What is Scarlet Fever?

Scarlet fever is an acute respiratory infectious disease caused by hemolytic streptococcal infection in group A. Traditional Chinese medicine calls it "rotten throat". Its clinical features are fever, pharyngitis, a diffuse bright red rash throughout the body, and significant desquamation after rash regression. A small number of patients develop heart, kidney, and joint damage due to allergies. The disease occurs all year round, especially in winter and spring. Patients and carriers are the main source of infection, transmitted through air droplets, and can also be infected through skin wounds or birth canals. The population is generally susceptible, but the incidence is more common in children, especially in the age of 5 to 15 years.

Basic Information

English name

scarlet fever

Visiting department

Infectious Diseases

Multiple groups

5 to 15 years old

Common locations

Respiratory tract

Common causes

Caused by group A streptococcal infection

Common symptoms

Fever, rash, bayberry tongue are typical symptoms of scarlet fever

Contagious

Have

way for spreading

It can be transmitted through air droplets, or through skin wounds or birth canal infections.

Causes of scarlet fever

Scarlet fever is caused by group A streptococcus infection. Group A streptococci, also known as streptococcus pyogenes, can invade any part of the human body, with the most common invading the upper respiratory tract. The bacterial body components and the toxins and proteases produced by the bacteria are involved in the pathogenic process, causing a series of purulent, toxic and allergic diseases. Streptococci mostly invades the human body from the respiratory tract, first causing pharyngitis and tonsillitis. Under the action of proteases, streptococci spread inflammation and cause tissue necrosis. At the same time, due to the action of the pyrogenic exotoxin (rash toxin) produced by the bacteria, it can cause systemic toxemia.

Clinical manifestations of scarlet fever

The incubation period is 2 to 5 days, and can be as short as 1 day and as long as 7 days.

Precursory period

Most of them have a sudden chills and fever. In severe cases, the body temperature can rise to 39 ° C ~ 40 ° C, with headache, sore throat, bayberry tongue, loss of appetite, general discomfort, nausea and vomiting. Babies may have delirium and convulsions. Pharynx is swollen, and dots or flakes are visible on the tonsils. The soft palate is congested and edema, and may have large red spots or bleeding spots, that is, intramucosal rashes, which usually appear before the rash.

Rash period

The rash is one of the most important symptoms of scarlet fever. Most appear on the first or second day of onset. Occasionally, a rash occurs on the 5th day. Beginning behind the ears, at the bottom of the neck and upper chest, it spreads to the chest, back, upper limbs, and finally to the lower limbs within a day, and it takes a few days for the whole body to spread.

A typical rash is a dense and uniform punctate congestive rash spread on the basis of congestion and redness on the skin of the whole body. Occasionally "chicken skin" papules, severe poisoning may have bleeding rash, patients often feel itching. The skin folds such as the armpits, elbows, and groin can be seen as densely linear, known as "Pasteur lines." The face is congested and flushed, with a small amount of rash, and pale around the nose and mouth, called "Pale circle around the mouth".

At the beginning of the disease, the tongue was covered with white fur, and the nipples were red and swollen, protruding above the white fur, with the tongue tip and edges being prominent. After 2 to 3 days, the white moss begins to fall off, the tongue surface is smooth and flesh-red, and there may be superficial rupture, and the nipples still protrude.

The rash usually peaks within 48 hours and can completely disappear in 2 to 4 days. Severe cases can last 5 to 7 days or longer. The submandibular and neck lymph nodes can be swollen, tender, and generally non-purulent. When the rash develops, the temperature is higher. When the rash spreads throughout the body, the temperature gradually decreases, the symptoms of poisoning disappear, and the rash recedes.

3. Recovery period

Peeling began within a week after the rash, and the sequence of the peeling sites was the same as that of the rash. The trunk is mostly bran-like peeling, and large-scale membrane peeling is more common in the thick part of the soles of the palms of the hands. Peel-like crust-like peeling is typical. Peeling lasts 2 to 4 weeks without leaving pigmentation.

