Scarlet fever - Causes, Symptoms and Treatment .MF .
Scarlet fever - an acute, bacterial infection, with the airborne transmission mechanism, characterized by acute febrile onset and intoxication, as well as the presence of a sore throat and a rash on the skin.Once people are ill with scarlet fever.
Scarlet fever has been known since ancient times, but the most colorful description appeared in the Spanish «garotillo» title, the word garota - which means an iron collar with which the execution was carried strangled.From this name it is clear that the disease was extremely severe, accompanied by suffocating cervical lymphadenitis.
scarlet fever scarlet fever - β-hemolytic streptococcus group A, Streptococcus pyogenes.To all the characteristics typical of streptococci, and add more specifics to β-hemolytic group, which explains the characteristics of the disease: severe antifagotsitarnaya protection due to the presence
• antitoxic factor released during reproduction;
• «immunoglobulin-Fc-receptor" that interacts with a port
• M protein - is coupled to the capsule and provides adhesion as well as blockade of complement activation (a cascade of defense reactions);
• erythrogenic toxin (most important) - inhibits the synthesis of antibodies and stimulates TNF (tumor necrosis factor), it stimulates the development of toxic shock syndrome and rash;
• leukocidin - selectively affects the white blood cells.
• fibrinolizin (streptokinase) - distributes fibrin clots and causes the spread of the pathogen by the bloodstream to other organs and tissues;
• DNA-ase - destroys cellular DNA;
• hyaluronidase - causes intercellular separation, making the penetration of the pathogen freely after adhesion.
other pathogenicity factors complementary explanations fever, intoxication and rash:
• hemolysin (destroys red blood cells and has a cytotoxic effect on cardiomyocytes and phagocytes);
• enterotoxin (causes the clinic from the gastrointestinal tract);
• The presence of lipoteichoic acid explains the fever;
• Cross-antigens of the pathogen antigens of tissues of different organs, which subsequently can lead to the development of autoimmune diseases, because newly synthesized specific antibodies against Streptococcus will work against these tissues, which have similarity in the structure: the myocardium (myocarditis), fibroblasts (valvular lesion), glomerular renal system (the development of glomerulonephritis).Some clinicians suggest that the "cross-antigens", none other than as a direct tropism (electoral defeat) streptococci to these tissues.
About чувствительности/восприимчивости/распространенности/сезонности:β-hemolytic Streptococcus group A is stable to environmental factors.Resistant to boiling for 15 minutes, and are resistant to disinfectants (killed immediately, even if the action of chlorine bleach).
Natural susceptibility is high, without gender, age and geographical restrictions, but the most frequent incidence is registered in regions with temperate and cold climates.Also characteristic of the autumn-winter-spring season, especially in the intervals from November to December and from March to April.
for a period of seasonal rise of the incidence of a decisive influence of the collective organization and its population.Scarlet fever occurs in people who do not have immunity to toxigenic strains (types).After transferring the disease formed a durable, long lasting, antitoxic immunity, but retained an allergic condition to scarlet allergen in the form of periodic ups and temperature characteristic rash.
addition to the clinical facts, which can not always be stable, the presence of allergic availability can be checked by setting intradermal samples - the introduction of dead streptococci and, in place of the administration in the affirmative redness / swelling and soreness.Passive innate immunity observed in infants up to 4 months from birth (the tension of immunity is determined by the Dick reaction).
Causes infection scarlet fever
source - the sick person, the carrier, as well as ill streptococcal tonsillitis or nasopharyngitis.The mode of transmission - airborne, contact-household (through contaminated household items) and contact.
Symptoms of scarlet fever
incubation period lasts 1-10 days, but usually 2-4 days.The beginning of this period is counted from the moment of introduction of the pathogen to the first clinical manifestation.During this period, the originator gets on the mucous membrane of the nose and throat, the genitals or through damaged skin, in place of the introduction takes place attachment and beginning of life, as well as the action of pathogenic factors that cause vospolitelno necrotic lesion in the attachment point and the gradual spread through the blood and lymphatic vessels,giving rise to the next period - catarrhal (prodromal).Catarrhal period lasts about a week, and is characterized by:
• acute onset with the rise of temperature and symptoms of intoxication (often accompanied by vomiting once);
• From the first days, in parallel with the rise in temperature and the development of intoxication, there is a sore throat.It is often extensive, because it captures all limfoglotochnogo ring (palatine tonsils, pharyngeal tonsil, the lingual tonsil at the base of the tongue, the tonsils in the Eustachian tubes).Oropharyngeal hyperemia so expressed, and the edges it is so clear that the earlier doctors call this condition "sign glowing throat."Also, on the inflamed tonsils arise raids of varying intensity - from punctate to deep common.
