Scarlet fever. an acute infectious disease characterized by fever, intoxication, sore throat and profuse pinpoint rash. The causative agent of scarlet fever is

Lecture 26 Diphtheria Scarlet fever Measles http://prezentacija.biz/ 1 Diphtheria is an acute infectious disease characterized by toxic damage mainly to the cardiovascular and nervous systems and a local inflammatory process with the formation of fibrinous plaque. Refers to airborne anthroponoses. 2 The causative agent is Loeffler's bacillus, which produces a neurotropic exotoxin. The predominant localization of inflammation is the pharynx, larynx, nasopharynx, less commonly the bronchi, nose, and external genitalia in girls. 3 Clinically, there are two main forms - diphtheria of the pharynx and diphtheria of the larynx. With diphtheria of the pharynx, local changes are observed in the tonsils - sore throat. Typically fibrinous inflammation of the tonsils with the transition of fibrinous films to the arches and soft palate. The films are tightly bound to the mucous membrane and do not come off for a long time, which contributes to intoxication. The lymph nodes of the neck are enlarged due to necrosis and edema, which can spread to the entire neck and chest. 4 “Bull neck” with toxic diphtheria of the pharynx 5 Fibrinous films on the tonsils of the pharynx. 6 Toxic diphtheria of the throat. 7 Diphtheria tracheobronchitis 8 105 – croupous tracheitis 9 790 – diphtheritic amygdalitis 10 112 – diphtheritic amygdalitis 11 Exotoxin affects the myocardium, the nerves passing behind the tonsils, especially the vagus, in which neuritis develops with a break in the axial cylinders. Parenchymal, often fatty degeneration and parenchymal myocarditis occur in the myocardium. This can lead to death in the second week of illness from early cardiac paralysis. In such cases, myogenic dilatation of the ventricular cavities, dull, flabby myocardium, and often tiger heart are noted. 12 Myogenic dilatation of the heart muscle 13 67 - fatty degeneration of the myocardium “tiger 14 heart” A28 - fatty degeneration of the myocardium “tiger 15 heart” 102 – diphtheritic myocarditis 16 After 1.5-2 months, when local changes in the pharynx disappear, late cardiac paralysis may occur from damage to the vagus. At the same time, the heart appears unchanged at autopsy. 17 The third target of the toxin, in addition to the myocardium and vagus, is the adrenal gland, where a hematoma occurs, threatening death from collapse. 18 With diphtheria of the larynx, intoxication is less pronounced, since mucus collects under the fibrinous film, interfering with the absorption of the toxin. The main danger of this form is true croup - fibrinous inflammation of the larynx caused by diphtheria bacillus. 19 In the absence of any of these components, croup is not considered true, despite clinical manifestations such as suffocation and hoarseness. Such phenomena can occur with laryngeal edema (false croup). 20 Death in diphtheria is caused by acute insufficiency of the pituitary-adrenal system, toxic myocarditis, and asphyxia as a result of laryngeal stenosis. 21 Scarlet fever is an acute streptococcal disease; characterized by fever, general intoxication, sore throat, punctate exanthema, tachycardia. Refers to airborne anthroponoses. 22 Scarlet fever is a childhood infection. The causative agent is group A streptococcus, which causes tissue necrosis typical of scarlet fever. 23 227 – pharynx and esophagus with toxic scarlet fever 24 Pathogenesis. In the pathogenesis of scarlet fever, the pathogen itself, its toxins and allergens (infectious, toxic and allergic components of pathogenesis) are important. Streptococci secrete a pyrogenic exotoxin, which causes the fever and rash of scarlet fever. 25 Towards the end of the first and second days, a characteristic exanthema appears. Against the background of hyperemic skin, a bright, pinpoint rash appears, which thickens in the area of ​​natural folds of the skin (armpits, inguinal folds, inner thighs). 26 The face shows bright hyperemia of the cheeks and a pale nasolabial triangle. Along the edges of the blush, individual small-pointed elements of the rash can be distinguished. In the folds of the skin (especially in the elbow bends) there are small hemorrhages, which, merging, form a peculiar rich color of the folds (Pastia's symptom). 27 Pale nasolabial triangle and rash on the torso 28 Pinpoint rash on the torso 29 Rash on the thigh 30 Pastia's symptom 31 Subsequently, after 3-5 days (in mild forms earlier), the rash turns pale, and in the second week of the disease lamellar peeling appears, the most pronounced on the toes and hands. 32 Peeling on the hand 33 The tongue is coated at the root, but very quickly clears of plaque and takes on the characteristic appearance of a “raspberry” tongue - clean, purple in color, with enlarged papillae; the pharynx is brightly hyperemic; the zone of hyperemia is sharply demarcated from the pale hard palate. 34 White strawberry tongue (first 1-2 days of illness). 35 Red strawberry tongue (in a few days). 36 The tonsils are enlarged, sometimes they show necrotic changes, covered with fibrinous films. Regional nodes are enlarged and painful. Possible enlargement of the liver and spleen. 37 Based on clinical manifestations, scarlet fever is classified into mild, moderate, severe and extrabuccal scarlet fever. Currently, light and erased forms predominate. Severe forms are observed very rarely. 38 Extrabuccal scarlet fever (wound, burn, postpartum) is characterized by a short incubation period, a bright rash that begins around the gate of infection and is expressed most intensely here; there is no sore throat. Patients with extrabuccal scarlet fever are less contagious. 39 There are two periods of scarlet fever - the first with the phenomena of intoxication and degeneration of parenchymal organs and hyperplasia of the immune organs, in particular, with severe hyperplasia of the spleen, and locally - with necrotizing tonsillitis and exanthema. 40 The second period begins at 3-4 weeks. It is caused by the production of antibodies and bacteremia. The sore throat recurs, but is expressed moderately, in a catarrhal form. Allergic arthritis occurs, but the main thing is glomerulonephritis (!), which represents the main danger of the modern course of scarlet fever. 41 The main complications of scarlet fever are glomerulonephritis, necrotizing otitis media, after which hearing loss develops, otogenic brain abscesses, rheumatism, and myocarditis. 42 Measles is an acute viral disease characterized by fever, intoxication, a peculiar enanthema and maculopapular exanthema, damage to the conjunctiva and upper respiratory tract. Refers to airborne anthroponoses. 43 During the prodromal period of the disease, measles enanthema appears in the form of small red spots located on the mucous membrane of the soft and hard palate, Belsky-Filatov-Koplik spots, pathognomaniac for measles. These spots, most often localized on the mucous membrane of the cheeks, are small whitish, slightly raised spots, surrounded by a narrow reddish border. In appearance they resemble semolina or bran. With the appearance of exanthema they disappear. 44 Koplik spots 45 Ulcerative lesions of the oral mucosa in the area of ​​the exit of the salivary gland duct at the level of the small lower molars (Koplik spots) are caused by necrosis, neutrophilic exudate and neovascularization. 46 Measles exanthema is characterized by stages of rash: on the first day, elements of the rash appear on the face and neck; on the second - on the torso, arms and thighs, on the third day the rash covers the legs and feet, and the face begins to turn pale. The rash consists of small papules of about 2 mm, surrounded by an irregularly shaped spot. 47 The mottled, red-brown measles rash on the face, trunk, and proximal extensors is observed due to skin vasodilation, edema, and moderate, nonspecific mononuclear perivascular infiltration. 48 Measles exanthema consists of large spots and papules 49 Koplik spots usually disappear with the appearance of the rash, but sometimes they persist 50 Measles exanthema on the face (1st day) 51 Large spots on the trunk (2nd day) 52 Confluent spots on the trunk ( 3rd day)53 Severe bronchitis due to measles occurs only as complications when a secondary infection occurs. Unlike influenza, it is characterized by damage to small bronchi and bronchioles with necrosis of the epithelium, accompanied by panbronchitis, as well as peribronchitis, i.e. inflammation of the adjacent alveoli. 54 Multinucleated giant cells (called Warthin-Finkeldey cells) that have eosinophilic inclusions in the nucleus and cytoplasm. These are pathognomaniac cells for measles and are found in lymph nodes, lungs and sputum. 55 Measles pneumonia giant mononuclear cells 56 Giant cell in measles pneumonia 57 Measles bronchopneumonia 58 Complications of measles - pneumonia, otitis, mastoiditis. Damage to the central nervous system (encephalitis, meningoencephalitis). Acute necrotizing laryngitis (measles croup), stomatitis, noma. 59 Measles encephalitis 60 Noma 61 Thank you for your attention 62

