Scarlet fever in children and adults the symptoms
Scarlet fever usually starts with one of the following symptoms: sore sore throat, vomiting, fever, headache.Within one or two first days of the rash appears.It begins with a warm moist parts of the body, such as the side of the chest, groin, back, which is a child.From a distance it seems consisting of identical red spots, but if you look closely, it is evident that each spot is made up of tiny red dots on the inflamed skin.The rash can capture the entire body and face, but the area around the mouth is usually pale.The throat is red, sometimes very strongly, and after a while the red and language, first at the edges.When the child has a fever and sore throat, you certainly need to call a doctor.
Scarlet fever - an acute infectious disease refers to a streptococcal infection caused by hemolytic streptococcus.It is characterized by symptoms of intoxication, sore throat and sores on the skin.(How to treat scarlet fever folk remedies, see here)
etiology of scarlet fever. causative agent of scarlet
hallmark hemolytic streptococcus is the property develop hemolytic poison, so that while its on media with the latest hemolyzed blood.When sowing hemolytic streptococci on blood agar plates after 24 hours colonies appears around its illumination zone of 2-3 mm diameter.
outside the human body for a long time keeps the viability of Streptococcus.The temperature was 60 ° it stands to 2 hours.Boiling, as well as solutions of mercuric chloride 1: 1 500 carbolic acid and 1: 200, Streptococcus kills at 15 minutes.
Started Gabrichevsky Russian scientist working on the etiological role of hemolytic streptococcus of scarlet fever and the establishment of the Americans in 1923, Dick toxigenic capacity scarlet races hemolytic streptococci significantly moved forward our knowledge of scarlet fever.An important result of this work was the introduction of scarlet fever specific methods of treatment and prevention.
hemolytic streptococci can be found in the mucus in the throat scarlet vast majority of patients with onset of the disease, and in the further course of scarlet fever - in the centers of local lesions in otitis, mastoiditis, lymphadenitis, arthritis, in some cases, and in the blood.Hemolytic streptococci isolated from the body of the patient scarlet, produces a toxin with a rise of liquid media.Intradermal administration of 0.1-0.2 strongly diluted toxin scarlet streptococcus causes at the injection site in individuals who are sensitive to this toxin, 4-6 hours after injection redness, which is one day reach 0.5-3 cm in size, rarely more.This is - a positive reaction Dick.One of the skin dose is considered the minimum amount of toxin that gives more clear reactions in sensitive individuals.
Dick Reaction never causes any common disorder and it may be safely used at any age and any health condition.
According to Zinger (USA), Dick was a positive response in 0-6 months 44.8% 6 months -3 years - 65-71%, 3-5 years, 56-46%, 5-20 years -37 - 24% in adults - 18%.These findings have been confirmed in other countries.Thus, a person susceptible to scarlet fever, often give a positive reaction Dick, while having a relative immunity, Dick reaction in most cases, is absent in adults and infants.It is usually absent and recovering from scarlet fever.Obviously, between the nature of the reaction of the subject and its susceptibility to scarlet fever there is a certain relationship, so the reaction of Dick and use to determine immunity to scarlet fever.
subcutaneous administration are particularly sensitive child, a large number (several thousand skin doses) of toxin can cause his poisoning phenomenon: after 8-20 hours the temperature rises, there is a state of weakness, appears punctulate scarlatiniform rash, sore throat, vomiting.These symptoms disappear within 1-2 days, but they quite clearly show that early scarlet fever syndrome depends on the patient's body toxin poisoning hemolytic streptococcus.By immunization of horses toxin scarlet hemolytic streptococcus obtained therapeutic serum, giving a favorable therapeutic effect when applied in the first days of the disease.Treatment for scarlet fever serum has become a practice of most major hospitals.Finally, the active immunization of infants a vaccine consisting of corpses scarlet hemolytic streptococci and toxin, increases resistance to scarlet fever.
hemolytic streptococcus sensitive to antibiotics - penicillin, makrolidamu, tetracycline, etc.
epidemiology of scarlet fever.. source of infection is sick with scarlet fever, streptococcus carrier, as well as sick streptococcal tonsillitis or nasopharyngitis.Scarlet fever is transmitted by airborne droplets.However, the infection can be transmitted through contaminated items, toys, clothes patients.
highest incidence is observed among children of preschool and early school age.Children under one year of life ill with scarlet fever is very rare, as rare ill adults.The most commonly scarlet fever recorded in the autumn-winter period.
