Childhood infections: whooping cough, scarlet fever, measles, chickenpox, rubella and mumps

What it is

Scarlet fever is an infectious disease caused by pathogenic bacteria - pyogenic streptococci. They provoke local inflammatory changes in the tonsils and pharynx area. Also, this group of microorganisms, during their life activity, releases toxic substances (toxins) into the blood, the most powerful of which is erythrogenic (scarlet fever) toxin.

How dangerous is streptococcal toxin?

The toxin leads to pathological changes in all organs, including the skin and mucous membranes, small vessels dilate, which causes the appearance of a characteristic rash. There is a disruption of the keratinization processes in the surface layer of the skin (epidermis) - the skin is severely flaky and flakes off. The toxin also damages red blood cells and other cells, causing fever, weakness and other symptoms of toxicity.

Streptococci can also cause serious allergic and autoimmune lesions caused by an excessive reaction of the immune system to scarlet fever toxin. As a result, the heart and kidneys are affected, and a disease called acute rheumatic fever develops.

Epidemiology

Scarlet fever is currently a rare disease, but it is found everywhere. The source of infection can only be a person.

The disease is called a childhood infection, along with whooping cough, measles, rubella, mumps and chickenpox. These infections are typical mainly for children of preschool and primary school age, since during this period of life they first find themselves in large children's groups, where they can meet a sick or hidden bacteria carrier. In adulthood, the disease is much less common.

From infection to the first symptoms it takes an average of 2 to 7 days4. The peak incidence is observed in the autumn-winter period.

Are they getting vaccinated today?

Are children vaccinated against scarlet fever? Many believe that since the disease belongs to the group of childhood infections, it means that the child can be protected from it if vaccinated. However, it is not. There is simply no vaccine against scarlet fever. A trial drug was recently released, but immunization with it has not met expectations. The reason turned out to be simple.

Scarlet fever is a disease that is caused by hemolytic streptococcus from group A. And streptococci are a very diverse group of bacteria. In fact, each bacterium is almost unique, which ultimately makes it impossible to create a universal serum at the moment. Read more about scarlet fever →

It is because of this that the immunization, which was carried out on a trial basis, turned out to be a failure. At best, the child did not react in any way to the administration of the drug, and sometimes immunity developed and sometimes not. At worst, the medicine, instead of protecting the baby, provoked the appearance of symptoms in him.

Cause of the disease

The direct cause of the disease is the bacteria Streptococcus pyogenes group A, which is also the causative agent of simple sore throat (pharyngitis), superficial skin infections (impetigo), erysipelas and cellulitis. The pathogen is transmitted primarily by airborne droplets from a patient or a bacteria carrier. Infection by contact through various objects is unlikely.

After recovery (even after an asymptomatic course of the disease), as a rule, stable immunity is formed. However, occasionally the infection can still recur.

Is it possible to get scarlet fever again?

Can. The reason for the recurrence of the disease is as follows. During the infectious process, 2 types of immunity are developed - antitoxic and antimicrobial. The first is effective against toxins of any subtypes of group A streptococci, while the second is active only against a specific subtype of a given type of bacteria. This explains the recurrent disease caused by a new subtype of the pathogen. It has a milder course.

Symptoms of scarlet fever

A bright red tongue is one of the most characteristic symptoms of scarlet fever.
Photo: SyntGrisha / (Creative Commons Attribution-Share Alike 4.0 International license) Scarlet fever manifests itself with characteristic symptoms that make it easy to establish a diagnosis. The following ones stand out:

