Scarlet fever

The title of this article is ambiguous. For more meanings, see Scarlet Fever (disambiguation) .

Classification according to ICD-10
A38	Scarlet fever
ICD-10 online (WHO version 2019)

Raspberry tongue (also strawberry tongue ) with a white coating

The scarlet or ( latin ) scarlet ( English scarlet fever ) is a sudden (acute) childhood illness with a rash that occurs primarily at the age of four to seven years. It is a bacterial infectious disease caused by β-hemolytic streptococci . The disease typically begins after an incubation period of one to three days with fever, chills, vomiting and an inflammation of the throat (pharyngitis), but can also be accompanied by abdominal pain or headache. After one to four days, the characteristic rash appears with tightly packed, pinhead-sized, intensely red, slightly raised spots. Even after years of research, there is still no vaccine against scarlet fever. The reason for this lies in the diversity of the A streptococcal groups that are responsible for the infectious disease.

history

Scarlet fever, presumably already existing in ancient times, was extremely dangerous as an infectious disease before the introduction of antibiotics. It was introduced to Europe in the 9th century. The first morphological descriptions 1556 by Giovanni Filippo Ingrassia Palermo (as Rossania ) and in 1578 by Jean Coyttard ( purple fever occupied). The harmless form of scarlet fever ( febris scarlatina ) was delimited in 1861 by the Englishman Thomas Sydenham . The long-time controversial etiology was largely clarified in 1924 by the American research couple Gladys and George Dick, after whom the Dick test (positive for skin reddening after intracutaneous toxin injection) is named.

Scarlet fever is regularly on the rise again as an epidemic, especially in the emerging countries of Eastern Europe.

On April 3, 2009, a scarlet fever epidemic was also reported in England . The incidence of the disease exceeds the figures for the past 20 years. A high mortality rate was reported for the highly dangerous scarlet fever disease ( Scarlatina maligna ) and a national emergency warning was issued.

Pathogen

Streptococcus pyogenes ( Pappenheim stain )

Scarlet fever is caused by Lancefield group A streptococci ( esp . Streptococcus pyogenes ). The infection usually takes place through droplet and contact infection via the mouth and throat . The pathogen can also be transmitted through open wounds (wound scarlet fever). Many healthy people carry the germ in themselves unnoticed and are the primary source of infection.

The bacteria must have a bacteriophage (a virus in the bacterium) that is responsible for producing a scarlet fever toxin . If the toxin gets into the skin, the rash that is typical of scarlet fever develops. Without this, purulent tonsillitis alone occurs .

Treatment with antibiotics results in immunity to the toxin in question. Since there are three different toxins (SPE-A, -B and -C), people can develop scarlet fever several times over the course of their lives. Multiple infections can also be due to non-lifelong immunity. Due to recurring natural refreshments ("boostering") due to the high spread of the pathogen, the immunity lasts for a long time. In any case, immunity to the scarlet toxins does not prevent the underlying infection with the actual A streptococci, of which more than 80 serotypes exist.

Symptoms

Perioral pallor

Flaking of the skin on the fingertips

The disease typically begins after an incubation period of one to three days (rarely longer) with fever (scarlet fever), chills , vomiting and an inflammation of the throat ( pharyngitis ), but can also be accompanied by abdominal pain or headache. The pharynx is typically deep red and the tonsils are swollen (scarlet fever angina ), and blotchy, whitish coatings appear as the disease progresses. Swallowing pain and swelling of the submandibular lymph nodes develop . The tongue is initially covered in white, later the coatings come off and the tongue appears shiny red with protruding taste buds . This is known as the raspberry tongue or strawberry tongue. This symptom can be confused with the raspberry tongue in Kawasaki syndrome and this must therefore be considered.

After one to four days, the characteristic rash appears with tightly packed, pin-head-sized, intensely red, slightly raised spots. Preferred areas are the armpits and the groin , but the whole body can also be affected, but the mouth-chin triangle remains free. This perioral pallor is sometimes colloquially referred to as milk beard . Approximately 14 days after the start, the skin on the tips of the fingers or toes, or on the entire palms of the hands and soles of the feet, can also be characteristic. This sometimes allows the diagnosis to be made retrospectively.