The initial source of infection of scarlet fever is sick or convalescent, in the throat and nasopharynx which contains the infectious agent.What role is played in the transfer of scarlet fever healthy people come into contact with patients, we do not know, but to deny the possibility of infection in this way there is no reason.scarlet fever virus gets into the environment from the discharge of mucous membranes pharynx and nasopharynx.He scattered mainly by droplets.Until recently, the thought particularly contagious skin scales at peeling scarlet patients.But now there is sufficient reason to believe that exfoliate while peeling the epithelium contains a pathogen scarlet fever only if the patient's skin - medium scarlet virus - contaminated discharge of mucous membranes of his throat or nasopharynx that virtually, of course, is almost always the case.Infection of another person through the exfoliated flakes convalescents can only happen if the flakes fall into the mouth that person.The patient with scarlet fever becomes contagious from the onset of the disease.Contagious patient remains in a period of convalescence.Most convalescent becomes dangerous to others through 35-40 days rocked by the disease.Deadline scarlet isolation of patients - 40 days.Convalescents complications of tonsillitis, purulent inflammation of the middle ear, festering glands et al. Present a danger to others for a longer time.Especially dangerous convalescents with inflammation in the throat and nasopharynx (sore throat, runny nose).
contagion convalescents, of course, is increasing, if it comes into contact with the scarlet patients who are in the midst of illness.This is due to the fact that the convalescents, already freed from the carrier, could again be infected by surrounding patients.If the ward is placed fresh convalescent patients, then recovering again become carriers of infection.
contrast, scarlet convalescents are not infectious to others under the following conditions:
1) sanitary maintenance, personal care and thorough current disinfection in hospital wards;
2) isolation in small chambers for 3-4 beds, which limits to a minimum the contact with other patients;
3) convalescent stay in good weather on the terrace or forced ventilation chambers (opening windows in good weather);
4) individual isolation for 12 days at home after discharge from the hospital, and the use of fresh air.The last rule should be widely applied to all scarlet discharged from offices;
5) reorganization of the throat, nose and throat by spraying a solution of penicillin (2000 ME in 1 cm3);better to alternate it with other antibiotics (gramicidin).
Pathogen resistant scarlet fever in the external environment.Objects used by patients, especially underwear, bedding, toys, books ,null, scarlet child, and the room where the patient was, for a long time can be a source of infection.
Some foods, especially milk contaminated scarlet patients, can serve as a source of the spread of scarlet fever.
However, the role of contaminated items is negligible in comparison with the role of a sick person and convalescents.
Pathogenesis and scarlet fever patomorfologija .The infection is most often (97%) enters the body through the tonsils, more rarely (1.5%) through broken skin or mucous membrane of the uterus (ekstrafaringealnaya form of scarlet fever).Possible (up to 1%) of agent penetration through the lungs.In scarlet fever development are 3 lines of pathogenesis: septic, toxic and allergic.
Getting on the mucosa or damaged skin, beta-hemolytic streptococcus causes inflammatory and necrotic changes in the place of introduction.In the lymph and blood vessels pathogen penetrates into the regional lymph nodes, causing a purulent inflammation.Otitis media, mastoiditis, phlegmonous adenitis, inflamed sinuses and the other purulent septic complications are the manifestations of scarlet fever.
toxin hemolytic streptococcus, penetrating into the blood and having a tropism for vegetative-vascular, neuro-endocrine apparatus, causes symptoms of intoxication, lesion of the central and autonomic nervous systems.
As a result of the collapse of the circulation and beta-hemolytic streptococci increases the sensitivity of the organism to the protein component of the microbe and evolving infectious allergy is clinically manifested in the form of allergic rashes, complications (psevdoretsidivy, nephritis, arthralgia, and others.).
in place of the primary fixation of scarlet fever pathogen observed desquamation of epithelium, accumulation of streptococci, necrobiosis and necrosis area, extending inland.The regional lymph nodes are also found necrosis, edema, fibrinous exudate and myeloid metaplasia.In septic form of purulent and necrotic lesions are localized in various organs and tissues.In the myocardium, there are degenerative changes in the liver - fatty degeneration.In the brain - sudden acute swelling and circulatory disorders.
