Scarlet fever in children: causes, symptoms and treatment

Scarlet fever is a common, mostly pediatric infection transmitted by airborne droplets. The absence of a vaccine for scarlet fever leads to a high incidence of scarlet fever in the age group from 2 to 8 years. The prevalence of scarlet fever pathogen, streptococcus is very high. If we take into account that a large enough group of people of different ages is an asymptomatic carrier of the infection, the reason for the frequent incidence of scarlet fever becomes clear.

The children’s body is most susceptible to the influence of the causative bacterium, and after a past illness a strong immunity is formed. This allows us to rank scarlet fever as infectious diseases of childhood. In extremely rare cases of people who have suffered from scarlet fever, infection is reversed in adulthood. Scarlet fever is a dangerous disease, every parent needs to be aware of its features, clinical presentation and prevention of complications.

Scarlet fever: etiology and symptoms of the disease

The disease has been known for a long time as dangerous for children aged 1 to 9 years with a significant number of deaths. Before the advent of modern medicine in most countries of the world during the epidemics of scarlet fever died a huge number of children. The reason for limiting the age period is the presence of the child’s protection with maternal antibodies in the first period of life up to 1-2 years depending on the type of feeding and immunity of the mother and the formation of the body’s own immune protection in children 8-9 years old.

Scarlet fever history

Scarlet fever as a separate disease was isolated in 1675 by Sidengam. In the years 1789-1824 Bretonneau was engaged in compiling a complete clinical picture. Loffler was the first doctor who expressed in 1882 the idea of ​​streptococcus as the causative agent of scarlet fever on the basis of its isolation from the throat, blood and organs of the dead. Then, infectious disease specialists Pirquet and Mooser in 1903, in support of this hypothesis, reported that scarlet streptococcus, unlike other types of bacteria of this group, is agglutinated with serum of convalescents (recovering) after scarlet fever.

I.G. Savchenko (1905) was the first to isolate streptococcal toxin, which he successfully immunized in the course of experiments on horses, which made it possible to create an antitoxic serum that has a therapeutic effect on this disease.

In 1906 G.N. Gurbichevsky developed anti-streptococcal vaccine for the prevention of the disease. G. F. Dick, G. H. Dick (1923 – 1925) suggested an intracutaneous test with a streptococcus toxin to determine susceptibility to this infection.

Etiology and types of infection

The name is based on a description of the symptoms of the disease. The Latin word scarlatum, meaning “bright red”, “scarlet”, describes one of the characteristic symptoms of scarlet fever — a rash of bright red. The characteristic scarlet-like rash, a rash of a certain shape, size and location is the main clinical sign that allows the doctor to diagnose infection with streptococcus.

The bacterium of the type of streptococci, namely beta-hemolytic streptococcus group A, is the causative agent of infection and the cause of scarlet fever. Infection occurs through contact with sick people or hidden carriers, as well as without direct contact, when using certain items of hygiene, dishes, toys, other objects and food. The disease is also transmitted through a third party who has come in contact with a sick person or a carrier of a streptococcal infection of this type.

Manifestations of the disease

A characteristic scarlet rash that occurs with scarlet fever is the body’s response to erythrotoxin, which from the first day of the development of the disease produces streptococcus during reproduction on mucous surfaces. Under the influence of this toxin, small blood vessels dilate, forming spots of red color and rounded shape.

This clinical symptom clearly indicates scarlet fever. The combination of sore throat and red rash, gradually capturing the body surface, starting from the head and going down, allows you to confidently diagnose this disease during an external examination.

Specific symptoms also include the absence of a rash in the nasolabial triangle, which, together with severe hyperthermia, reddening of the cheeks and puffiness of the neck due to an increase in cervical lymph nodes constitutes a characteristic picture of the appearance of the sick child. Filatov’s symptom, a pale nasolabial triangle, is not pantognomic only for scarlet fever, it is manifested in other diseases as well.

The exanthema manifests itself several hours after the acute manifestation of the disease. The incubation period from the moment of infection to the onset of overt symptoms averages 5-7 days, but there are cases when the hidden phase lasted from several hours to 12 days. At the same time, the child who is sick with scarlet fever is contagious from the very first day until clinical recovery, that is, for about three weeks.