• Intoxication syndrome: high body temperature (38–39°C), general weakness, headache, chills, nausea and vomiting, in severe cases - impaired consciousness.
• The so-called “flaming” throat. Bright red color of the mucous membrane of the pharynx and tonsils with clear boundaries.
• "Raspberry" tongue. In addition to the pharynx, the tongue has a bright red color. At the beginning of the disease, it is covered with a whitish coating, which is peeled off and exposes the burgundy-red surface of the tongue with clearly visible white dots - inflamed papillae of the tongue.
• Severe pain when swallowing. Caused by inflammation of the tonsils. When examining them, purulent plugs are visible, located in the recesses - crypts.
• Regional lymphadenitis. Often with scarlet fever, the submandibular lymph nodes become inflamed, which is reflected in an increase in their size and the appearance of pain when palpated.
• Red (pink) pinpoint rash. It occurs in the first two days of the disease on the face, neck and upper body, and later spreads to the entire surface of the body. The rash is often concentrated in the folds of the arms and legs, in the lower abdomen, on the sides of the body and in natural skin folds.
• Peeling of the skin. It begins after the rash subsides in the second week of illness. The nature of peeling differs depending on the location: on the body, as a rule, the scales are small, and on the palms and soles they are large.
• Filatov's symptom. Redness of the forehead, cheeks and temples, while the area of ​​the nasolabial triangle remains unaffected and therefore appears pale.
• White dermographism. When passed over the skin with a hard, blunt object, white marks are left that last for quite a long time.

If you notice these symptoms, you must exclude contact with other people and consult a doctor. In case of high temperature (under 40°C), severe vomiting, or convulsions, it is imperative to call an ambulance. If a patient with scarlet fever is identified, quarantine is imposed. Therefore, it is necessary to notify the educational/working organization about the emerging disease.

Preventive actions

The best preventative action for your baby is to reduce the amount of contact with people who are sick. In addition, you need to constantly improve your child’s immune system; to do this, consult a doctor who will prescribe a course of vitamins and the right diet.

It is also important for pregnant women to adhere to these rules, in addition to regularly visiting a gynecologist for timely detection of other pathologies.

This means that scarlet fever is not dangerous today. There is no specific vaccine against this disease, but there are methods that will reduce the risk of developing such an infection. Treatment for scarlet fever will cause less damage to the immune system than existing vaccinations, so parents should consider the need for such procedures. Diagnosis of the pathology is also not difficult, so at the first symptoms it is enough to contact a highly qualified specialist who will prescribe a suitable treatment method. Timely treatment is the key to a quick recovery without complications. In addition, if a girl gets this disease at an early age, she will not have to worry about the likelihood of developing such a pathology during pregnancy.

Classification and stages of the disease

In Russia, the disease is usually classified according to symptoms, severity and nature of the course (see table below).
Table 1. Classification of scarlet fever

*Atypical forms are relatively rare. With the erased version, the symptoms are very mild, the rash may be completely absent, and the disease quickly regresses within a few days.

Extrapharyngeal variants are characterized by the absence of pharyngitis, typical of scarlet fever. In these cases, the “gateway” of infection becomes, for example, wound and burn surfaces.

Intensified (or aggravated) forms are characterized by a severe course with the development of bleeding, toxic shock and are the most severe variants of the disease.

Features of the disease in adults

In adults, the infection is usually more severe, with severe fever and convulsions. Diagnosis also causes difficulties: usually the doctor does not expect to see scarlet fever in an adult.

Scarlet fever in young children

In children under one year of age, infection is less common. Quite often the disease is complicated by pneumonia, bronchitis, otitis media and other pathologies that increase the scope of treatment.

Scarlet fever in pregnant women

Scarlet fever during pregnancy can cause miscarriages, as well as severe streptococcal postpartum infections in the mother, which are difficult to treat. The main difficulty is due to the fact that during pregnancy the use of antibacterial drugs is limited.

Staging

The infection occurs according to certain patterns. So, they talk about four main periods or stages of the disease:

• Incubation period. The time that passes from infection to the appearance of the first symptoms, that is, the period of active reproduction of bacteria. On average it lasts 2–4 days.
• Initial period. This is the period of time from the appearance of the first symptoms to the appearance of the rash. This period is characterized by the symptoms of intoxication that we have already discussed, a “flaming” pharynx, inflammation of the tonsils and submandibular lymph nodes. This period lasts from several hours to 2 days.
• Rash period. It is characterized by the appearance of a rash in the first 2 days of the disease. While initially bright, the rash fades by 3–4 days of infection. During this period, Filatov’s symptom is observed, later - “crimson” tongue and white dermographism.
• Recovery period. It begins from the 2nd week of the disease, this stage is characterized by peeling of the skin. Specifically large-plate peeling on the palms and soles. During this period, the patient is no longer contagious.

