If the child is ill with scarlet fever without a rash. Severe toxic form of scarlet fever

Lyudmila Permyakova from Tula is interested in:

Daughter diagnosed. At the same time, she felt fine, there was no temperature. I had to go to the doctor because of a skin rash. So I'm thinking, can scarlet fever occur without fever and without symptoms? Or was the doctor wrong?

Answer from our specialist:

Scarlet fever is a highly contagious disease caused by the . Infection occurs at the slightest contact with the carrier, airborne, household way. Children of preschool, primary school age get sick more often, less often - who did not get sick in childhood. Having transferred the disease once, a person acquires immunity to it forever.

The incubation period of the disease lasts from 3-4 to 12 days. The disease makes itself felt sharply, acutely. The first sign is fever, fever, often rising to 40 degrees.

Symptoms inherent in scarlet fever:

signs of intoxication;
sore throat, its redness;
characteristic skin rash;
crimson tongue a few days after the onset of the disease;
a sharp decline in strength;
peeling of the skin - at the final stage.

There are three key symptoms: fever, skin rash,. Regarding the question of whether scarlet fever can occur without fever and without symptoms, cases of the so-called mild form have recently become more frequent.

In this case, its signs are more reminiscent of: angina is mild, the condition worsens slightly. Sometimes vomiting occurs during the initial stage of the disease. And the temperature either remains normal, or rises slightly - no more than 38 degrees.

With a mild form, the disease is diagnosed by a rash - this symptom always remains. But the danger is that the rash is also mild, parents often take it as a sign of allergies or allergic irritation, they try to treat it on their own, incorrectly.

Often a child develops peeling of the skin of the palms that occurs during the recovery stage, which makes it possible to determine that this was precisely this infection. Improper treatment or its absence leads to complications, so it is important to diagnose it correctly and in time.

That is why you should consult a doctor, after consulting a doctor, parents will be completely sure that the child has allergies, SARS or something else.

The asymptomatic course of scarlet fever leads to, the occurrence of this type of disease has become more frequent, this fact complicates therapy, leads the situation to a dead end.

During the treatment of asymptomatic scarlet fever, attention should be paid to the person's diet, foods that can cause allergies should be excluded from it. Such a warning will help to avoid problems. The accompanying allergic rash will significantly damage human health.

Video: Scarlet fever in children

Valya, Valentina,

What's wrong with you now?

white chamber,

Painted door.

Thinner than a web

From under the skin of the cheeks

Smoldering scarlet fever

Death Flame.

E. Bagritsky

There is such a Greek word streptos, which means "twisted", "twisted", "having the appearance of a chain." And there is such a microbe - streptococcus : if you look at it under a microscope, you can clearly see the real chains, consisting of motionless balls.

Streptococci are very common microbes that can cause a wide variety of diseases in humans. Scarlet fever is one of them, perhaps the most famous, but, unfortunately, far from the only one.

Scarlet fever has been known to people since antiquity, and the attitude towards it is quite serious, which, however, is quite logical and justified. Although the ancient doctors (Hippocrates and company) always confused scarlet fever - sometimes with measles, sometimes with rubella, sometimes with something else. True, no one was worse off than that. After all, we are smart now - we know that measles and rubella infections are viral, and scarlet fever is a bacterial infection. Therefore, measles and rubella will go away on their own, and antibiotics will help a lot with scarlet fever. But Hippocrates did not know anything about antibiotics, so he had the moral right to confuse scarlet fever and measles, which, however, humanity has been successfully doing for almost 2000 years after Hippocrates. And only in 1675, the doctor Thomas Sydenham described in detail the symptoms of scarlet fever and called it scarlet fever - purple fever. From the word scarlet - "purple", "bright red" - and went the modern name of the disease.

The fact that scarlet fever is a serious and deadly disease, a certain part of the readers of this book, especially those who studied in the Soviet school, learned in childhood from the famous poem by Eduard Bagritsky "Death of a Pioneer" (see epigraph). The poor pioneer Valya died of scarlet fever, and this is how, very tragically, the fate of a sick child seemed before the advent of antibiotics - after all, a very insidious and very dangerous microbe, this streptococcus.