4.Type

(1) Ordinary type Over 95% of patients in this period belong to this type. The clinical manifestations are as described above. Pharyngitis, typical rash and general symptoms of poisoning, enlarged submandibular lymph nodes, the course of the disease is about 1 week.

(2) Mild It shows low or no fever, mild systemic symptoms, mild congestion of the pharynx, few rashes, pale, and atypical, with a small number of flakes. The whole course of the disease is 2 to 3 days, which is easily missed. In recent years, See more.

(3) Poisoning type The symptoms of systemic poisoning are obvious. Fever, severe vomiting, headache, rash can be flaky or hemorrhagic ecchymosis, or even unconscious. Poisonous myocarditis and peripheral circulation failure, purulent meningitis, poisoning Shock, sepsis, etc. This type of case fatality rate is high and is currently rare.

(4) Septic type Mucosal necrosis of the pharynx and cheeks forms ulcers and purulent pseudomembranes. Can cause a variety of purulent complications and sepsis, such as purulent otitis media, sinusitis, mastoiditis, cervical lymphadenitis, etc., are rare.

(5) Surgical or obstetric pathogens invade from the wound or birth canal, and the rash first appears locally, which extends to the whole body, but there is no pharyngitis, and the systemic symptoms are mostly mild.

Scarlet fever check

Surrounding blood

The total number of white blood cells and the proportion of neutrophils are increased. The white blood cell count can reach (10-20) × 10 ⁹ / L. The neutrophils can reach more than 0.8. Poisonous particles can be seen in the cytoplasm. Those with purulent complications are more high. Eosinophils increase in the blood after the rash, which can account for 5% to 10%.

2. Etiological examination

Pharyngeal swabs or other lesion secretions can grow with hemolytic streptococcus. Examination of the throat swab smear by immunofluorescence can be used for rapid diagnosis.

Scarlet fever diagnosis

It has the characteristic clinical manifestations of scarlet fever; the white blood cell count of peripheral blood is increased, and neutrophils account for more than 80%; group A streptococcus can be obtained by throat swab and pus culture; there is a history of contact with patients with scarlet fever or angina The disease. It needs to be distinguished from other common acute pharyngitis and eruptive diseases such as measles, rubella and drug rash.

Scarlet fever treatment

Patient isolation

Isolate the patient for more than 6 days until the throat swab culture is negative for 3 times and no complications can be removed. Those with a positive pharyngeal swab culture should extend the isolation period.

2. General treatment

The acute phase should rest in bed. Eat thin, light food and drink plenty of water. Keep mouth and skin clean and hygienic to prevent secondary infections. Elderly children can gargle with normal saline.

3. Antibiotic therapy

Penicillin is a commonly used drug for the treatment of scarlet fever and all streptococcal infections. Early application can shorten the course of disease and reduce complications. In severe cases, increase the dose. In order to completely eliminate pathogenic bacteria and reduce complications, the course of treatment is at least 10 days. People who are allergic to penicillin can use erythromycin or cephalosporin. In severe cases, it can also be administered intravenously for 7 to 10 days.

4. Symptomatic treatment

Hyperthermia can use smaller doses of antipyretics or physical cooling. If toxic shock occurs, blood volume should be actively replenished to correct acidosis. Complications such as otitis media, sinusitis, nephritis, and myocarditis should be actively treated.

Scarlet fever prevention

1. Patients with scarlet fever should be treated in isolation. During the epidemic of scarlet fever, patients with suspicious scarlet fever, acute pharyngitis, and tonsillitis should be treated in isolation. Carriers can be treated with a conventional therapeutic dose of penicillin until the culture turns negative to control the source of infection.

2. Close contact with patients with scarlet fever should be observed closely. Quarantine 7 to 12 days, if conditions permit, do swab culture or preventive administration of penicillin.

3. During an epidemic, avoid crowded public places, especially children.