Passing plaque in the language of scarlet fever
• The regional lymphadenitis - an increase perednesheynyh lymph nodes, which are painful on palpation and sealed.
• The first days of the disease tongue coated thick white coating, but with 4 days this plaque starts to descend, and in its place you can see the bright red with crimson tinge tongue surface with clearly protruding nipples.This eye-catching color language persists for 2-3nedel called "symptom crimson language".
• By the end of the first day or the beginning of the second, against fever, intoxication and sore throat, begins to appear a rash that has features:
- punctulate rash appears first on the face, neck and upper body, and then on the flexor surfaces of the extremities, on the sidethe surfaces of the chest and abdomen.And also on the inner thighs.
- In areas of natural bends (elbow, inguinal, axillary) rash forms a cluster in the form of dark red stripes.
Pilot at the folds of scarlet fever
- In the face of a rash "touches" only nasolabial triangle - it becomes pale ( "symptom Filatov"), the presence of this symptom is caused by irritation of the toxin lower portion of the trigeminal nerve, which corresponds to the vasoconstrictorfibers.
symptom Filatov (pale nasolabial triangle)
- when pressed on the spot rash rash disappears for a while, but then reappears - "palm symptom."
- for 4-7 days the rash begins to fade, leaving behind no pigmentation, but when it comes exfoliation of the epidermis, especially on the heels of the palms and notice krupnoplastnoe peeling, which is due to tighter coupling between cells in these areas.Peeling lasts two weeks
- rash may be not only in the form of small spots, but in the form of small bubbles (vesicle-papular rash).
rash of scarlet fever is the main, most pathogenic feature that explains the action of the toxin on erythrogenic small-caliber vessels in the skin and other organs.
rash on the palms when skaralatine
With regard to the variability of the disease, the symptoms can be very, very different, but always a rash!When the first symptoms of scarlet fever should call a doctor.
As already mentioned, after the disease, formed a long / stable / practically lifelong immunity, but he tipospetsifichen, ie a person does not get sick again with the same serovar streptococcus, but there will always be a risk of infection to other views.
Diagnosis of scarlet fever
1. According to clinical data during inspection and clarification of complaints:
- acute onset with fever and intoxication
- acute catarrhal or catarrhal-purulent tonsillitis
- characteristic rash
2. Laboratory tests:
- KLA (↑ A ^, Hf with a shift to the left, ESR ↑).
- OAM and ECG - as additional methods of indicating the degree of compensation.
- Bacteriological method performed by bacterial seeding material (throat swab / serum / blood) on blood agar, whereby there is an abundant growth of the pathogen, with the destruction of erythrocytes about themselves (hemolysis zone).
- Definition rise in antibody titer by ELISA (enzyme-linked immunosorbent assay), which indicates the intensity of immunity or stage of the disease (IgG-indicates the duration of the disease, IgM - says an acute course of the process)
Treatment of scarlet fever
1. Etiotropic treatment isuzkospektornyh in the application of the drugs of choice - erythromycin.If this is not possible - the choice is shirokospektornoy group of antibiotics, cephalosporins.Treatment is possible in the home at the age child older than 3 years and in the course of mild form of the disease.In other cases required hospitalization.Treatment duration of 7 days.
2. Local treatment is the use of drugs such as Joks, Geksoral, stopangin, Tantum Verde (subject to age restrictions - some drugs can be used with 3 years, some with 12, etc).For topical treatment can also include gargling with a solution of chamomile, furatsilina 1: 5000, Rotokanom.
3. anti-inflammatory therapy and immunotropic: lizobakt, immudon.
4. Desensebiliziruyuschee treatment (protivotoksicheskoe action). Suprastin, tavegil, Zyrtec and other
5. Symptomatic means the presence of complications or concomitant symptoms weighting - the use of antipyretics, antitussives
Admission drugs is carried out after consultation with the doctor.
complications of scarlet fever
lymphadenitis, otitis media, sinusitis, mastoiditis, nephritis, arthritis myocarditis, as well as complications of infectious and allergic genesis (shown in the form of temperature rise to 38 ° C and a rash of different character on the extensor surfaces).But at the time begun treatment and adequate antibiotic therapy outcome is favorable.
scarlet fever patients should be hospitalized with severe and moderate forms, especially families with children up to 10 years, without a history of scarlet fever.The insulation should lasts 10 days from the beginning of the disease.In child care, where the outbreak, quarantine is imposed on the group, taking into account medical supervision.
Spetsifichekoy prevention and treatment has not been developed.
therapists Shabanova IE