It should be noted that scarlet fever is far from the only disease that owes its existence to streptococcus. Most tonsillitis, rheumatism, glomerulonephritis, erysipelas are all variants of streptococcal infection.

But scarlet fever is a special disease. And may readers forgive me for trying to explain its essence, since it is very difficult to do this in simple words. However, let's try. So...

Streptococcus is a loose concept. This word means dozens, if not hundreds of bacteria, on the one hand, similar to each other, on the other, having significant differences in their structure. Each specific type of streptococcus is capable of producing very specific toxins. Having been ill with one variant of streptococcus and having developed immunity to this variant, a person may not quite safely meet with another streptococcus, which, in turn, produces its own toxins and causes the need to get sick again and again produce regular antitoxic antibodies.

At the same time, some streptococci (I emphasize, far from all, only some) have the ability to produce a certain toxic substance, which is called erythrotoxin .

Erythrotoxin has two features. First, it causes quite definite changes in the body, and these changes manifest themselves in the form of quite definite symptoms, inherent precisely in the action of erythrotoxin; secondly, having developed immunity to the erythrotoxin of one streptococcus, the body stops responding to the erythrotoxin of any other streptococcus, since antibodies to erythrotoxin constantly circulate in the blood.

Now we can already say what scarlet fever is.

Scarlet fever is a special variant of streptococcal infection with a pronounced reaction of the body in response to the action of erythrotoxin. Thus, scarlet fever can be once in a lifetime, but streptococcal infection - its other forms, of course, you can get sick as much as you like.

The term "erythrotoxin" in literal translation from Greek means "red toxin". In this translation is the essence of the “quite definite symptoms” already mentioned by us.

But let's start from the beginning - how everything happens. Streptococcus enters the human body by airborne droplets, although infection is possible through food, dirty toys, and clothing. The source of infection can be a patient with any variant of streptococcal infection or a healthy carrier of streptococcus. 90% of all those who fell ill are children under 16, but children of the first year of life almost do not get sick, because they have innate antitoxic immunity inherited from their mother.

The incubation period is from 1 to 12 days. Once in the human body, streptococcus settles on the mucous membranes, mainly in the throat (on the tonsils) and begins to multiply, while releasing erythrotoxin. The disease begins acutely - high fever + sore throat. And after a few hours, a rash appears - this is a response to erythrotoxin. The general color of the skin is reddish, and against this red background one can see numerous very small red dots (redder than the general background). The rash quickly covers the entire body, it is especially pronounced on the lateral surface of the trunk, on the flexion areas of the arms and legs. The skin is dry, if you hold it with your hand, it resembles sandpaper. The appearance of the face is especially characteristic - bright red cheeks and a pale, rash-free triangle between the nose and lips. The tongue is also bright, crimson, and on its surface there are sharply enlarged papillae. Well, in the throat, on the tonsils, there is a real sore throat: everything is very red and inflamed, on the tonsils there are purulent raids.

The child owes all these symptoms to streptococcus erythrotoxin, which in a special way affects the skin and mucous membranes. This lesion leads to mass cell death of the outermost layer of the skin (epidermis), and the skin begins to peel off. Peeling appears on the face by the end of the 1st week of illness, then on the trunk, hands and feet.

What you need to know:

Streptococcus, fortunately, is highly sensitive to antibiotics. especially to penicillin. Already 12-24 hours after the start of treatment with penicillin, a clear improvement is observed in the condition of a sick child. Intolerance to penicillin is not a problem, since the choice of antibiotics that are active on streptococcus is quite large.
Anyway, scarlet fever refers to diseases that, with timely antibiotic treatment, almost always end happily, and without treatment, almost always end in severe complications. Complications of scarlet fever are primarily heart damage (rheumatism) and kidney damage (glomerulonephritis).
It is very dangerous to stop treatment immediately after the condition improves. Antibiotics must be used for a strictly defined time, otherwise complications are very likely.
The timely use of active antibiotics sometimes (very rarely) leads to the fact that the body does not have time to develop sufficient immunity to erythrotoxin - streptococcus dies very quickly. The consequence of this is the possibility of getting sick again with scarlet fever. These repeated cases, however, proceed quite easily.
The throat and tonsils are not the only way streptococcus enters the human body. Infection can also occur through any wound on the skin (abrasion, cut, surgery). In this case, all the symptoms of scarlet fever will occur, except for a sore throat. The principles of treatment from this do not change.
Mild and sometimes moderate forms of scarlet fever are safely treated at home, without any hospitals. The child, as a rule, is completely isolated for 10 days, after which - if the condition is good - it is quite possible to walk. But!!! For a survivor of scarlet fever, repeated contact with streptococcus is a serious danger - this can lead to allergic diseases and complications. Therefore, you can live normally and walk around, but communication with other people, especially children, should be reduced to a minimum. At least, from the onset of the disease to going to school or kindergarten, 3 weeks should pass, at least.