Complications of scarlet fever

Filatov's symptom (left) and a characteristic rash on the body are signs of scarlet fever.
Photo: Estreya at English (Creative Commons Attribution 2.5 Generic license) Complicated course of infection can be caused by toxic, septic and allergic complications. Moreover, the first two types are more often classified as early complications, while allergic ones are mainly regarded as late ones.

The toxic form is characterized by extreme manifestations of intoxication syndrome:

• temperature rise above 40°C;
• repeated vomiting;
• convulsions;
• disturbances of consciousness;
• bright, profuse rash with subcutaneous hemorrhages;
• ECG signs of toxic myocarditis;
• decreased blood pressure;
• (in some cases) death from toxic shock.

The septic form is distinguished by an overly pronounced inflammatory process of a purulent-necrotic nature:

• the tonsils, arches and base of the uvula are inflamed;
• inflammation in the lymph nodes (which can lead to necrosis of the tissues surrounding them);
• bronchitis;
• pneumonia;
• otitis;
• peritonsillar abscess (local accumulation of pus in the tonsil area);
• (in the absence of timely treatment) sepsis and death.

Important! Toxic and septic forms of scarlet fever, as a rule, develop in the absence or incorrectness of treatment. Early competent antibiotic therapy minimizes the risk of such complications.

Complications of the allergic form include:

• myocarditis;
• poststreptococcal glomerulonephritis;
• acute rheumatic fever;
• a number of other pathologies.

The causes of these complications are still the subject of debate. Most often, doctors are inclined to autoimmune disorders that are caused by one of the components of the streptococcal cell wall. Such complications are rarely fatal, but can lead to long-term consequences such as chronic damage to the heart and kidneys.

Diagnosis of scarlet fever

The doctor checks the patient's throat and tongue.
Then, to confirm the diagnosis, blood and an oropharyngeal swab are sent for analysis. Photo: freepik.com When making a diagnosis, doctors are guided by typical symptoms of the disease and a number of clinical and laboratory methods:

• Clinical blood test. The appearance of nonspecific signs of inflammation is characteristic: an increase in the number of leukocytes, an increase in the erythrocyte sedimentation rate (ESR).
• Culture of oropharyngeal swabs. The material collected from the surface of the pharynx is inoculated on special bacteriological media. After cultivation, the properties of the colonies grown on the media are studied and the pathogen is identified.
• Express diagnostic methods. They are based on searching for fragments of a microorganism in material collected from the surface of the pharynx using special reagents.
• A blood test to check for the presence of specific antibodies to streptococcus produced by the body. The study proves the presence of the pathogen in the body.

Instrumental research methods for scarlet fever

Typically, examining symptoms and laboratory tests is more than enough to make a diagnosis. In severe cases of the disease with damage to the heart and kidneys, doctors can resort to instrumental methods for studying them: ECG, ultrasound.

What parents need to know about scarlet fever in children

• The baby should be properly prepared for a rapid test or throat culture. The child should not brush their teeth, eat or drink. If the test is not done early in the morning and the baby has had a snack, the test should be carried out no earlier than 2 hours later.
• To alleviate the condition, it is important to properly care for a sick baby. The air in the room should be humid. The premises should be cleaned regularly.
• There is no need to treat the rash on the body with anything, but if there are pustules, use local antiseptic ointments.
• A light hygienic shower is allowed, but it is worth remembering that after a shower it is better not to wipe the skin with a towel, but to gently blot it.
• Thick drinks like jelly or smoothies can also smooth out a sore throat.
• Do not wipe with cold water. This contributes to the narrowing of blood vessels, which makes it difficult for the body to transfer heat.
• The baby should be isolated from other young family members to prevent infection.

Scarlet fever in children goes away without a trace and does not cause complications, but only if treatment is started on time and completed. Therefore, at the first signs of illness, you urgently need to show your child to a doctor and undergo the necessary tests. There is no vaccine against scarlet fever, so preventative measures are very important. You need to wash your hands, handle toys, dishes and other household items, regularly clean the house and ventilate the rooms, and also strengthen the baby’s immunity.

FIND OUT PRICES

Treatment of scarlet fever

Most often, the doctor leaves the patient at home, prescribing him a course of antibiotics, anti-inflammatory drugs to reduce fever and vitamins.
Photo: ccaetano / Depositphotos Depending on the severity, treatment is carried out on an outpatient basis or in a hospital setting. Indications for hospitalization are:

• moderate to severe forms of infection;
• failure of outpatient treatment;
• immunity disorders;
• congenital malformations of the heart and blood vessels;
• the presence of other children in the family who have not had scarlet fever.

Important! Under no circumstances is it recommended to self-medicate. Only a pediatrician should determine in what conditions treatment should be carried out and what medications should be prescribed.

If the doctor considers that you can limit yourself to home treatment, you should not forget that the child needs to be provided with rest, plenty of fluids, and high-quality nutritious nutrition that meets the body’s needs for vitamins and microelements.

Drug treatment

Includes the use of various groups of drugs:

• Antibacterial drugs from the penicillin series, macrolides, cephalosporins. They are used to eliminate the pathogen - the cause of the disease. They are of paramount importance in drug therapy.
• Non-steroidal anti-inflammatory drugs: paracetamol, ibuprofen and others. They are used as a means to lower the temperature (at 38°C and above).
• Local antiseptics in the form of aerosols. Used as antimicrobial and anti-inflammatory agents for irrigation of the pharynx.
• Antihistamines and electrolyte solutions for infusion. Used as a means to reduce intoxication of the body.

Prognosis and prevention

The prognosis in the vast majority of cases is favorable. Most often, early complications can be successfully avoided thanks to timely antibiotic therapy.

Allergic complications after streptococcal infection are more difficult to eliminate. It has been established that incomplete treatment plays a significant role in this. Therefore, antibiotic therapy should not be stopped even if symptoms have disappeared. It is necessary to carry out the course to the end, leaving no chance for bacteria to “counter-offensive”.

The main areas of prevention are:

• isolation of the patient from the team;
• quarantine measures;
• reducing crowding and team size;
• high-quality disinfection regime.

Preventing infection presents some difficulties. This is due to the fact that the pathogen is very contagious and is transmitted by airborne droplets. And there is no vaccine for scarlet fever on the market yet.

History of vaccination

A short excursion into the history of treatment of this disease and attempts at vaccination will be interesting. Previously, scarlet fever was considered a dangerous disease. It caused serious complications in sick children: purulent otitis media, kidney and heart pathologies, lymphadenitis, meningitis, rheumatoid arthritis and others. Sometimes it could lead to death.

Therefore, it is not surprising that scientists have attempted to create an effective vaccine that can protect children of the most vulnerable age from the disease. In addition, streptococcus causes a number of other diseases: tonsillitis, otitis media, rheumatism, chronic tonsillitis, streptoderma and others. Therefore, vaccination would be very important.

Already at the beginning of the 20th century, namely in 1905, the first vaccine containing weakened streptococcus and its toxins was created. Development continued to improve the existing drug. After 20 years, the dose of the toxin in the composition was increased, and there were attempts to offer vaccine options from the toxin purified with aluminum hydroxide or magnesium sulfate.

But in practice, such a vaccine did not show the necessary effectiveness: the immune response was weak, a minimum five-time administration was required, which provided protection for only a couple of years, and the adverse reactions were strong.

When the successful treatment of scarlet fever with antibiotics was introduced, the issue of vaccination against this disease faded into the background. But even now scientists are working to create a vaccine that would reliably protect not only from this disease, but also from all those caused by streptococcal infection. There are already first successes, and development continues.