Text C. Scarlet Fever

The incidence of scarlet fever is the highest during the second five years of life. Infants are rarely attacked, but after the age of six month their innate immunity gradually wanes.

Although there are several ways in which the disease may disseminated the most common is by direct transmission of organisms from the nasal and aural secretions, and in certain instances from the discharge of otitis media of an active or convalescent case. Hemolytic streptococcus of group A is commonly associated with scarlet fever.

The usual incubation period is three days, variations being from 12 hours to 6 days. The onset is usually sudden and is accompanied by chillness, vomiting, headache and sore throat. As in diphtheria and acute tonsillitis, the child often makes no complaints of sore throat, which may only be discovered on routine examination.

The face is flushed and the skin feels hot and dry. In children a rapid pulse rate out of proportion to the height of temperature is one of the features of the disease. The rash appears in 24 to 40 hours. Occasionally it arises simultaneously with the first symptoms, or may be delayed until the fifth or sixth day of the disease. The usual duration of rash is three days, a profuse rash causing considerable itching. In most cases the tongue quickly becomes covered with white fur, through which the swollen papillae protrude as red points. The temperature continues to rise with the progressive development of the rash. Later defervescence occurs pari passi with the disappearance of the rash and reaches the normal by lysis at about the seventh to tenth day of the illness.

Examination of the blood reveals a marked polymorphonuclear leucocytosis. Eosinophilia is also found, varying with the stage and severity of the disease. With the subsidence of the febrile symptoms desquamation sets in, usually towards the end of the first week, but it may begin with the rash still present, or be delayed for some weeks.

Scarlet fever may bring about serious complications such as otitis, nephritis, rheumocarditis, endocarditis, myocarditis, lymphadenitis, mastoiditis, pneumonia. Cardiac disorder commonly called “cor scarlatinosum” is rather typical complication after scarlet fever. The symptoms of scarlatinous heart were first described by the founder of pediatrics N.Filatov.

The treatment for scarlet fever consists of giving antibacterial and antistreptococcal preparations. The use of penicillin and other antibiotics not only relieves the clinical course of the disease but is an effective means of preventing complications. General antiepidemic measures are carried out, prophylactic inoculation and sero-immunization being of great importance for prevention of scarlet fever. The children who have been exposed to the disease must be given immunoglobulin.

15. Answer the following questions using text II:

1. When is the incidence of scarlet fever the highest?

2. Why is the incidence of scarlet fever low during the first five years of life?

3. How is scarlet fever disseminated?

4. What is the causative agent of scarlet fever?

5. What is the incubation period of scarlet fever characterized by?

6. What is the onset of scarlet fever accompanied by?

7. What does the physical examination of the child ill with scarlet fever show?

8. What is the period of eruption characterized by?

9. What does blood test reveal?

10. When does the period of desquamation usually start?

11. What complications may follow scarlet fever?

12. What is the usual treatment for scarlet fever?

13. What preventive measures are usually carried out?

16. Read and translate text III. Report on the topic “The Discovery of Vaccination”.