Stages of manifestation of the rash and its variations depending on the form and severity of the disease

First of all, pink dotted rashes appear on the face, side surfaces of the body, in the skin folds of the armpits, in the groin, neck, etc. In places of increased friction of the skin on clothing and bedding (for example, on the back) rash has a confluent character and can cover large areas of the skin almost entirely. Scarlatinal exanthema polymorphism, uneven manifestations are characteristic of severe, septic forms and early layering of allergic reactions. In case of severe intoxication, an uneven, scanty cyancous rash with hemorrhagic events is possible.

The most pronounced rash on 3-5 days after the onset of scarlet fever, after which the rash fades, disappears without a trace, and begins significant peeling of the skin, which is also a consequence of the effects of a specific toxin on the body.

The pronounced exfoliation of epidermis particles is noticeable on the hands and the soles of the feet: the so-called “palm symptom” describes skin detachment in the form of a kind of “glove”, in whole layers, extending from the area around the nail plates to the entire surface.

Scarlet rash, especially in children with a diagnosis of exudative diathesis, may be accompanied by moderately severe itching. In some cases, most often in cases of mild and moderately severe disease, groups of whitish small bubbles with initially transparent and then cloudy content are added to the classical type of rash at the places of the folds and natural folds. According to N. F. Filatov, a similar rash, miliaria crystalline, has a favorable prognostic value. By the end of the disease bubbles dry up, leaving a slight peeling of the skin.

Angina and other symptoms of the disease

When the clinical image is insufficient, scarlet fever can be diagnosed as a sore throat, as the disease is accompanied by laryngeal inflammation, also provoked by streptococci. Primary localization of the introduction and reproduction of streptococci in most cases – the nasopharynx, and especially during infection and the development of scarlet fever in a child, an inflammatory process begins in this area, develops angina with reddening of the soft palate, enlarged tonsils, grayish purulent bloom, accompanied by an increase and tenderness of local lymph nodes due to an allergic reaction to toxins. The characteristic “scarlet” language of bright crimson color with prominent taste buds is observed on the fourth day from the onset of the disease. It can also develop purulent-septic foci of inflammation on the mucous membrane and skin, especially during primary infection with streptococcus through the surface of wounds and abrasions.

Thus, the symptoms of scarlet fever include:

• sudden onset of the disease with fever, high fever, significant deterioration of health, signs of intoxication of the body (nausea, vomiting, signs of increased tone of the sympathetic nervous system may occur);
• streptococcal sore throat, accompanied by an increase in local lymph nodes;
• “flaming throat”, hyperemia, redness of the mucous throats, limited by the line of the hard palate;
• rash of a characteristic type and localization;
• “Crimson” language.

Depending on the severity of the disease and the degree of intoxication of the body, the clinical picture may be complemented by symptoms of septic complications, allergic reactions, and damage to internal organs.

Varieties and complications of scarlet fever in children

Scarlet fever in recent decades, most often occurs in a mild form. This is connected both with the invention of effective medicines and the possibility of treatment with antibiotics, and with improving lifestyles, a variety of nutrition, and medical care that allow children to form a higher body resistance than in past centuries.

Mild symptoms of the disease

The mild form of the disease is quite moderate, manifesting itself with the following symptoms:

• hyperthermia no higher than 38.5 ° C;
• vomiting, nausea, headache absent or mild;
• catarrhal manifestations (pharyngitis, angina) occur without complications;
• purulent-necrotic plaque on the tonsils and soft palate is absent;
• the rash is dull, not abundant or absent;
• Peeling of the skin is mild.

The course of the disease is moderate, the acute febrile stage ends in 3-4 days, by 5-6 there is sore throat, skin rashes. Complications develop in rare cases.

Their characteristic signs of scarlet fever, which make it possible to distinguish an erased form from a sore throat, distinguish scarlet-colored tongue of a crimson color with pronounced papillae, this symptom is also present during the mild stage of the disease.

