Abstract

Scarlet fever is one of the infectious diseases caused by the erythrogenic toxin of Group A streptococcus (S. pyogenes), typically characterized by high fever, rashes in skin folds, a strawberry-like tongue, and blanching of the nasolabial triangle. It predominantly occurs in children aged 5–15 years, often following acute tonsillopharyngitis, and usually presents as a mild illness that resolves without complications under antibiotic therapy. However, in the clinical case we present, scarlet fever and one of its rare complications, pneumonia, are discussed in a 20-year-old female patient.

Cover Letter

The Causative Agent Is S. pharyngitis with pyogenes is usually a mild disease that heals under antimicrobial treatment.

Clinical symptoms are manifested in untreated patients for 3-5 days with sore throat, high fever, fever, hyperemia and lymphadenopathy. Scarlet fever is a toxigenic complication of pharyngitis caused by Group A streptococcus, caused by the bacterium's erythrogenic toxin. In some cases, however, it can also occur after wound infections and outwardly sepsis. After an incubation period of 1-2 days, maculopapular rashes spread throughout the body, which usually begin on the top of the trunk and neck, fading with pressing. A rash around the mouth and nose is not observed. Due to the intensity of the rash on the skin folds, a symptom of Pastia specific for scarlet fever is observed. In patients, due to hyperemia of the tongue, the appearance of a raspberry-like tongue is striking. The rash usually begins to disappear on the 5 – 7th day of treatment with a glove-style flaking, which begins on the hands and feet.

Clinical Case
A 20 - year-old female patient entered the TTTY Department of the Clinical Medical Center with complaints of 4-day malaise, high fever (39 C), spreading rashes on the body, nausea, shortness of breath. As a result of the examinations, the patient was observed in the objective examination - redness of the face , whitening in the nasopharyngeal triangle, petechiosis and maculopapulosis rashes (Figure 1 ) and raspberry tongue (Figure 2). The patient was initially diagnosed with “scarlet fever” based on clinical signs and was admitted to inpatient treatment in the Infectious Diseases Department . In laboratory tests taken when the patient was admitted to the Department-WBC - 7.17 x 10^3/µL; HGB-8.4 g/dL; MCV-67.3 fL; PLT-229 x 10^3 /µL; NEUT%-61.3%; albumin-3.02 g/dL; ALT-49 U/L; AST-32.7 U/l ; in Instrumental examinations - during radiography - pneumonia of the upper share of the right lung a slight liquid was found in the sinus. At the time of admission to the patient, empirically therapy with ceftriaxone (2 g x 1 time) and Levofloxacillin (500 mg x 1 time ) was initiated. Despite the treatment carried out, the patient was sent for a chest CT scan due to increased oxygen demand ( SpO2 – 7% against the background of mask o8-2 l ) and shortness of breath and Temperature (93-39C). Chest CT scan-large areas of consolidation with an air bronchogram inside in the upper and lower share of the right lung, fluid prone to sacciation with ~ 33 mm in the thickest place in the right hemithorax,location-to-location alveolar infiltration in the lower share of the left lung, and fluid measuring ~14 mm in the thickest place in the left hemithorax After that , the patient's treatment was changed to vancomycin (1 g x 2 times), clindamycin (600 mg x 3 times), Levofloxacillin( 500 mg x 1 time). The patient, after a review by a thoracic surgeon, was given pleurodrenage under sterile conditions and about 1 liter of pyuric fluid was drained. A bacteriological examination was sent from the liquid, and its result came as “the microorganism did not develop.” As a result of the examination and treatment, the patient's temperature decreased, oxygen needs ( SpO2 - 98%) and dyspnea decreased. Pleurodrenage was removed after 3 days from the date of its laying. Antimicrobial therapy was completed in 14 days. During this time, he did not have any complications. Supervision of a field therapist and thoracic surgeon with improvement in adequate condition.

Discussion
Complications of scarlet fever are divided into 2 groups, septic and toxic. Septic form usually manifests itself with high temperature and toxic symptoms. Pneumonia, which is one of the complications, is more common in individuals who do not receive treatment, mainly in the first days of the disease. In our patient, too , at the time of appeal to the clinic, he began to complain for 4 days, but did not receive any antibacterial treatment. Since the causative agent of scarlet fever is Group A strepotococci, the patient has S.in this regard, the empirical treatment of pyogenes-related pneumonia was started. S.pyogenes is a rare but very dangerous causative agent of pneumonia.S.pneumonia in diseases caused by pyogenes occurs in 10% of cases. It is reported that the cause of pneumonia is mainly caused by streptococci type M1 and M3. Usually, patients experience an acute onset, pain in the chest , pleural fluid. There was a greater risk of death in this pneumonia , mainly manifested by lung abscesses , necrotic pneumonia, cavitation changes and empyema.3 since the causative agent is usually sensitive to penicillin group antibiotics, it is recommended to give clindamycin in the first days in the treatment of the disease, mainly for penicillins and anti-toxin action.

The result
Although scarlet fever usually occurs as a complication of pharyngitis in children aged 5-15 years, it can also be observed in adults in severe forms. Pneumonia in patients with scarlet fever was a rare complication, more often in a necrotic form and with the accumulation of pleural fluid in the lung. This is also most often caused by a group of enzymes secreted by Group A streptococci, which cause necrosis in the lung. In each patient diagnosed with pharyngitis of Group A streptococcal origin, antibacterial treatment should be started from the first days, and the treatment period should be completed in 10 days. In cases of pneumonia, however, clindamycin should be added in the first days of this treatment.

Figures

Keywords

• Scarlet fever
• group A streptococcus
• pneumonia
• complications

References

Article Info:

Publication history

Published: 25.Feb.2025

DOI: https://doi.org/10.28942/ajim.v2i1y2025.25

Copyright

© 2022-2025 Azerbaijan İnternal Medicine Society. Published by "Uptodate In Medicine" health sciences publishing. All rights reserved.

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