Scarlet fever, sore throat? It's the same thing.

Author: Chen Dianjie, Fifth Medical Center, PLA General Hospital

Reviewer: Zhang Jieli, Deputy Chief Nurse, Fifth Medical Center, PLA General Hospital

Scarlet fever is an acute respiratory infectious disease, the main symptoms of which are fever, pharyngitis, diffuse red rash all over the body and post-rash desquamation.

Traditional Chinese medicine also calls this disease "rotten throat sha", which means that the throat is red, swollen and ulcerated, and the rash is as dense as sand.

Scarlet fever is mainly spread through air droplets, such as talking, coughing, sneezing, etc. In some cases, it can also invade through skin wounds or the birth canal of parturients, causing "surgical scarlet fever" or "obstetric scarlet fever".

Group A beta-hemolytic Streptococcus is the culprit that causes scarlet fever. This bacterium is not resistant to heat, dryness and commonly used disinfectants (iodine tincture, ethanol, "84" disinfectant, etc.) and can be killed by heating at 56°C for 30 minutes.

This disease is more common in children, especially those aged 2 to 10 years old. It should be noted that many adults infected with group A β-hemolytic streptococcus only show throat discomfort, which is not easy to detect, but can excrete a large number of bacteria and are contagious. If they have close contact with children, they may cause children to be infected.

Figure 1 (copyright image from the gallery, unauthorized reproduction)

There is currently no vaccine to prevent scarlet fever, so more attention should be paid to maintaining environmental and personal hygiene, carrying out daily disinfection and ventilation, and improving personal immunity.

There are many types of scarlet fever with varying clinical manifestations. The most common type of scarlet fever has the following four typical symptoms.

Fever: Mostly persistent and can reach 39°C, accompanied by general symptoms such as headache, general malaise, and lack of appetite.

Pharyngitis: Symptoms include sore throat, odynophagia, pharyngeal congestion, sometimes purulent exudate, congestion of the upper palate or hemorrhagic mucosal rash.

Diffuse erythema all over the body ("chicken-like rash"): The rash begins to appear on the second day after the fever, usually starting from behind the ears, neck and upper chest, and quickly spreads throughout the body within 24 hours; it reaches its peak in 48 hours, when the body temperature is also the highest; the typical rash is evenly distributed millet-sized papules on diffusely congested skin, and the skin between the rashes is also red, and the child feels itchy.

Desquamation after the rash subsides: Generally, after 3 to 5 days, the rash will begin to desquamate in flakes in the order in which the rashes appeared. The more rashes there are, the more obvious the desquamation will be.

Scarlet fever also has the following special signs:

"Pa's lines": In the skin folds, the rash is dense or appears as purple-red lines due to friction and bleeding, which are called "Pa's lines" (also known as linear rash).

"Perioral pallor": There is only congestion in the facial area but no rash. The congestion around the mouth and nose is not obvious and appears pale compared to the facial congestion. This is called "perioral pallor".

"Grassroots tongue" and "Yangmei tongue": The tongue papillae swell up at the same time as the rash. In the early stage, the tongue is covered with white fur, and the swollen tongue papillae protrude from the tongue surface covered with white fur, which is called "grassroots tongue". After 2 to 3 days, the tongue fur falls off, the tongue surface becomes smooth and crimson, and the tongue papillae protrude, which is called "Yangmei tongue".

Figure 2 (copyright image from the gallery, unauthorized reproduction)

Complications are rare in clinical practice, and most children have mild clinical symptoms. If the condition is serious and not treated in time, it may cause complications such as otitis media, pneumonia, myocarditis or nephritis.

When a child is found to have a high fever, parents should pay attention to observation. If the child has scarlet fever, a rash will usually appear in 1 to 2 days. Once a child is found to have a high fever and a rash, the child should be taken to the hospital immediately.

At present, penicillin is the first choice for treating scarlet fever. Children who are allergic to penicillin can choose other types of antibiotics, such as macrolides, according to the doctor's advice.

It should be made clear that using antibiotics to treat viral infections is an abuse, but using antibiotics to treat bacterial infections is the right medicine for the right disease. Parents must not blindly reject the use of antibiotics; nor should they reduce or stop taking the medicine on their own just because the symptoms have eased, as this will prolong the course of the disease and make it easier for them to develop drug resistance.

Figure 3 (copyright image from the gallery, no permission to reprint)

Children will feel itchy during the rash period. To prevent children from scratching their skin and causing infection, they should have their nails cut short or wear gloves. When it itches, you can apply calamine lotion to relieve itching, but be careful not to apply it to ulcers and exudates; you can also use warm water to wash the child's skin to relieve the itching, but do not use soapy water or alcohol to scrub.

The child's clothes should be loose and breathable, preferably made of pure cotton. Do not wear chemical fiber or flannel clothes, otherwise the child will feel more itchy when rubbed against the skin. The child's mattress should be clean, dry, soft and flat. Clothes and bedding should be washed and aired frequently.

During the recovery period, when the rash subsides and the skin peels off, do not tear it directly with your hands. Let the dandruff fall off on its own. If there are large areas of peeling skin, you can use clean scissors to trim them to prevent infection.

As long as the patient receives active and effective antibacterial treatment, the prognosis of scarlet fever is generally good, and the skin regenerates better after the rash subsides.

Parents need to take good care of themselves while taking good care of their children. Parents should wear masks when in contact with children. Children's secretions, such as sputum and nasal discharge, should be cleaned up with tissues and thrown into the trash can in a timely manner. All kinds of supplies used and touched by children need to be wiped and disinfected with disinfectants such as ethanol, iodine tincture or "84" disinfectant. For items that cannot be washed, they can be exposed to the sun or boiled at high temperatures.