1. Introduction

Scarlet fever remains a serious problem among childhood infections [1,3]. In recent years, the incidence of Scarlet fever has been low, but it is most often manifested in groups of preschool children [1,4]. The widespread use of antibacterial drugs has led to the prevalence of mild, moderately severe forms of the disease [2,3,5]. However, in the formation of chronic diseases of the nasopharynx, the importance of streptococcal infection is undeniable [8,11]. The risk of allergy from streptococci causing heart and kidney disease is high [6,9]. In some cases, severe septic complications and even death may occur [10].

Aim of the study: to investigate clinical and laboratory features of scarlet fever in children.

2. Materials and Methods of Research

Clinical and laboratory observation of 102 patients diagnosed with Scarlet fever in Samarkand Regional Infectious Diseases Clinical Hospital in 2023 was carried out. Clinical examination included objective examination of patients, anamnestic data, laboratory examination: general blood analysis, general urine analysis, nasopharyngeal mucosa smear, determination of C reactive protein and ASLO, ECG.

3. Discussion of the Study

The age of the examined patients ranged from 12 months to 18 years. Children aged 4-6 years (50 patients - 49.1%), 19.6% children aged 1-3 years, 31.3% patients older than 7 years.

The number of hospitalised patients for 2023 has significantly decreased compared to the previous years - 102 and 278 for 2013-2014, respectively. This is due, on the one hand, to a significant decrease in the incidence of Scarlet fever in Samarkand oblast, and on the other hand, to a decrease in the proportion of hospitalised compared to outpatients due to changes in the health care system.

When analysing the time of hospitalisation, 19 patients (18.6%) were hospitalised on the 1-2nd day of the disease, and 76 patients (74.5%) were hospitalised on the 3-5th day of the disease. Hospitalisation of 7 (6.9%) patients after the 6th day of the disease was assessed as delayed. In many cases, this was due to complications or other infectious diseases, in particular, deterioration of the patient's general condition.

The majority of children (90 - 88.2%) sought hospitalisation without referral and were admitted with a diagnosis of Scarlet fever. Only 12 (11.8%) patients were admitted with a referral diagnosis of ‘Scarlet fever’.

In all children the disease was characterised by periodicity typical for Scarlet fever. Data on contacts with exanthematic patients suggested that the duration of the incubation period averaged 2.7 ± 0.4 days.

In 62.7% of patients, the early period of illness could be determined on the basis of anamnesis. It lasted from 1 to 3 days, with an average of 1.5 ± 0.6 days. The majority of 68(66.6%) children had a rise in body temperature and varied and ranged from 37.1°C to 39°C; 34 (33.3%) patients had a temperature of 39.1-400°C. 80.4% of patients complained of sore throat and difficulty in swallowing as well as headache, restlessness, general malaise, loss of appetite, nausea and vomiting;

Acute tonsillitis syndrome was detected in all patients and appeared as hypertrophy of tonsils, hyperaemia of the pharyngeal mucosa of varying intensity. An increase in peripheral lymph nodes was observed.

The rash period began with the appearance of a skin rash and lasted from 3 to 6 days, on average 4.8 ± 0.1 days. All children had persistent symptoms of intoxication and acute tonsillitis with peripheral lymphadenitis.

Hyperaemia and hypertrophy of the pharynx, tonsils, and varying degrees of hyperaemia of the arches and soft palate were also detected during this period. In the majority (62-58,8% of patients) changes on tonsils had catarrhal character, in 30(29,4%) - follicular, in 10(9,9%) - lacunar character.

In 79% of cases, the size of lymph nodes was characterised by a small increase (up to 1-2 cm), and only 21% of patients had a significant increase (more than 2 cm).

About 1/3 of patients (32.6%) had rash as the first symptom of the disease. On day 1-2 the rash appeared in 78(76.6%) patients, on day 3 - in 22(23.4%). In all children, the rash was small-pointed and coalesced within a few hours. Small papules and petechiae were rarely observed on its background. The localisation of rashes retained its peculiarities for all patients: mainly on the lateral surfaces of the body and limbs, in natural folds. The intensity of rashes varied: in 76.3% of patients the rash was pronounced, with a hyperemic skin background, and in 23.7% of patients the rash was pale pink in colour against a background of unchanged skin. A pale nasolabial triangle was identified in 97(95%) children. Many patients had typical changes on the tongue: on the first day of the disease, the tongue was covered with plaque; on day 3-4 it gradually cleared. The average duration of fever was 3.4±0.2 days. During the same period, the symptoms of intoxication disappeared and the rash persisted for an average of 3.9±0.1 days. Changes in the pharynx gradually disappeared: plaque disappeared first (on average 2.3±0.1 days), then hyperaemia decreased.

