflammation and affect other organs.

In severe and hypertoxic course of the disease, disruption of the blood vessels is possible. This can lead to hemorrhages in internal organs, including the brain.

Other early complications:

• accumulation of purulent masses in the tonsils;
• cervical lymphadenitis;
• otitis;
• tonsillitis;
• sinusitis;
• purulent processes in the kidneys and liver.

Late

The late ones include the consequences that occur after about 3 weeks after the cure for scarlet fever. There is also a relapse of this disease. Other types of them:

• Rheumatism of the joints. It develops approximately 15 days after the cure for streptococcal infection. Rheumatism causes pain in the knees, elbows and joints of the fingers. The disease is characterized by an asymmetric lesion, i.e. pain syndrome occurs on one or the other side of the body. There is also hyperemia of the skin in the area above the joint.
• Heart valve disorders. Associated with an allergic disease. The complication can be eliminated only by surgery. The valves become less elastic and may burst. This disorder is one of the reasons for the development of heart failure at a young age. Patients who have had scarlet fever and suffer from joint pain are strongly advised to be examined by a cardiologist.
• Chorea. The beginning of its development falls on the 15-20th day after the end of the disease. distraction, nervousness, bad dream, inadequate response to stimuli are the main symptoms of Sydenham's chorea. After a while, hands and feet begin to shake, speech changes. In some cases, the child remains with disorders, such as gait or coordination.
• Streptococcal glomerulonephritis. Pain in the lower back, an increase in temperature after scarlet fever, swelling, a decrease in urine volume are the main signs of pathology. Often treated to the end and leaves no traces.