Scarlatina: symptoms

Scarlet fever, the symptoms of which have been known to mankind for many centuries, is a dangerous disease caused by streptococci - Streptococcus pyogenes, which belong to the group of hemolytic streptococci. This type of bacteria can also provoke chronic tonsillitis, turning into rheumatic diseases, streptoderma, glomerulonephritis. Unlike viral infections - measles, rubella, scarlet fever is a disease of bacterial etiology, accordingly, it has quite specific symptoms. For quite a long time, scarlet fever was not differentiated from similar diseases accompanied by a rash, and only at the end of the 17th century was the disease studied and described in detail. Due to the characteristic symptom - bright red color of the tongue and oral mucosa, purple color of the small-point rash, the disease was called scarlet fever.

Scarlet fever has fairly typical symptoms, but they can vary depending on the mechanism of transmission of the bacterial infection.

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Ways of infection with scarlet fever, mechanism of disease development

In scarlet fever, streptococcus infection occurs in two ways - airborne and household, so the disease can spread extremely quickly. The source of infection is only a person who can be a hidden carrier of streptococci and release bacteria into the environment for a long time without showing any obvious clinical symptoms of the disease. According to statistics, more than 15% of people suffering from chronic sore throats can be potential carriers of scarlet fever. The contact-household route is also common - food, through toys, household items, dirty hands. The insidiousness of scarlet fever is that after recovery, a person does not acquire a stable immune response to the infection, so relapses are possible if infected with a different type of streptococcus. It is believed that the incubation period of scarlet fever does not exceed ten days, of which the first two days are the most dangerous in terms of the spread of infection.

Classification of the disease

Scarlet fever is usually differentiated by form and severity of the disease. This classification was adopted more than twenty years ago and helps to more accurately determine the nature of the disease in order to effectively manage it and minimize possible complications.

Form:

• Typical form of the disease.
• An atypical form of the disease, which may be without skin manifestations (rash), may have a hemorrhagic form, and an extrabuccal form (infection outside the nasopharynx) is also possible.

The severity of the disease can be as follows:

• Mild severity.
• Moderate severity, tending towards a more serious form.
• Severe form, hypertoxic, accompanied by sepsis.

Scarlet fever also develops and progresses differently and can be like this:

• Acute form of the disease.
• A protracted, chronic form of the disease.
• Scarlet fever that has no complications and is not accompanied by allergic reactions.
• Scarlet fever, the symptoms of which indicate complications and allergic reactions.

Complications may include the following:

• Allergic forms of complications – myocarditis, renal pathologies (nephritis), lymphadenitis, synovitis (inflammatory process in the joints).
• Purulent pathologies.
• Sepsis and bacterial embolism – septicopyemia.
• A combination of several pathologies developing after scarlet fever.

Clinical manifestations of scarlet fever are grouped according to the forms of the disease and the severity. There are typical signs of the disease, and varieties of manifestations of scarlet fever are also described, the symptoms of which vary depending on the localization of the infectious process.

Scarlet fever has the following symptoms:

• Rapid development of the disease, acute form.
• Hyperthermia is an increase in temperature to 39-40 degrees.
• Intoxication of the body, accompanied by nausea and vomiting (toxic form).
• Angina, severe sore throat.
• Bright red, purple tongue.
• Characteristic white skin color in the nasolabial triangle against the background of facial exanthema.
• Inflammation of the lymph nodes - lymphadenitis.
• Characteristic rash on the first or second day.
• Peeling skin on the palms and feet.