Etiology

Epidemiology

Epidemiology

Pathogenesis

Classification

Clinical picture, typical form

Clinical picture, typical form

Clinical picture, typical form

Clinical picture, typical form

Clinical picture, typical form

Scarlet fever, pinpoint rash

Scarlet fever, pinpoint rash, Pastia lines

Scarlet fever, catarrhal tonsillitis

Scarlet fever, language changes, 1st day of illness

Scarlet fever, "raspberry tongue"

Scarlet fever, lamellar peeling

Clinical picture, atypical forms (extratonsillar)

Features of clinical forms of scarlet fever

Features of clinical forms of scarlet fever

Complications

Laboratory diagnostics

Differential diagnosis

Treatment

Treatment

Dispensary observation

Prevention

An acute infectious disease characterized by fever, intoxication, sore throat and profuse pinpoint rash. The causative agent of scarlet fever is group A streptococcus, which can also cause kidney damage (glomerulunophritis), sore throat, chronic tonsillitis, rheumatism and other diseases. Scarlet fever occurs if at the time of infection there is no immunity to streptococcus The source of infection is a patient with scarlet fever, tonsillitis or a “healthy” carrier of streptococci

The infection is transmitted by airborne droplets (by sneezing, kissing, etc.). In addition, you can become infected with scarlet fever through food, shared utensils, clothing, or simply by holding a door handle that was previously opened by a completely healthy-looking carrier of the infection.

How does it manifest? Scarlet fever begins acutely: with a sharp rise in temperature to 39º C. The child complains of headache, nausea, severe malaise, and severe pain when swallowing. At the end of the first and beginning of the second day, a small, itchy rash appears, which covers almost the entire body within a few hours. An important sign of scarlet fever is thickening of the rash in the form of dark red stripes on the skin folds in places of natural folds in the groin folds, armpits, and elbows. The skin feels very dry and feels like sandpaper.