This clinical form of the disease is manifested by a full range of symptoms. The onset of the disease is acute: there is an increase in temperature up to 39 ° C, and on some days even up to 40 ° C, headache, malaise, lack of appetite, increased heart rate up to 140-160 beats per minute, sometimes delirium at night. Quite often there is initial vomiting, sometimes multiple. Angina develops according to the catarrhal type: pronounced reddening of the pharynx, soreness in the throat when swallowing are determined. In rare cases, plaques or even small necrosis are found in the lacunae of the palatine tonsils. At the usual time, a bright, profuse scarlatinal rash appears. The symptom of "scarlet fever" in the moderate form of the disease, as a rule, does not develop.

By the 7th-8th day, body temperature returns to normal. At the same time, the initial symptoms of the disease disappear. Complications are much more common than with a mild form of the disease, and are observed both in the initial and late periods.

Severe toxic form of scarlet fever

This clinical form of the disease is very rare. The onset of the disease is violent, sudden. The patient has a rise in body temperature to 40-41 ° C, severe agitation or, conversely, depression, blackout, delirium, sometimes convulsions and meningeal phenomena (see "Meningococcal infection"). There is repeated vomiting, often accompanied by diarrhea, which can continue during the 2nd, and sometimes even the 3rd day of illness. In the pharynx, signs of severe angina of a catarrhal nature are revealed, in some cases small raids on the tonsils are found. There is dryness of the lips. Scarlet fever profuse, bright. In patients, an increase in heart rate up to 160 beats per minute or more, a decrease in blood pressure are determined.

In cases of pronounced toxicosis, almost complete loss of consciousness, blanching of the scarlet fever rash, cyanosis of the skin are observed. The child's limbs become cold, the pulse becomes thready.

With early diagnosis of the disease and rational timely treatment, the symptoms of intoxication are relatively quickly stopped.

Severe septic form of scarlet fever

This clinical form of the disease is extremely rare and is primarily characterized by the development of necrotic tonsillitis, the manifestation of a violent inflammatory reaction from the regional lymph nodes.
and extreme frequency of septic complications. In this case, the phenomena of intoxication recede into the background.

The disease begins with a sharp rise in temperature, significant disturbances in general well-being, malaise, lethargy (up to immobilization of the child). However, quite often the disease is initially manifested by a complex of symptoms similar to moderate scarlet fever, and does not cause much concern among others.

After 2-4 days, the general condition of the patient worsens, the temperature rises to 40 ° C or more. The cervical lymph nodes increase in size, become dense and painful when palpated, with this form of scarlet fever, surrounding tissues may be involved in the inflammatory process (periadenitis, adenophlegmon).

A necrotic process develops on the palatine tonsils, which tends to quickly spread to the soft palate, pharynx and nasopharynx. Soreness when swallowing sharply increases: the child refuses to eat and drink. Dryness and lining of the tongue, the appearance of cracks on the lips are noted. Nasal breathing is difficult due to the formation of copious mucopurulent discharge. With the spread of the infectious process from the throat, various purulent complications (sinuitis, otitis media) develop. Patients have a symptom of "scarlet heart".

Usually the disease is delayed, the patient recovers very slowly. Death can occur on the 7-10th day of illness. Also, deaths are recorded on the 2nd-4th week due to the development of severe purulent complications or septicopyemia.

Severe toxic-septic, or mixed, form of scarlet fever

This clinical form of the disease is due to a combination of signs of both toxic and septic severe forms of scarlet fever. As a rule, it begins as toxic scarlet fever, and clinical manifestations of the septic form are added from the 3-5th day.

