Clinical manifestations of scarlet fever in children in the megalopolis at the present stage

Abstract

BACKGROUND: According to the literature, an increase in severe forms of scarlet fever among children was noted in several countries in 2022–2023.

AIM: To identify the current clinical features of scarlet fever in children in a large metropolis in Russia.

MATERIALS AND METHODS: An observational descriptive retrospective continuous study of the clinical features of the course of scarlet fever in children was conducted based on patient case histories from 2020 to 2022.

Statistical processing was performed using methods for calculating extensive and intensive indicators (p₁ and p₂), errors of extensive indicators (m₁ and m₂), and standard deviations (p_max↔ p_min), considering the confidence interval (t) and confidence probability (P=95%).

The percentages were compared using Fisher’s exact criterion. The differences were considered significant at p <0.05.

RESULTS: The abolition of anti-epidemic restrictions on COVID-19 in 2022 led to an increase in the incidence of scarlet fever among children aged 0–18 years by 3.6 times compared to that in 2021 and to an increase in hospitalization in hospitals in Moscow. The number of hospitalized children with scarlet fever in 2022 increased by 18.0 times compared to that in 2020. Majority of those hospitalized (83.4%) were children of preschool and school age, including those aged 3–7 years (52.9%) and 7–15 years (39.3%), with an average severity of the disease of 93.6%.

Among the examined children, 53 (18.0%) had a history of COVID-19, and among this group of children, one in 5^th had severe scarlet fever.

Every 8^th–9^th patient (12.2%) had various complications, mainly of a septic nature, that occurred at week 1 of the disease; at week 2 and later, complications of infectious and allergic nature were observed.

Antibiotics of the cephalosporin (53.6%) and penicillin (46.4%) series were used to treat scarlet fever.

CONCLUSION: In modern conditions of the megalopolis, scarlet fever occurs with typical clinical characteristics. In most children, scarlet fever was characterized by a moderate course, and various complications were identified in 12.2% of children. It was noted that against the background of an increase in the number of hospitalized patients, the number of patients with severe scarlet fever decreases and the incidence of complications does not change (12.3–12.8%). Scarlet fever is 8.3 times more likely to occur in severe form in patients who have had COVID-19 than in those who did not have a history of COVID-19.

Keywords

group A streptococcus / scarlet fever / children scarlet fever / clinic scarlet fever

References

[1] Increase in invasive Group A streptococcal infections among children in Europe, including fatalities. In: World Health Organization [Internet]. Geneva: World Health Organization; 2022 [cited 2024 May 28]. Available from: https://www.who.int/europe/news/item/12-12-2022-increase-in-invasive-group-a-streptococcal-infections-among-children-in-europe--including-fatalities

[2] В Европе растет распространенность инвазивных стрептококковых инфекций группы А среди детей. Есть летальные исходы. В: Всемирная организация здравоохранения [Интернет]. Женева: Всемирная организация здравоохранения, 2022. Режим доступа: https://www.who.int/europe/ru/news/item/12-12-2022-increase-in-invasive-group-a-streptococcal-infections-among-children-in-europe--including-fatalities Дата обращения: 28.05.2024.

[3] de Ceano-Vivas M, Molina Gutiérrez MÁ, Mellado-Sola I, et al. Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Coming back to the previous incidence. Enferm Infecc Microbiol Clin (Engl Ed). 2024;42(2):88–92. doi: 10.1016/j.eimce.2023.04.021

[4] de Ceano-Vivas M., Molina Gutiérrez M.Á., Mellado-Sola I., et al. Streptococcus pyogenes infections in Spanish children before and after the COVID pandemic. Сoming back to the previous incidence // Enferm Infecc Microbiol Clin (Engl Ed). 2024. Vol. 42, N 2. P. 88–92. doi: 10.1016/j.eimce.2023.04.021

[5] Hussain Z. Scarlet fever infections rise to nearly 30 000, UKHSA reports. BMJ. 2022;23(379):3059. doi: 10.1136/bmj.o3059

[6] Hussain Z. Scarlet fever infections rise to nearly 30 000, UKHSA reports // BMJ. 2022. Vol. 379. P. o3059. doi: 10.1136/bmj.o3059

[7] Glushkova EV, Brazhnikov AYu, Krasnova SV, et al. Clinical and epidemiological characteristics of scarlet fever in Russia. Epidemiology and Vaccinal Prevention. 2023;22(3):14–25. EDN: MROGBQ doi: 10.31631/2073-3046-2023-22-3-14-25

[8] Глушкова Е.В., Бражников А.Ю., Краснова С.В. и др. Клинико- эпидемиологическая характеристика скарлатины в России // Эпидемиология и вакцинопрофилактика. 2023. Т. 22, № 3. С. 14–25. EDN: MROGBQ doi: 10.31631/2073-3046-2023-22-3-14-25

[9] Iskova IA, Kliaritskaia IL, Tsapyak TA, Krivoy VV. Group A streptococcal infection: its significance and diagnosis. Crimean Journal of Internal Diseases. 2021;(1):32–36. EDN: HVKKEC

[10] Иськова И.А., Кляритская И.Л., Цапяк Т.А., Кривой В.В. Cтрептококковая инфекция группы А: ее значение и диагностика // Крымский терапевтический журнал. 2021. № 1. С. 32–36. EDN: HVKKEC

[11] Matsubara VH, Christoforou J, Samaranayake L. Recrudescence of scarlet fever and its implications for dental professionals. Int Dent J. 2023;73(3):331–336. doi: 10.1016/j.identj.2023.03.009

[12] Matsubara V.H., Christoforou J., Samaranayake L. Recrudescence of scarlet fever and its implications for dental professionals // Int Dent J. 2023. Vol. 73, N 3. P. 331–336. doi: 10.1016/j.identj.2023.03.009

[13] Timchenko VN, Pavlova EB, Pavlova NV, Sertakova ZL. Features of the clinic and treatment of modern scarlet fever. Detskie infekcii. 2004;(3):71–73. (In Russ.) EDN: KAPRVB

[14] Тимченко В.Н. Павлова Е.Б., Павлова Н.В., Сертакова З.Л. Особенности клиники и лечения современной скарлатины // Детские инфекции. 2004. № 3. С. 71–73. EDN: KAPRVB

[15] Ilunina LM, Kokoreva SP, Stahurlova SE, Klemjatina EJu. Clinical characteristics of modern scarlet fever in children hospitalized in a hospital. Applied and IT Research in Medicine. 2017;20(3):128–132. (In Russ.) EDN: ZCQDYJ

[16] Илунина Л.М., Кокорева С.П., Стахурлова С.Е., Клемятина Е.Ю. Клиническая характеристика современной скарлатины у детей, госпитализированных в стационар // Прикладные информационные аспекты медицины. 2017. Т. 20, № 3. С. 128–132. EDN: ZCQDYJ

[17] Pavlova NV, Pavlova EB. Clinical and epidemiological characteristics of scarlet fever in children in St. Petersburg (2003–2009). The Scientific Notes of the Pavlov University. 2011;(2):18–20. (In Russ.) EDN: SNMSBR

[18] Павлова Н.В., Павлова Е.Б. Клинико-эпидемиологическая характеристика скарлатины у детей в Санкт-Петербурге (2003–2009 гг.) // Ученые записки СПбГМУ им. акад. И.П. Павлова. 2011. Т. 18, № 2. С. 18–20. EDN: SNMSBR

[19] Levanovich VV, Timchenko VN, editors. Evolution of streptococcal infection: a guide for doctors. Saint Petersburg: SpetsLit; 2015. 495 p. (In Russ.)

[20] Эволюция стрептококковой инфекции: руководство для врачей / под ред. В.В. Левановича, В.Н. Тимченко. Санкт-Петербург: СпецЛит, 2015. 495 с.

[21] Gashina EA, Joidik SN, Golovanova NV. Features of scarlet fever in children and experience of application of streptatest system. Vestnik SurGU. Meditsina. 2020;(4):46–50. (In Russ.) EDN: OCFEQZ doi: 10.34822/2304-9448-2020-4-46-50

[22] Гашина Е.А., Жойдик С.Н., Голованова Н.В. Современное течение скарлатины у детей и опыт применения метода экспресс-диагностики стрептатест // Вестник СурГУ. Медицина. 2020. № 4. С. 46–50. EDN: OCFEQZ doi: 10.34822/2304-9448-2020-4-46-50

[23] Ivanova ON. Post-COVID syndrome in children. International Research Journal. 2021;(9-2):35–39. EDN: SFNKUA doi: 10.23670/IRJ.2021.9.111.040

[24] Иванова О.Н. Постковидный синдром у детей // Международный научно-исследовательский журнал. 2021. № 9-2. C. 35–39. EDN: SFNKUA doi: 10.23670/IRJ.2021.9.111.040

[25] Pokrovskij VI, Briko NI, Rjapis LA. Streptococci and streptococcosis. Moscow: GEOTAR-Media; 2006. (In Russ.)

[26] Покровский В.И., Брико Н.И., Ряпис Л.А. Стрептококки и стрептококкозы. Москва: ГЭОТАР-Медиа, 2006.

[27] Novosad EV, editor. Scarlatina in children. Textbook. Moscow: RNIMU named after. N.I. Pirogov; 2020. (In Russ.)

[28] Скарлатина у детей. Учебное пособие / под ред. Е.В. Новосад. Москва: РНИМУ им. Н.И. Пирогова, 2020.

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