The occurrence of such scarlatiniformen rash does not prove that the person concerned of scarlet fever is ill. Many other diseases, above all various viral diseases, as well as allergic reactions to drugs or other substances can result in such a rash.

The course of this disease can be severe, i.e. with severe pain, high fever and clear rashes, or it can be mild, with only a slight sore throat and a few abnormalities. Scarlet fever can also occur without a fever, red tongue, and rash so it is not always recognized as scarlet fever. However, there is always a more or less pronounced tonsillitis or - if the tonsils have already been removed - an inflammation of the throat .

treatment

Scarlet fever responds well to oral penicillin V treatment . Because of the increased risk of complications and long-term effects if the course is untreated or discontinued too early, this therapy should be carried out consistently for ten days. If there is a penicillin allergy , a macrolide antibiotic such as erythromycin or clarithromycin can be used. In addition, the treatment includes symptomatic measures such as lowering the fever, relieving swallowing difficulties by gargling or locally pain relieving lozenges.

Prevention

As a prevention, it is advisable to avoid contact with the sick during the potential infection period, and in the case of unavoidable contact to regularly wash hands with soap to avoid smear infection . Preventive treatment of contact persons with antibiotics is only recommended for people who have a weak immune system or who have serious underlying diseases and are therefore particularly at risk.

Sick people should limit contact with other people as possible during the contagious phase and turn away from them, especially when coughing and sneezing. It is particularly recommended not to sneeze or cough into the palm of your hand, but into a paper tissue or something similar, and then immediately dispose of this in a waste container with a lid.

A protective vaccine against scarlet fever does not currently exist. A former product called Behring's diphtheria scarlet fever vaccine consisted of a mixture of equal parts diphtheria vaccine Al. FT and Scarlet Fever Adsorbate Vaccine.

infection

Scarlet fever is contagious as soon as and for as long as a patient carries the relevant pathogen, but at least two to four days before the first symptoms appear. The risk of infection lasts at least until the symptoms have subsided. This usually takes up to two weeks after the symptoms start. With antibiotic treatment, it is assumed that there is no longer any risk of infection after 24 hours. Around every fifth person is a germ carrier without being sick themselves. However, healthy germ carriers play a minor role as disease carriers.

Complications

The most feared complications are the so-called streptococcal secondary diseases: post-streptococcal glomerulonephritis and rheumatic fever with rheumatic endocarditis . These are immunological diseases caused by the immune system's defense reaction against the scarlet fever pathogens that can occur around four to six weeks after the disease.

There is also evidence that the streptococcal - infection neuropsychiatric autoimmune diseases can result. See PANDAS , Tourette syndrome , minor chorea .

In addition, the dangerous streptococcal toxic shock syndrome can occur if the pathogens enter the bloodstream.

Legal situation / obligation to notify

According to Section 34 of the Infection Protection Act, people with scarlet fever and Streptococcus pyogenes as well as people suspected of being infected are not allowed to stay in community facilities (e.g. schools). The management of the community facility has an obligation to report or notify the health department .

In Austria, cases of illness and death from scarlet fever are subject to notification in accordance with Section 1 ( 1) (2) of the 1950 Epidemic Act .

In Switzerland, there is no general obligation to report cases of illness or death from scarlet fever. Apart from that, however, the following are notifiable in Switzerland: illnesses or deaths [as well as laboratory analysis results] that exceed the extent to be expected for the relevant period or location and are presumably due to a communicable disease and could require measures to protect public health. This also applies to cases of illness or death that do not have to be reported in individual cases or not within 24 hours. This results from the Epidemics Act (EpG) in conjunction with the Epidemics Ordinance and Annex 1 or Annex 3 of the Ordinance of the FDHA on the reporting of observations of communicable diseases in humans .