Moderate form of scarlet fever

Scarlet fever in moderate form is distinguished by the following characteristic features:

• significant increase in body temperature – 39-40 ° C;
• a sharp deterioration in health, chills, weakness, headache, nausea, vomiting (sometimes exhausting, repeated);
• possible phenomena of delirium, hallucinations as a result of intoxication and excitation of the sympathetic nervous system;
• tachycardia, palpitations, scarlet-heart symptom, accompanied by shortness of breath, shallow breathing, pain in the sternum;
• purulent-necrotic plaque on the tonsils, purulent tonsillitis;
• bright, numerous eruptions on the skin, abundant peeling of the skin during recovery.

The duration of the manifestation of the primary symptoms and the acute period in the moderate form of the disease is 7-8 days, during which hyperthermia persists. This form is characterized by early and late complications of the course of the disease, which often requires placement of the sick child in the hospital for timely detection of symptoms.

Severe Scarlet Fever

Due to the timely prescription of antibiotics and immunization of the population as a whole, the severe form is quite rare today. The disease is characterized by the following symptoms:

• increase in body temperature to critical limits (41 ° C);
• severe nausea, repeated vomiting, headache, tachycardia;
• mental disorders: confusion, delirium, hallucinatory phenomena;
• nasopharyngeal inflammation extends to the soft palate, mouth area, local lymphatic system, middle ear;
• A rash is abundant, uneven, coalescing, pronounced.

There are three forms of severe scarlet fever:

• toxic, provoked by abundant secretion of erytotoxin. This form is accompanied by severe intoxication of the body and can be the cause of toxic shock and death;
• purulent-necrotic lesion of the nasopharynx and adjacent tissues characteristic of the septic form in the severe stage;
• toxic-septic, the most dangerous combined form of scarlet fever, combining septic phenomena and severe intoxication.

Scarlet fever in severe form requires mandatory admission to the hospital for both children and adult patients.

Early and late complications of scarlet fever in children

In general, the occurrence of complications of the early and late period is associated with late diagnosis or failure of treatment of the disease. Treatment of scarlet fever requires strict adherence to all appointments of a specialist, not only for quick and effective recovery, but also to prevent the development of numerous and sufficiently serious complications of this infection.

Early complications of scarlet fever

When introduced into the body, the infectious agent begins to negatively affect various organs and systems. The most common complications of the early period of scarlet fever in children include such phenomena as:

• otitis media , inflammation of the tonsils, sinuses due to development of infection in the nasopharynx;
• inflammatory processes, purulent foci in the liver, kidneys;
• change, thinning of the heart walls, which leads to an increase in the size of the heart, reducing its efficiency, the level of filling of blood vessels. “Scarlet fever” or toxic heart as a syndrome is accompanied by a decrease in blood pressure, a decrease in heart rate, shortness of breath, pain in the chest;
• disorders in the circulatory system due to streptococcal effects on the walls of blood vessels, which is dangerous with hemorrhages in various parts of the body, including in the brain.

These complications develop when scarlet fever is weakened by a child or if therapy is not timely, leading to severe scarlet fever.

Late complications of scarlet fever

Most of the late complications of scarlet fever disease are associated with an untimely start of treatment and failure to comply with prescriptions in regimen and load limiting during illness and recovery.

Articular rheumatism

Rheumatism affecting the joints is one of the frequent late complications of scarlet fever. The first symptoms occur on average two weeks after clinical recovery and include the following manifestations:

• pain in large joints of limbs;
• asymmetric localization of inflammatory processes;
• redness, swelling over the joint.

Myocarditis

Inflammation of the heart muscle or myocarditis develops as a result of the inflammatory process in myocardial tissues, as a result of which the elasticity of the tissues and their contractility are reduced.

Inflammation develops when Streptococcus enters the heart muscle. To cure myocarditis, it is necessary to eliminate the cause of the disease, which implies a complete treatment of scarlet fever.

To reduce the likelihood of myocarditis during the period of illness and within two weeks after recovery, it is necessary to limit physical activity. Therefore, scarlet fever in children requires the release of physical education classes for a period of two weeks and bed rest during the treatment of scarlet fever.

Glomerulonephritis

Hemolytic streptococcus group A causes a strong allergic reaction in the body, provoking the destruction of body tissues by immune cells. With the defeat due to allergy of the renal glomeruli, the main filtering elements of the kidneys, the child develops glomerulonephritis.