Hypertoxic, or fulminant, form of scarlet fever

This clinical form of the disease is extremely rare. It is manifested by a catastrophically rapid increase in the manifestations of severe intoxication: high temperature (40-41 ° C), pronounced arousal or, conversely, depression, blackout of consciousness, delirium, repeated vomiting, convulsions, a sharp increase in heart rate, etc. The child usually falls into a coma and may die within the first days or even hours. At the same time, the main symptoms of scarlet fever (tonsillitis, rash) may remain unrecognized against the background of total blueness of the patient's skin, which leads to an incorrect diagnosis of the disease.

Even more rarely, there is a kind of hypertoxic form, described under the name of hemorrhagic scarlet fever. With this form of the disease, in addition to the symptoms of severe intoxication, the patient has extensive hemorrhages in the skin and mucous membranes (hemorrhagic rash). As a rule, in such cases a fatal outcome is recorded.

Erased forms of scarlet fever

This group includes diseases of scarlet fever, in which there is either a complete absence of certain main symptoms, or a slight severity and rapid disappearance of all symptoms of the disease. Patients with erased forms of the disease are the most dangerous, since they disperse scarlatinal infection due to difficulties in making a diagnosis in such cases. Obviously, the erased forms of scarlet fever are much more common than they are detected.

According to the severity of various clinical manifestations of the disease, all erased forms of scarlet fever are divided into three main types: a rudimentary form, scarlet fever without a rash, and scarlet fever.

A rudimentary form of scarlet fever

The rudimentary form of scarlet fever has the mildest course with very mild main signs of the disease. The temperature can rise to subfebrile numbers within 1-2 days or remain within the normal range throughout the illness. The state of health of patients is not disturbed, as a rule, they carry the disease "on their feet" and often, if they are not under medical supervision for epidemiological reasons, consider themselves healthy. Regional lymph nodes are usually unchanged or slightly enlarged. A moderate increase in heart rate is determined, which is replaced on the 4th-5th day of illness, on the contrary, by its slowdown.

When examining the oral cavity, a point intense reddening of the pharynx is detected,
sometimes patients note moderate soreness in the throat when swallowing.

At a rash with rudimentary

form of scarlet fever have a typical appearance for this disease, however, they are distinguished by pallor and scarcity.

In some cases, the rash is localized only in certain parts of the patient's body: on the abdomen, inner thighs, in places where the limbs are bent. In most cases, with a careful examination of the skin of the articular folds, characteristic petechial hemorrhages are determined. The pallor of the nasolabial triangle is slightly pronounced or completely absent.

The initial symptoms of the disease in the rudimentary form of scarlet fever quickly fade away. The rash may disappear after a day or even a few hours. Scarlet peeling is either completely absent, or late and weakly expressed.

In some cases, after suffering a rudimentary form of scarlet fever, complications (nephritis, otitis media, etc.) develop in the late period.

Scarlet fever without rash

Scarlet fever without a rash is manifested by the absence of the most important main symptom - a rash - in the presence of other typical clinical manifestations of scarlet fever (tonsillitis, inflammation in the regional lymph nodes, language changes, etc.). In this form of scarlet fever, short-term, scanty eruptions sometimes appear, which can be easily seen due to their insignificance. Scarlet fever without a rash can be severe with the development of typical necrotizing tonsillitis and be accompanied by early purulent complications. Scarlet angina Scarlet angina has the character of a common angina. As a rule, the suspicion of the scarlet fever nature of such angina appears only when taking into account the connection with patients with this infection: when the disease is detected in family members or in the children's team. However, in some cases, with a thorough examination of the patient, it is still possible to identify individual features characteristic of scarlet fever. Subsequent peeling of the skin and complications of the second period of scarlet fever in this form of the disease are rare.

Extrapharyngeal, or extrabuccal, form of scarlet fever

This clinical form of scarlet fever occurs in about 1-2% of all cases of the disease and differs from others in that the entrance gate of infection is not the pharynx, but damaged skin or mucous membranes of various areas. The pathogen enters the human body through the wound surface. A person with an extrapharyngeal form of scarlet fever does not spread the infection by airborne droplets when talking, sneezing, so it is relatively low contagious to others.