Trivia

The disease also found its way into poetry: the poet Friedrich Rückert wrote the Kindertotenlieder around 1830 after two of his children had died of scarlet fever.

Historical literature

• DF Erhard: About the external use of cold water as a remedy for scarlet fever . Beck, Nördlingen 1824 ( digitized edition of the University and State Library Düsseldorf )
• Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 9-223, here: pp. 78-84.

See also

• Exanthema # Fourth Disease: Filatov's or Dukes Disease (Rubeola scarlatinosa)

Web links

Commons : Scarlet  - Collection of images, videos and audio files

Wiktionary: scarlet fever  - explanations of meanings, word origins, synonyms, translations

• Scarlet fever - information from the Robert Koch Institute
• "Scarlet fever" at infektionsschutz.de , Federal Center for Health Education (BZgA)
• Scarlet in eMedicine (English)

Individual evidence

1. ↑ ^{a b} Pschyrembel - Clinical Dictionary , Walter de Gruyter GmbH Berlin 2014, 266th edition, p. 1897
2. ↑ Max Micoud: The infectious diseases. Clinical observation. In: Illustrated History of Medicine Vol. 4, p. 2196
3. ^ Albrecht N. Rauch: disease names in German. A dialectological and etymological study of the names for diphtheria, Febris scarlatina, Morbilli, parotitis epidemica and varicellae. Stuttgart 1995 (= Journal for Dialectology and Linguistics , Supplement 84).
4. ^ Paul Richter: Contributions to the history of scarlet fever. In: Sudhoffs Archiv 1, 1908, pp. 161–204.
5. ↑ Werner Köhler : Scarlet fever. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , p. 1289.
6. ↑ Karl Wurm, AM Walter: Infectious Diseases. In: Ludwig Heilmeyer (ed.): Textbook of internal medicine. Springer-Verlag, Berlin / Göttingen / Heidelberg 1955; 2nd edition, ibid. 1961, pp. 9–223, here: p. 78.
7. ↑ Green Art Lab Alliance: Scarlet .
8. ↑ Group A streptococcal infections: third update on seasonal activity, 2008/09 , The National Archives - UK Government Web Archive, Health Protection Report, News Archives Volume 3 No 13; April 3, 2009, accessed July 24, 2017
9. ↑ Medical microbiology and infectious diseases; Mims, Dockrell; Elsevier 2006
10. ↑ DGPI Handbook: Infections in Children and Adolescents; German society f. Pediatric Infectiology (editor); Georg Thieme Verlag, 2013; P. 97
11. ↑ RKI leaflet: Pathogens ( Robert Koch Institute )
12. ↑ Medical microbiology and infectious diseases; Hahn, Kaufmann, Schulz, Suerbaum; Springer 2009; P. 209
13. ↑ Training - Health Professions - Scarlet Fever: Exam Questions , accessed July 23, 2017
14. ↑ "Scarlet Fever" - How can I protect myself? at infektionsschutz.de of the Federal Center for Health Education (BZgA), retrieved on July 23, 2017
15. ↑ "Scarlet Fever" - What do I have to watch out for in the event of an illness? at infektionsschutz.de of the Federal Center for Health Education (BZgA), retrieved on July 23, 2017
16. ↑ RKI leaflet: Preventive and control measures ( Robert Koch Institute )
17. ↑ Rudolf Franck - Modern Therapy in Internal Medicine and General Practice - A Handbook of Medicinal, Physical and Dietetic Treatments of the Last Years . Springer publishing house. Retrieved January 9, 2017.
18. ↑ RKI leaflet: Reservoir ( Robert Koch Institute )
19. ↑ Professional association of paediatricians e. V. Scarlet Fever
20. ↑ Notifiable communicable diseases and pathogens. (PDF, 4 MB) Guideline on mandatory notification 2020. Federal Office of Public Health FOPH, Communicable Diseases Department, February 23, 2020, accessed on March 8, 2020 (page 8). 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !