Isolation (rubella):

• 4 first days of the disease; inborn rubella - 2 years

• At contact with pregnant woman without rubella in the past – Ab evaluation twice in dynamics

Scarlet fever

Definition:

Acute infectious disease caused by β-hemolytic Streptococcus Group A and presented with :-

1. intoxication syndrome,

2. tonsillitis,

3. exanthema

Etiology (SCARLET FEVER):

• β-hemolytic Streptococcus, group A

• Produces exotoxin (Dick’s) → responsible for clinics (Rash)

• If anti-toxic immunity is absent → scarlet fever

• If anti-toxic immunity is present → tonsillitis, pharyngitis, carriage, etc.

Pathogenesis (SCARLET FEVER):

3 main pathogenetic components of scarlet fever:

1. Toxic

2. Septic

3. Allergic

Clinics (SCARLET FEVER):

1. Incubational period - 2-7 days

2. Rash period - since 1^st day: Intoxication syndrome + tonsillitis + rash

3. Recovery period

Clinics – rash characteristics (SCARLET FEVER):

1. Character of the elements – pointed macular m

2. Prevalent localization – cheeks, side surfaces of the body, flexion surfaces of the extremities, inquinal area; nasolabial triangle is pale

3. Background skin color – hyperemic

4. Time of appearance – 1^st day of the disease

5. Connection to fever – intoxication of the first day

6. Itching – no

7. Fusion of rash elements – no

8. Step-wise appearance – no

9. Presence of enanthema – scarlet hyperemia of tonsillitis

10. Disappearance of the rash – scaled desquamation of palms and feet and branny desquamation of the rest of the body

Pathognomic skin symptoms (SCARLET FEVER):

• Pastia’s sign – increased brownish (tiny hemorrhages) lines in the physiological folds of the body

• Filatov’s sign - Pale nasolabial triangle

Tonsillitis

• Most often – lacunar

• Bright localized hyperemia of the pharynx (“burning pharynx”)

• Strawberry tongue – forms by the 3^rd day of the disease

Classification (SCARLET FEVER):

1. Typical (mild, moderate, severe) and atypical (extratonsillar)

• Mild: fever under 38,5С, mild intoxication, rash and tonsillitis

• Moderate: fever 39С, vomiting, prominent tonsillitis and rash

• Severe: fever 40 and higher, loss of consciousness, septic and toxic complications

2. With / without complications

Complications (SCARLET FEVER):

1. Toxic

2. Septic

3. Allergic

Toxic complications Hemodynamic disturbances Adrenal hemorrhages Brain edema Septic shock syndrome

Septic complications Pneumonia Otitis Sinusitis Necrotic tonsillitis Paratonsillar and retropharyngeal abscesses Purulent lymphadenitis Septic arthritis, etc.

Allergic complications Rheumatic fever Myocarditis Poststreptococcal glomerulonephritis Polymorphic skin rash Acute allergic lymphadenitis Sinoviitis

Laboratory diagnosis (SCARLET FEVER):

• CBC: leucocytosis, neurophiles, bands, elevated ESR

• Throat culture (confirmative) – positive for β-hemolytic Streptococcus Group A

• Serological – increase of titer of antostreptolysin O, anti-DNAsa in dynamics

Treatment (SCARLET FEVER):

• Diet – allergy free, mechanical and thermal mild (tonsillitis)

• Antibiotics !!!

  1. Penicillins – 10 days

  2. Macrolides – at allergy to penicillins

  3. Cephalosporins – at complications

• Detoxication

• Anti-histamine drugs

• Symptomatic

Prophylaxis (SCARLET FEVER):

No vaccination

All contact patients – throat Cx & treatment of the carriers

Treatment of other streptococcal diseases

Contagious period (SCARLET FEVER):

The last 1-2 days of incubation period – till 24 hours after beginning of adequate antibiotic therapy