During the convalescence period (starting on days 8-10 of the illness), 16% of children had mild, round-plate peeling on the skin folds of the limbs, palms, heels and fine-plate peeling on the body.

Scarlet fever mostly (101 people - 99%) had a typical clinical form. Atypical form of Scarlet fever (extrabuccal), where tonsils were not the gateway of infection, was observed in 1 child (1%) post-burn Scarlet fever.

The severity of the disease was assessed by signs of intoxication and the severity of local changes. In the acute period, Scarlet fever was established on the basis of severity criteria - general condition of the patient, body temperature, severity of signs of intoxication, and the nature of the rash.

The mild form of Scarlet fever was observed in 25(24,5%) patients, with satisfactory general condition, body temperature within 37-38,5°С, without vomiting, with low or moderate hyperaemia of the pharynx, not expressed rash, with its rapid reversal.

In 67(65,7%) patients, the moderately severe form was manifested by fever up to 39,5°C, weakness, headache, decreased appetite, repeated vomiting, marked sore throat and pharyngeal hyperaemia, acute follicular and lacunar sore throat.

Severe form of the disease was observed in 10(9,8%) patients and was manifested by body temperature 40°C and higher, headache, agitation, impaired consciousness, convulsions, repeated vomiting, marked hyperaemia in the pharynx with marked plaques on tonsils, sharp hyperaemia of the pharynx with small pitting rashes sometimes with haemorrhagic elements.

In 86 (84.3%) children the course of the disease was assessed as smooth, no pathological changes were observed after normalisation of body temperature and disappearance of symptoms of the acute period. At the same time, 16 (15.6%) patients had a non-smooth course of Scarlet fever, which was caused by concomitant diseases in 7.7% of cases, complications in 10% of patients in the form of toxic kidney 7.8%, catarrhal stomatitis 2%. Among comorbidities, giardiasis (7.8%), acute respiratory viral infections (4.9%), pneumonia (2%) were observed.

Comparison of Scarlet fever severity in the current and previous decade (2013 - 2014) showed that in hospitalised patients, the number of moderately severe forms of the disease increased significantly (50.2% vs. 65.7%) and mild forms decreased from 45% to 24.5%, respectively.

Laboratory diagnosis of Scarlet fever includes testing for the presence of haemolytic streptococcus in all patients hospitalised. Bacteriologically, the disease was confirmed in only 20.2% of those examined for Scarlet fever. The low percentage of bacteriological analysis is associated with antibacterial therapy started in outpatient settings and late hospitalisation of patients.

Blood examination in the acute period of the disease revealed leukocytosis (37.3%), relative neutrophilosis with left shift (28.4%), eosinophilia (11.7%), in 19.6% of patients the COE values were determined up to 10 mm/h, in 56.9% from 10 to 15 mm/h, and in 23.5% of cases - more than 15 mm/h.

In hospital, 74.5% of patients were treated with intramuscular penicillin. The course duration averaged 7.6 ± 0.1 days. In the remaining 25.5% of cases, other antibacterial drugs (cefazolin, ceftriaxone, ultrasidime) were prescribed. In some cases, antibacterial treatment required combination antibiotic therapy due to lack of therapeutic efficacy. This therapy was mainly performed in patients with complicated course or concomitant bacterial pathology. All patients were prescribed detoxification and desensitisation therapy.

Most children (59.5%) were discharged from the hospital with recovery on the 8-11th day of the disease. At discharge, observation by a paediatrician at the place of residence was recommended. Due to early complications and concomitant diseases, 9.8% of patients were discharged home on the 13th-15th day of the disease.

4. Conclusions

1. During the analysed period, the number of observed patients with moderately severe forms of the disease increased - 65.7% versus 50.2%.

2. At present, complications of the disease occur, mainly related to late prescription of antibacterial therapy.

3. Due to the low percentage of bacteriological detection of hemolytic streptococcus (20.2%), clinical diagnosis remains the main method of diagnosing the disease.