If you look into the patient’s mouth, you can see bright red inflamed mucous membrane, purulent deposits on the tonsils and a crimson tongue with sharply enlarged papillae. Doctors characterize this condition of the throat with the expression “flaming throat.” On the face, the rash is located on the cheeks, to a lesser extent on the forehead and temples, while the nasolabial triangle remains pale and free of rash elements (a characteristic sign of scarlet fever)

After 3-5 days, the skin turns pale and severe peeling begins, especially pronounced on the child’s palms: the skin is removed from them like gloves. Lymphadenitis (damage to the lymph nodes) Purulent otitis (ear inflammation) Allergic kidney disease - glomerulonephritis Arthritis, synovitis - joint inflammation Allergic myocarditis - heart damage Pneumonia (pneumonia) Complications

The diagnosis is made on the basis of contact with a patient with scarlet fever, tonsillitis, in the presence of a characteristic rash and throat lesions. Treatment is usually carried out at home. Children with severe and complicated forms of scarlet fever are hospitalized. Bed rest must be observed for 7-10 days. To suppress the growth of streptococcus, antibiotics are used for a 10-day course. In addition, gargling with a solution of furacillin, infusions of chamomile, calendula, and eucalyptus is prescribed. Antiallergic drugs and vitamins will also be used. The diagnosis is made on the basis of data on contact with a patient with scarlet fever, tonsillitis, in the presence of a characteristic rash and throat lesions. Treatment is usually carried out at home. Children with severe and complicated forms of scarlet fever are hospitalized. Bed rest must be observed for 7-10 days. To suppress the growth of streptococcus, antibiotics are used for a 10-day course. In addition, gargling with a solution of furacillin, infusions of chamomile, calendula, and eucalyptus is prescribed. Antiallergic drugs and vitamins are also used

Scarlet fever is an acute infectious disease caused by beta-hemolytic streptococcus of group A.O

The first symptoms of scarlet fever

Skin rashes appear. They have a natural character, inherent only to scarlet fever. appears a few hours after the onset of pain

Then, as a rule, the entire surface of the body is affected, except for the nasolabial triangle, which remains unaffected. Pink rash on background

Diagnostics

It is necessary to differentiate scarlet fever primarily from measles, rubella and other diseases accompanied by the appearance of a rash.

COMPLICATIONS Due to the fact that modern medicine has developed a number of medications that successfully suppress streptococcal and

Acute infectious disease - SCARLATINA The work was carried out by 3rd year student Filippova I.N.

Scarlet fever Scarlet fever is an acute infectious disease manifested by a pinpoint rash, fever, general intoxication, and sore throat. The causative agent of the disease is group A streptococcus. Infection occurs from patients through airborne droplets (when coughing, sneezing, talking), as well as through household items (dishes, toys, underwear). Patients are especially dangerous as sources of infection in the first days of illness.

Incubation period The incubation period usually lasts 2-7 days, it can be shortened to several hours and extended to 12 days. Typical scarlet fever begins acutely with a rise in body temperature. Malaise, loss of appetite, sore throat when swallowing, headache, tachycardia are noted, and vomiting is often observed. A few hours after the onset of the disease, a pink, dotted skin rash appears in the area of ​​the cheeks, torso and limbs. The skin of the nasolabial triangle remains pale and free of rash. The rash is more intense in the natural folds of the skin, on the sides of the body, and in the lower abdomen. Sometimes, in addition to pinpoint elements, there may be rashes in the form of small (1-2 mm in diameter) bubbles filled with clear or cloudy liquid.

Symptoms The first symptoms of scarlet fever are signs of acute intoxication of the body: a sharp increase in temperature (39-40? C), refusal to eat, drowsiness, pain throughout the body, weakness, irritability. A local reaction to the proliferation of microbes in the area of ​​the tonsils (tonsils) and pharynx manifests itself in the form of redness of the tonsils and pain when swallowing. Young children may vomit or have diarrhea. These symptoms of scarlet fever, however, do not yet allow us to identify scarlet fever, since exactly the same symptoms can occur with many other “cold” diseases. However, symptoms characteristic of scarlet fever appear quite quickly: a pink rash all over the body

Treatment Treatment is usually carried out at home. Inpatient treatment is necessary in severe cases and in the presence of complications. Until the temperature drops, patients should remain in bed. In the acute period of the disease, you need plenty of warm drinks (tea with lemon, fruit juices), liquid or semi-liquid food with some restriction of proteins. Penicillin antibiotics (amoxicillin, retarpen, amoxicillin, amoxiclav) are prescribed for 5-7 days. Additionally, vitamin therapy is prescribed (B vitamins, vitamin C). In severe cases, a glucose solution or hemodez is prescribed intravenously to reduce intoxication.

After suffering from the disease, the body develops immunity, and the person no longer suffers from it throughout his life. Most often the disease occurs in children.

THANK YOU FOR YOUR ATTENTION!