Scarlatina

Description of the disease

This is an acute highly contagious bacterial infection characterized by fever, intoxication, inflammation of the tonsils, and body rash.

Pathogen

Scarlet fever is caused by Group A beta-hemolytic streptococci in 90% of cases, less commonly by Groups C or G. These bacteria produce fever-inducing toxins, of which there are 5 types, so there may be several episodes of scarlet fever.

Spread

The main source of infection is a patient with scarlet fever, especially important are those with mild forms, as well as patients with streptococcal angina or inflammation of the nose and throat. The patient is contagious from the onset of the disease and if left untreated, remains so for 10-21 days, whereas with treatment, the period is shortened to 24 hours. The infection is transmitted through respiratory droplets, by contact with a patient or carrier. Infection through food, milk, or water is rare. The incidence increases during the cold season, with preschool-aged children being the most affected. After recovery, immunity is acquired, and reinfection is rare.

Symptoms

Symptoms usually appear 2-7 days after infection. The onset of the disease is acute. Scarlet fever is primarily a throat (pharyngeal and tonsillar) infection, manifesting as tonsillitis, sore throat, difficulty swallowing, coated tongue, and tender submandibular lymph nodes. Headache, high temperature (39-40°C), increased pulse, and sometimes vomiting and abdominal pain are present due to toxic manifestations. Besides tonsillitis, there may be a rash on the palate, known as enanthema. The rash consists of bright red spots that may be seen throughout the throat. The surface of the tongue is white, with deposits, and red dots on the tip of the tongue: the characteristic “strawberry tongue” of scarlet fever stands out. Later, similar spots peel off, leaving a red sensitive surface, visible tongue papillae – this appearance is called “raspberry tongue.” The uvula may be swollen, and enlarged lymph nodes, especially in the neck or submandibular area, are observed. Scarlet fever is characterized by a body rash, called exanthema, which appears within 24 hours. It appears suddenly, from the chest towards the limbs, the face becomes red. The palms, soles, and the area around the mouth remain unaffected. The rash is symmetrical, non-irritating, with small dots on the reddened skin. The lower abdomen, back, armpits, groin, and inner thighs are more affected. Petechiae – small blood spots that appear at the elbow bend, also known as Pastia’s sign. The skin is dry, hot, and rough. The skin erythema and general symptoms of the disease disappear within 6-9 days. In the second week of the disease, the skin begins to peel finely and continues for several weeks, especially affecting the palms and soles. Recently, mild manifestations of the disease have become more common. Scarlet fever rarely complicates with cervical adenitis, more frequently with inflammation of the ear, nose, sinuses, and throat. A late complication is acute poststreptococcal rheumatism.

Diagnosis

The main basis for diagnosis is clinical, especially the signs of enanthema. Blood tests are also used, if an increased number of neutrophils and eosinophils are found. The diagnosis of scarlet fever is supported by the presence of Group A streptococci in a throat or nasopharyngeal swab culture or an elevated titer of antibodies against the bacterial excreted enzyme – streptolysin.

Treatment

Scarlet fever is treated with antibiotics to prevent early purulent complications and acute poststreptococcal rheumatism. Rest is recommended for up to 15 days. In severe cases, detoxification with electrolytes, glucose solutions, intravenously. Antipyretic drugs are prescribed for fever. The mouth is rinsed with a 2% soda or other disinfectant solution. Vitamins, especially ascorbic acid, are administered. When the skin starts to peel, it is recommended to shower daily with warm water and soap.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology