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 a number of foreign countries in 2022-2023. AIMS: to identify the current clinical features of scarlet fever in children in a large metropolis of Russia. MATERIALS AND METHODS: an observational descriptive retrospective continuous study of the clinical features of the course of scarlet fever in children was conducted according to 295 case histories of patients diagnosed with Scarlet fever from 2020 to 2022 on the basis of the GBUZ "DGKB named after Z.A. Bashlyaeva DZM", GBUZ "DGKB No. 9 named after G.N. Speransky DZM" in Moscow. The statistical processing of the material uses traditional methods for calculating extensive and intensive indicators (p1 and p2), errors of extensive indicators (m1 and m2) and standard deviations (rmax↔rmip), taking into account the confidence interval (t) and confidence probability (P=95%), a method for comparing indicators using a well-known formula, where at t ≥ 2.0 P ≥ 95% p ≤ 0.05, the definition of standard deviations, taking into account the confidence interval (t) and the confidence probability P = 95%. The comparison of percentages in the analysis of four-field conjugacy tables was performed using the exact Fisher criterion. The differences were considered statistically significant at p 0.05. RESULTS: as a result of the study, it was revealed that the abolition of strict anti-epidemic restrictions on COVID-19 in 2022 led not only to an increase in the incidence of scarlet fever among children from 0 to 18 years of age by 3.6 times in 2022 compared with 2021, but, as a result, to an increase in hospitalization of children in hospitals in Moscow. Thus, the number of hospitalized children with scarlet fever in 2022 increased by 18.0 times compared to 2020. The majority of those hospitalized (83.4%) were children from organized groups, including those aged 3 to 7 years (52.9%) and from 7 to 14 years (39.3%), with an average severity of the disease (93.6%). It was noted that that among the examined children, 53 children (18%) had a history of COVID-19, and among this group of children, one in five children had severe scarlet fever, while among children who did not have a history of COVID-19, these were significantly (p 0.001) 8.4 times less (respectively, 20.7% versus 2.5%). It was revealed that every 8-9 patients (12.2%) had various complications, mainly of a septic nature and those that arose in the first week of the disease, including otitis media, sinusitis, community-acquired pneumonia, parathonsillar and lateral pharyngeal abscesses and toxic shock syndrome. In the second week and later, complications of an infectious and allergic nature were reported, including tubulointerstitial nephritis, acute renal injury, post-infectious cardiomyopathy, acute post-streptococcal glomerulonephritis, toxic allergic vasculitis, post-streptococcal arthritis. Beta-lactam antibiotics remain the etiotropic drugs of choice. Antibiotics of the cephalosporin 53.6% and penicillin 46.4% series were used to treat scarlet fever. CONCLUSIONS: in modern conditions of the megalopolis, scarlet fever occurs with a typical clinical picture. The majority of those hospitalized were children of preschool and school age, only 12.2% of children were diagnosed with various complications of scarlet fever and the vast majority of children (93.6%) had a moderate severity of scarlet fever. 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, while the incidence of complications in patients does not change (12.3% - 12.8%). It was shown that among patients who had suffered from COVID-19, scarlet fever was 8.3 times more likely to occur in severe form compared with children who had no history of COVID-19 disease (respectively, 20.7% vs. 2.5, p 0.0001).