By the nature of the entrance gate of infection and the mechanism of infection, it is customary to distinguish the following variants of extrapharyngeal scarlet fever: burn (with burns of II and III degrees); wound, or traumatic; wound postoperative; postpartum; complicating various open purulent foci in the skin.

The incubation period for this form of scarlet fever is significantly shortened (sometimes up to a day or several hours), so it is not always possible to establish it.

The clinical picture of extrapharyngeal scarlet fever has a number of distinctive features. So, it is characterized by the absence of any signs of angina (pain and redness in the throat, raids, etc.). In addition, inflammatory changes are detected not in the cervical lymph nodes, but from the regional lymph nodes located near the entrance gate of infection. A scarlatinal rash also appears first near the entrance gate of infection.

With this form of the disease, the usual scarlet fever complications occur ("scarlet fever", nephritis, otitis media).

Clinical manifestations of the disease in young children

Children under 2 years of age, especially in infancy, have a particular tendency to the septic type of the course of the disease, while the symptoms of intoxication are usually relatively mild. In some cases, the initial symptoms of scarlet fever are slightly expressed in patients: low fever, mild sore throat, scanty soft rash. Other children have a severe septic course of scarlet fever with severe necrotic tonsillitis and nasopharyngitis, numerous purulent-necrotic complications. Allergic manifestations, nephritis, synovitis, "scarlet fever" in young children are rare.

In childhood, such ailments can happen to a person that are characteristic only of children, but for adults they are not dangerous. One such disease is scarlet fever. How to recognize it, how to distinguish it from other infections and properly organize the treatment of a baby, says an authoritative pediatrician, author of books, articles and television programs about children's health Evgeny Komarovsky.

What it is

Scarlet fever is an infectious disease caused by group A streptococci.

A child can become infected with these hemolytic microbes in one single way - from a person:

if the baby has been in contact with someone who fell ill with angina or streptococcal pharyngitis, especially at the initial stage of the disease,
if he interacted with a person, who recovered from scarlet fever not so long ago - not even three weeks have passed since the cure.

In addition, there are perfectly healthy people, including adults, who are carriers of streptococcus A. They may not even be aware of this, because they themselves do not get sick, but they regularly release microbes into the environment. Such people are not as few as it seems. According to infectious disease specialists, about 15% of the total adult population are carriers of streptococcus A on the planet.

Children's immunity is weaker than an adult, which is why adults do not get sick with scarlet fever, because they have an acquired immunity to streptococci. The child has no such protection. The only exceptions are babies up to a year old - they have innate, received from the mother, anti-toxic immunity. Therefore, scarlet fever in children of the first year of life is an extremely rare phenomenon.

The rest of the children, up to 16 years old, are at risk. When communicating with someone from the above groups (who have been ill, sick or carriers), when sharing toys, household items, by airborne droplets or contact, infection occurs.

It is this insidious microbe (do not confuse it with all streptococci, because there are many of them), when it enters the child's body, it begins to secrete a strong poison called erythrotoxin. The body reacts violently to it, which causes the symptoms of the disease. The incubation period lasts from one day to 12 days. For habitation and reproduction, streptococcus A chooses the mucous membranes of the tonsils.

Because of the erythrotoxin, which stains the tonsils in a bright red color, the disease has a second name - purple fever.

Symptoms

Scarlet fever always begins acutely:

body temperature rises sharply;
there are severe pain in the throat;
tonsils, larynx and tongue at the same time have a scarlet, very bright color. Fragments of purulent plaque may be observed on the tonsils. On the tongue, granular formations become noticeable on the 3-4th day;
the body reacts to the strong toxin produced by Streptococcus A with a rash. It appears almost immediately after the onset of the disease.

This last feature is considered the most characteristic. You should learn more about it. Small red dots appear on the already reddened skin, which are brighter in terms of the degree of color expression, they are not difficult to see in all details. The rash spreads quickly until it covers the entire body of the child. Most of all red specks are on the sides, on the folds of the arms and legs. The skin becomes dry and rough to the touch, like textured cardboard.