Depending on the duration of incubation, the manifestations of scarlet fever may be latent in the clinical sense, but they may be very obvious. If scarlet fever does not show symptoms or proceeds in a mild, latent form, the first signs of malaise may be severe fatigue, decreased appetite, less often - headache and mild chills. Much more often, scarlet fever shows symptoms suddenly and in an acute form. In such cases, in addition to a sharp increase in body temperature, vomiting, aching joints, severe headache and sometimes delirious states join the symptoms. During the first 12 hours of rapid development of the disease, hyperemia of the uvula, severe redness of the tonsils, enlargement of the lymph nodes, and plaque on the tongue are already noticeable. The cheeks are hyperemic, often during the first day a typical scarlet fever rash appears, which begins to cover the skin with small pinpoint eruptions, gradually merging into reddish-purple spots. The rash typically spreads from the upper neck down the chest and all over the body. The patient's face turns red with a "classic" white triangle in the nasolabial triangle. This symptom was first described and introduced into clinical diagnostic practice by the great doctor, pediatrician Nil Fedorovich Filatov, after whom the triangle was named - Filatov's symptom. In addition, it was Filatov who pointed out the typical combination of tonsillitis and scarlet fever when he said the following: "Scarlet fever without tonsillitis is practically uncommon, so diagnosing it based on the rash alone is quite risky." As the infection develops, it is accompanied by general intoxication of the body, which manifests itself in constant nausea, sometimes vomiting, while the tongue is covered with a characteristic grayish coating, which disappears on the fifth day of the disease. After 4-5 days, scarlet fever symptoms become more obvious: the tongue turns purple (scarlet), the lymph nodes increase in size, lymphadenitis often spreads to the submandibular region and the back of the head. The red color of the tongue persists for 15-20 days. A blood test taken in the first days of the disease shows an increase in the number of leukocytes, which is explained by the primary response of the immune system to infection. Then leukocytes return to normal, the level of eosinophils increases as a response to allergic intoxication. If scarlet fever is not accompanied by purulent complications, after a week the blood test shows relatively normal indicators. Gradually, the rash disappears, body temperature also returns to normal and the following signs of scarlet fever appear - peeling of the skin, which is localized first on the palms, less often on the feet (soles) of the feet. Peeling palms are a typical sign of infection with streptococci, which cause scarlet fever. It is this symptom that sometimes clarifies the diagnosis of the disease, the symptoms of which are similar to classic tonsillitis, when scarlet fever occurs in a latent, asymptomatic form. The peeling can be intense or very insignificant,It depends on the extent of the exanthema (rash).

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Other types of scarlet fever

Scarlet fever, the symptoms of which may depend on the form of the disease, affects not only the pharynx and tonsils. The forms and signs of scarlet fever can be as follows:

• Scarlet fever that develops outside the nasopharynx is extrabuccal. This form of the disease is characterized by infection of damaged skin (burn wounds, traumatic wounds, eczema, streptoderma). The signs of extrabuccal scarlet fever are not much different from the typical picture of the disease, with only one difference - the localization of the rash, which begins to spread from the site of infection (from the site of skin damage). The cervical lymph nodes do not increase, the pharynx, tonsils remain unchanged.
• The latent form of the disease is typical for adult patients. Scarlet fever, the symptoms of which are weakly expressed, is accompanied by a pale exanthema (rash) that quickly disappears. Despite the unmanifested symptoms, this type of disease is dangerous due to its latent course, which can suddenly develop into a toxic form. The main diagnostic criterion can be peeling palms in combination with weak signs of catarrhal angina and small hyperemic areas of the skin.

Scarlet fever, the symptoms of which are expressed as toxic, is the most severe form of the disease, fortunately, it is very rare nowadays. Toxic-septic type of scarlet fever, as a rule, is typical for adult patients. This form of the disease begins rapidly, the body temperature steadily rises within 8-10 hours, heart failure develops with a sharp drop in blood pressure, a decrease in pulse rate. Scarlet fever in this form is characterized by its abundant hemorrhagic rashes, signs of catarrhal tonsillitis, uncontrollable vomiting, diarrhea and delirium. In especially severe cases, convulsive syndromes are possible. If emergency medical care is not provided in a timely manner, the patient may die within 24 hours from general extensive intoxication and cardiac arrest. Toxic-septic form can be a consequence of the septic form, not diagnosed, not recognized in time. In the septic form, scarlet fever exhibits the following symptoms:

• Severe enlargement of the tonsils.
• White coating on the tonsils and tongue.
• The characteristic purulent smell of their nasopharynx.
• Mucous discharge with pus from the nose.
• Difficulty breathing, mouth constantly open.
• Severe swelling of the upper facial area.
• Enlargement of the lymph nodes in the neck, sometimes to the point of tumor.
• Purulent discharge from the ears.

Scarlet fever, the symptoms of which are well studied, is dangerous both as an independent disease, which sometimes proceeds very severely, and scarlet fever is also dangerous due to its complications in the form of nephritis, purulent otitis, cardiopathologies, lymphadenitis, arthritis. Early diagnosis is the main way to timely stop acute symptoms, reduce the risk of the disease becoming severe and minimize the formidable complications of scarlet fever.