Clinical classification of scarlet fever.The scarlet fever is currently used classification proposed NINisevich, VFUchaikin (1990).
1. In form:
a) erased (without rash);
b) forms with agravirovannymi symptoms (hypertoxic, hemorrhagic);
c) ekstrafaringealnaya (ekstrabukkalnaya), abortive.
2. By severity:
• Lightweight, passing to moderate severity;
• moderate, passing severe;
• heavy - toxic, septic, toxic-septic.
3. In course of the disease:
• without allergic complications, and waves;
• allergic waves and complications.
4. By the nature of complications:
• allergic (nephritis, myocarditis, synovitis, reactive lymphadenitis, and others.);
• mixed infection.
main clinical manifestations of scarlet fever: acute onset, body temperature rise to high numbers, intoxication symptoms, sore throat (sore throat), the presence of regional lymphadenitis, and rash at the end of the first or second day of illness.
symptoms. incubation period for scarlet fever lasts an average of 3-7 days, sometimes stretched to 12 days.In some cases it is, apparently, can be shortened to one day.Sometime during the incubation children complain of fatigue, lack of appetite, headache.In most cases, the expression of prodromal phenomena do not happen, and the disease appears suddenly, more or less strong fever or slight chilling.It appears vomiting.The temperature during the first 12 digits watch is high (39-40 °).Sick children appear seriously ill and complain of general weakness, fever, heaviness and pain in the limbs, rump, headache, dry mouth.Swallowing painful.Sleep is disturbed, the night the patient was delirious.Already in this period are rapid pulse, limited bright red soft palate, uvula and tonsils.Submandibular lymph glands painful at palpation.Tongue coated gray-white coating.Face puffy.Cheeks feverishly red.During the first few days, rarely 3-4-th day from the beginning of the disease, there is a characteristic skarlatiioznaya eruption, consisting of a single bright red punctate elements, coalescing into a solid red.The rash begins with a neck and upper chest and spreads throughout the body within 2-4 days.Face scarlet patient during this period is extremely distinctive look thanks to bright red cheeks and contrasting white triangular chin area and circumference of the mouth (Filatov).Following the precipitation the temperature rises slightly and held for several days in high numbers.In uncomplicated cases, simultaneously with blanching rash and temperature falls, reaching a rate of 9-12-th day.At the height of the pulse accelerated disease, common symptoms of intoxication and local phenomena in the throat worse.On the tonsils appears gryaznobely or yellow-white patches, which can spread to the soft palate and uvula.Language is gradually released from the plaque and to 4-5-th day of the disease takes, due to increased papillae, characteristic bright red, crimson.Submandibular gland increased along with the growth of lesions in the throat;sometimes involved in the process and occipital lymph glands.
From the blood in the first days of the disease is marked neutrophilic leukocytes.On the 3-4th day appears zozinofiliya.In the absence of complications, and favorable flow of blood to the 7-10 th day comes to normal.In introducing new complications observed leukocytosis.
Together with the disappearance of the rash, and the temperature drops gradually diminish and the phenomenon on the part of the throat.The skin appears scaly at first, but on the 3-4th week - lamellar, very characteristic, especially on the palms of hands and soles of the feet, peeling.
Peeling is an important symptom, which is rarely absent even in mild cases, and often makes it possible to install later a diagnosis of scarlet fever.
Questions pathogenesis of scarlet fever extensively studied by Soviet scientists (Kissel, Koltypin, silence).
During scarlet fever it is necessary to distinguish between the first period of illness (sore throat, rash, symptoms of intoxication and fever), followed by a period of relative prosperity before the third week, and the second period, with 15-20-th day, when developing common complications:lymphadenitis, nephritis, otitis media, and so on. in the second period in scarlet patient, apparently, there is a particular sensitivity to streptococcus, which is reflected in the frequency and nature of complications.
Depending on the severity of the epidemic, the massiveness of infection, virulence and pathogenicity of this strain, the degree of immunity became newly infected, and will appear as described moderate forms of the disease, or may provide all the transitions from lightning to light cases, obliterated.
Almost scarlet fever to distinguish between mild, moderate and severe, or as many refer to, scarlet fever I, II and III.In mild scarlet fever the first period of the disease is milder.Consciousness is preserved.