Manifestations of glomerulonephritis can be observed both after a few days, and a few weeks after the scarlet fever disease. At the onset of the disease, the following symptoms appear:

• hyperthermic turn, increased body temperature;
• lumbar pain;
• decrease in the total volume of urine excreted, change in its transparency, the presence of sediment;
• swelling, especially manifested after sleep.

Treatment of glomerulonephritis after scarlet fever in children is carried out in stationary conditions and requires strict medical supervision after recovery to prevent the acute form of the disease from becoming chronic.

Pneumonia

In 5% of cases, a late complication of scarlet fever is pneumonia or pneumonia. As a rule, streptococcal pneumonia develops in the first week of septic scarlet disease due to streptococcus entering the lungs through the respiratory tract.

If pneumonia is noted later, then usually the pathogen is pneumococcus, which joins in the background of a weakened immunity of the child’s body.

Pneumonia is a dangerous disease at any age, requiring long-term therapy and a recovery period. Timely taking antibiotics for scarlet fever helps prevent the infection from moving from the nasopharynx to the lungs and avoid developing such a complication.

Principles of treatment for scarlet fever in childhood

When diagnosing scarlet fever, treatment is determined by a specialist. First of all, the choice of therapy is based on the form of the disease, the severity of its course and associated diseases, dysfunctions and the individual characteristics of the child.

The mild form does not always require antibiotics, the need for antibiotic therapy is determined by the pediatrician. In compulsory maintenance therapy aimed at alleviating the symptoms and reducing the likelihood of complications, include antihistamines, anti-inflammatory drugs for the nasopharynx, fever, if there is such a need. A prerequisite is abundant drinking, as well as the patient’s bed rest, lack of exercise, rest, diet food.

The moderate and severe forms of scarlet fever are cured with antibiotics of the penicillin group, the most effective against streptococci. If the diagnosis of scarlet fever does not allow treatment with penicillin antibiotics (for example, if there is an allergic reaction to penicillin), other groups are selected, to which the sensitivity of the infectious agent is established.

In addition to the mandatory antibiotic therapy, antihistamines, antipyretics, detoxifying drugs, vitamins are prescribed. When joining complications, an appropriate course of treatment is selected.

Scarlet fever is treated by a pediatrician, self-prescription drugs are unacceptable. In any form of scarlet fever disease, plenty of drinking is necessary to remove erytotoxins and alleviate the patient’s condition, as well as bed rest and complete rest of the patient. It should be remembered that scarlet fever in mild form, in case of non-compliance with doctor’s prescriptions, can cause serious complications leading to chronic diseases or disability of a person.

Scarlet fever: disease prevention methods

Scarlet fever is a disease that is not yet preventable by vaccination methods. Therefore, in order to avoid scarlet fever disease, measures of non-specific prophylaxis are taken to prevent the spread of infection in children’s groups. In the absence of an effective vaccine, quarantine, isolation of the diseased and personal hygiene rules are basic ways to prevent the incidence of scarlet fever.

Therefore, when diagnosing scarlet fever in a child attending a preschool or school educational institution in the classroom or kindergarten group, a weekly quarantine is established. In the presence of contact with a child with scarlet fever, other children are allowed into the team only after 17 days in the absence of symptoms of the onset of the disease.

Those who have suffered scarlet fever at home are allowed to visit the institution after 22 days from the first day of illness, and those discharged from the hospital – 12 days after discharge.
Such quarantine measures help reduce the incidence rate and prevent epidemics in kindergartens, schools and other forms of children’s groups.

Personal hygiene is also one of the methods of preventing scarlet fever disease. Mandatory washing of hands with soap for 30 seconds, careful treatment of them, especially after returning from crowded places, regular sanitization of toys, objects, surfaces, washing food can effectively destroy most pathogens.

In the house where the patient is scarlet fever, special hygienic measures are carried out, including regular surface treatment with chloramine, boiling of bedding, underwear and dishes, antiseptic processing of toys.

In contact with patients with scarlet fever, regular gargling with an antiseptic is recommended, especially in the presence of chronic nasopharyngeal diseases (pharyngitis, tonsillitis, sinusitis, etc.), washing the nasal passages with saline.