Scarlet fever

The scarlet fever or scarlet fever (or 2nd disease ) is a Infectious illness due to a Bactérie: the Streptocoque of group A. It is toxinic, i.e. the streptocoques ones secrete Toxine S known as erythrogenes still called exotoxins pyrogenic: With, B, C, D. These toxins are immunogenic. They are responsible for a vasodilatation, associated with an edema dermic and a lymphocytary infiltrate. The benign forms of scarlet fever are associated with the toxins B and C whereas the rare more virulent forms are associated with toxin A. Its name of scarlet fever is due to coloring red-lilac characteristic of the skin than confers this affection, caused by toxins erythrogenes secreted by the streptocoques ones.

History

With the XVIIIe century the scarlet fever was often confused with the Diphtérie or the heat pisses from the presence of angina and the identical seasonal frequency of the two diseases. Many particularly virulent epidemics prevailed of 1838 with 1870 and made of it the infantile Maladie most dreaded. It is only at the beginning of the XXe century that the assumption of the streptococcic origin of the scarlet fever emitted per H. Bergé (1893), preceding work by G.F. Dick in 1924, definitively showed the role of streptocoque haemolytic localized in the throat (angina), which secretes a toxin known as erythrogene which diffuses and reaches the vegetative Nervous system (eruption, possibly complications and malignant syndrome).

Epidemiology

Become rare in France, the scarlet fever touches especially the children from 5 to 10 years, by small school epidemics during the winter. It is rare in the children of less than 2 years because of the presence of maternal antibodies directed against the pyrogenic exotoxins and of the lack of former sensitizing. At 10 years, 80% of the children developed antibodies against these exotoxins, which will protect them throughout their life. Thus the scarlet fever is possible in the adult, but very rare.

Contamination

The infection occurs especially in cold period and is done starting from a child reached of Angine or scarlet fever due to streptocoque, by air (“postilions”). The eruption itself is not contagious. The incubation of the disease is short, about 2 to 5 days. The patients are contaminant before the beginning of the Symptômes, with the result that epidemics can develop in spite of the insulation of the patients.

Symptoms

One finds:

a high Fever (up to 40°C),
of the Pain S of the Pharynx resembling an angina,
of the abdominal pains,
of the Vomiting S,
a Tachycardia,
possible a Phimosis,
a tachycardia supra ventricular,
of the pre-senile insanities before 5 years
Exanthème: it is a uniform red coloring of the skin, which starts with the thorax and the root of the members, then extends gradually to all the body (except plant of the feet and palm of the hand). Prevailing on the level of the folds of inflection (knee, elbow, groin) and being able to involve itchings,
énanthème: it is a red coloring of the Muqueuses, constant and characteristic (it associates a thick and red language resembling a raspberry, a red throat, cervical Adénopathie S).

The attenuated forms are frequent. The fever is less important. The eruption is pinker than red, often localized with the folds of inflection. On the other hand the aspect of the throat and the language remains often characteristic.

the body is covered with small buttons which resemble buttons of heat

Examination

The examination of the throat finds a red angina associated with Ganglion S under the angle with the jaw. White at the beginning, the language becomes gradually red. The palpation of the pulse finds an increase in the heart rate. The examination of the exanthème finds a hot, dry and rough skin. The biological examinations do not show specific elements in favor of the infection. For example the taking away of throat, carried out above all antibiothérapie, finds the streptocoque one but its presence is neither essential to the diagnosis, nor sufficient (there exist healthy carriers).

Diagnosis

The diagnosis is primarily clinical (epidemic context, aspect characteristic and constant of the énanthème). The signs of the disease are sufficient to evoke the scarlet fever, no examination biological is not useful (except in the event of atypical form). One should not confuse the scarlet fever with other bacterial infections of the skin, in particular those dependant on the staphilococca or with viral infections responsible for cutaneous demonstrations: Rubella, infectious Mononucleosis. In all the cases, the characteristic énanthème directs the doctor towards the diagnostic one of scarlet fever.

Evolution

The general signs (pains, fever) disappear in one week, whereas the exanthème can last one month. It finishes with an exfoliation of the skin in large scraps very significant. The complications are rare since the discovery of antibiotics:

local Complications: Adénite cervical (infection of the lymphatic ganglia of the neck), Otitis (infection of the ear), Rhinitis, Sinusitis,
early Complications: they are related to the diffusion of toxin and touch especially the kidney, the articulations,
late Complications: they are represented primarily by the acute rheumatoid arthritis (infection of several articulations, risks of cardiac attack engraves).

Treatment

It is absolutely essential in order to avoid occurred of potentially serious complications. It rests on a Antibiothérapie anti-streptococcique. The duration of the treatment is 10 days and must be absolutely respected:

Penicillin V by oral way or benzathine-penicillin by intramuscular way (in the event of risk of bad follow-up of the treatment),
In the event of allergy to penicillin, the doctor can prescribe Macrolide S,
Repos with the bed and insulation during 15 days (school ousting),
a soft and nonaggressive food is often necessary for the comfort of the patient.

The doctor particularly endeavors to supervise the Cœur, the Articulation S and the urines of the subject infected 15 days after the infection, because of the risk of serious complications. At the subjects in liaison with the patient, the doctor will found a treatment by penicillin V or macrolide during one week. There does not exist Vaccin against the scarlet fever, and one can catch it once more.

See too

List of the pathogenic bacteria for the infantile Man
Disease

External bonds

eruptive Diseases by Pr J. Gaudelus, Hospital Jean Verdier, Bondy and Université of Paris XIII
Strategies of control of communicable diseases Ministry for the French Community, Head office of Health
eMedecine - Scarlet Fever by Pr Jerry Balentine, New York College off Osteopathic Medicine, Holy Barnabas Hospital
KidsHealth - Scarlet Fever by Dr. Joel Klein

Random links: