Fourth Illness: Scarlattinetta

Scarlattinetta

The fourth disease is one of the typical exanthemic diseases of the pediatric age; these are contagious skin infections, characterized by the appearance of reddish spots and eruptions on the skin.

The fourth disease is also known by other names:

"Scarlattinetta", because the symptomatological picture is very similar to that of scarlet fever (although the symptoms appear much milder):
"Dukes' disease", by the doctor who first described the pathology around 1900.

Some authors do not consider it appropriate to consider scarlet fever a real disease; rather, this should be considered a variant or in any case a mild prodrome of other exanthemic diseases, such as scarlet fever, measles or rubella. The fourth disease, although typical of childhood, could also involve adults.

Causes

Despite the many studies on scarlet fever, the main cause has not yet been identified: from the most recent assumptions, it seems that the main culprit of the fourth disease is a bacterium (not a virus, as for the fifth and sixth diseases), belonging to the group of beta-hemolytic type A streptococci. This hypothesis seems to be confirmed by the marked spread of the fourth disease in kindergartens, where promiscuity certainly facilitates the infection and transmission of the disease among children.

Contagion

The fourth disease is contracted by indirect contact with the respiratory drops spread with the cough from an infected patient, or by direct contact with saliva or mucus thereof.

The fourth disease is contagious starting from the incubation and the risk of transmission continues until the exanthemic manifestations.

Symptoms and complications

The first symptoms of the fourth disease begin about a week or 10 days after the infection, time necessary for incubation of the bacterium: in general, the patient complains of headache, drowsiness, low-grade fever, apathy and lack of appetite. These first symptoms are subsequently replaced by fever, sore throat and inflammation / enlargement of the latero-cervical lymph nodes. In general, the exanthema proper - however always fleeting and modest - begins after these manifestations: the most subject anatomical sites are the buttocks, the groin and the face. The rash is manifested by very close reddish dots, so as to form more or less extensive patches: the lesions tend to regress spontaneously in a few days (usually 4 or 5), leaving possible traces on the skin (desquamation).

It is not uncommon for the typical symptoms of the fourth disease to remain almost unnoticed by the patient: the scarlet fever, therefore, is a mild disease whose prognosis is always excellent and complications unlikely. However, in sensitive subjects with kidney problems, the fourth disease could worsen the functioning of the kidneys: in this regard, urine testing is recommended.

Diagnosis and therapies

The diagnosis for scarlet fever is very simple, since it is based on simple objective examination.

We have seen that urinalysis is indicated to monitor renal function; furthermore, among the diagnostic strategies, a throat swab may be necessary in order to confirm the responsible bacterium.

Any therapy, however not always essential, is generally antibiotic and should be continued for 10 days. In case of fever associated with the fourth disease, the most indicated therapy is antipyretic.