It is easy to suspect scarlet fever even at one glance at the baby's face: bright red cheeks with a rash, the same forehead. At the same time - a completely clean and pale nasolabial triangle. After 7-10 days, the skin affected by the rash begins to peel off strongly. After the first week of illness, the rash usually begins to disappear, leaving no traces on the skin, age spots and scars. Peeling usually stops 14 days after the onset of the disease.

Treatment

Despite the fact that scarlet fever has been known to doctors for a very long time, in ancient times doctors often confused it with measles and rubella. But if viral rubella and measles do not need any specific drug treatment, then antibiotics are indicated for scarlet fever. Therefore, before the advent of antibacterial agents, scarlet fever often led to death.

Today, doctors are divided into two “camps”: some believe that successful predictions in the treatment of scarlet fever became possible thanks to the invention of antibiotics, others claim that a general improvement in the quality of life and nutrition of children played a role. Yevgeny Komarovsky is sure that deaths from scarlet fever have decreased due to both causes.

Streptococcus A is very sensitive to antibiotics, so it is quite easy to deal with it. Treatment is usually prescribed at home, only very small patients who are under 2-3 years old, and children with a complicated form of scarlet fever, when there is a risk of damage to internal organs by hemolytic streptococcus, can be sent to the infectious diseases hospital.

The general rules of treatment look like this:

bed rest until the temperature drops and signs of intoxication disappear;
plentiful warm drink (juices, tea, fruit drinks, compotes). Milk is not recommended;
diet (according to the Pevzner method, the so-called table number 2). Food should be given in a mashed, mushy state, soups, semi-liquid mashed potatoes are welcome;
antibiotic therapy.

Most often, children are prescribed antibacterial agents of the penicillin group. These antibiotics do an excellent job with the causative agent of scarlet fever, and after 12 hours (maximum in a day) after the start of taking the drugs, the child becomes much better. If the baby has an intolerance to penicillin, other antibiotics can be prescribed for him - almost all existing groups of these drugs are quite effective against streptococcus A.

It is not at all necessary to give injections to a child, it is quite enough to drink a course of antibiotics in tablets, says Komarovsky. The most commonly prescribed drugs are "Amoxicillin" And "Retarpen". In case of a severe course of the disease in a hospital, the child will additionally be given droppers with gemodez to reduce intoxication.

Yevgeny Komarovsky claims that with the timely use of antibiotics, scarlet fever can almost always be defeated without serious complications. In the absence of adequate treatment or attempts by parents to treat a child with folk remedies, severe complications almost always occur, such as heart rheumatism, kidney damage (glomerulonephritis).

Prevention

Scarlet fever normally can not get sick two or three times in a lifetime. After an infection, the body develops lifelong immunity to a specific type of streptococcus. But this does not mean that the child cannot then get sick with any other streptococcal infection.

Recurrent scarlet fever is rare. Usually this becomes possible if the antibiotics in the treatment of the first ailment acted too quickly, the microbe was destroyed before the immune system formed specific antibodies to it. Also, the recurrence of the disease can occur in children with severely weakened immunity. A secondary infection should be treated in the same way as the primary one, although the doctor will have to choose a different antibiotic for this.

There is no vaccine for scarlet fever. After a sick child is identified, the children's team is quarantined for 7 days.

do not stop treatment at the first sign of improvement. The course of treatment must be strictly observed and must be completed to the end;
scarlet fever is contagious, but with the timely use of antibiotics, the child ceases to be dangerous to others as early as 2-3 days of antibiotic therapy. Usually the patient is isolated for at least 10 days. After that, you can walk, but for this it is better to choose places where the child will not be able to contact other children. Such a restriction must be maintained for at least 3 weeks after the onset of the disease. In the kindergarten - after 22 days;
if there are several children in the family, and one of them fell ill with scarlet fever, the rest should be taken to the clinic and take bakposev from the pharynx for the presence of a microbe. If it is not detected, children can visit their kindergartens and schools. If they are found, treatment and quarantine will be prescribed for them. In any case, the sick child must be isolated from brothers and sisters.

In the video below, Dr. Komarovsky reveals some of the details of this disease.

Symptoms and treatment
Doctor Komarovsky