Scarlet fever

Definition

Scarlet fever is an acute infection caused by toxigenic strains of group A beta

hemolytic Streptococcus.

Clinically manifested by: fever, enanthema and specific exanthema, which is sometimes

accompanied by alteration of the general condition, nausea, vomiting and abdominal pain.

Etiology

The etiological agent of scarlet fever is beta hemolytic streptococcus of group A,

less often of group C or G, it is part of the genus Streptococcus pyogenes and is a gram

positive coccus.

Epidemiology

Scarlet fever is an infectious disease with the highest incidence in the cold season,

which more frequently affects the school age group 6-14 years, being rare in adults.

The source of infection is the patient with scarlet fever or strep throat.

The way of transmission is airborne, but also through direct contact with contaminated

objects.

Clinical

Incubation varies from 1-5 days.

The onset is sudden, with fever, chills, odynophagia, dysphagia, nausea, vomiting.

The clinical examination highlights: intensely congested pharynx "red as a flame",

hypertrophic tonsils, sabural tongue, subangulomandibular adenopathy, less often

laterocervical.
 The condition period lasts 3-5 days and corresponds to the appearance of enanthema

and exanthem or rash on the skin is micro-papulo-erythematous, rough to the touch,

disappears under pressure.

It is more obvious in the chest, abdomen. In children, the "Filatov mask" is

described with red lips and hyperemic ("spalmed") cheeks. At the level of the flexion

envelopes, the Grozovici-Pastia sign can be observed, which consists of ecchymotic

horizontal lines. In children treated early with antibiotics, the rash may be discrete or absent.

Enanthema is always present, even in the absence of exanthema and is

characterized by:

- intensely congested pharynx

- hypertrophic tonsils, edematous with or without purulent deposits

The lingual cycle is always present:

- the first day: the sabural tongue, being covered by whitish deposits, being compared to a

"porcelain tongue"

- the second day: the tongue peels from the tip to the side edges to the base of the tongue, it

looks like a "tongue with red edges"

- on the third day it takes on the appearance of 2 V: a white V at the tip and a red V at the

base of the tongue

- on the fifth day the tongue begins to re-epithelize

- after 7 days the tongue is epithelized, being compared to a "lacquered tongue" or "cat's

tongue"

- after 2 weeks the tongue becomes normal in appearance.

Diagnosis

- blood count: leukocytosis with neutrophilia

- biological inflammatory syndrome present: increased VSH, increased fibrinogen, increased

C-reactive protein

- the pharyngeal exudate highlights group A hemolytic S. beta

- streptococcus can be isolated in cultures, if the portal of entry is extrapharyngeal

The differential diagnosis

The rash from some viral diseases:

- rubella/ chicken pox

- measles

- enteroviruses

- infectious mononucleosis

- acute viral hepatitis at onset

- post-medication allergic rash

- post insect sting

Complications

- toxic shock

- hemorrhagic eruption

- toxic nephritis

- toxic myocarditis

- toxic encephalitis

- acute articular rheumatism

- erythema nodosum

Treatment

1. Hygienic-dietetic treatment:

- isolation and bed rest in the hospital for at least 7 days

- lacto-hydro diet during the acute period of the disease

2. Etiological treatment (10 days)

- for patients who are not allergic to penicillin: Penicillin G (child 50,000 IU/kgc/day im, iv;

adult 3-6 million IU/day, in 3-4 doses) or Penicillin V oral 100,000 IU/kgc/day

- in case of allergies, you can use:

- macrolides (Erythromycin, Clarithromycin, Azithromycin) orally for 10 days

- Oral clindamycin for 10 days

- Cephalosporin of the 2nd generation orally, for 10 days.

3. Symptomatic treatment:

- antithermic: paracetamol

- anti-inflammatory

- antialgesic