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Scarlet fever (Clinical presentation (Rash 12-48h after fever/sore…
Scarlet fever
Clinical
presentation
Rash
12-48h after fever/sore throat
Starts on chest/abdo, spreads to limbs, neck etc.
Red pin prink, sandpaper like, blanching
Facial flushing
Red face with cicrumoral pallor
Strawberry tongue
May be white coated first, then strawberry red and inflamed
Fever
Typically high (>38)
Sore throat
Headache
Fatigue
N+V
Epidemiology
Commonest children 2-8y (peak 4y)
Seasonal (winter/spring)
Uncommon, but increasing incidence
Pathophysiology
Agent
Group A B-haemolytic strep pyogenes
Mechanism
Incubation period is 1-6d
Asymptomatic pharyngeal carriage of S pyogenes common
Toxin-producing strain infects the pharynx causing pharyngitis, releases exotoxins causing rash and fever
Can have life-threatening complications (TSS, necrotising fasciitis)
Transmission
Highly contageous
Infected saliva or aerosol transmission
Diagnosis
Examination
ENT examination
General: flushed face, circumoral pallor, swollen cervical LNs
Throat: strawberry tongue (may initially be white coated then beefy red),
red swollen tonsils and throat, red macules on palate (Forchheimer spots)
Ears/nose: NAD
Derm examination
Red florid rash, particularly in skin folds
May be peeling (particularly at digits)
Investigations
Bedside
Obs (fever)
History
PMH
Milestones and development
Known conditions, allergies,
immunocompromised, T1DM
DH
Current meds, allergies
PC/HPC
Rash (started trunk, moved peripheral, sudden,
red/pinkprick, blanching)
Associated fever, malaise, headache, sore throat, N+V
Red flags:
chest pain, syncope, confusion/headaches/weakness, hoarse voice/stridor/SOB, abdominal pain, bony pain
FH
Anyone else unwell
SH
Living arrangements, nursery/school
Prognosis
Usually mild and self limiting,
abx needed to reduce complications
Symptoms usually resolve by 1wk,
may get peeling skin after rash resolves
Unlikely to recur, but may get other
types of strep infection
Differentials
Infection
Viral: rubella, parvovirus B19, measles, roseola infantum,
adenovirus, enterovirus, tropical viruses, CMV, HIV,
Bacterial: staph TSS, brucellosis, syphilis
Parasitic: toxoplasmosis
Autoimmune
Kawasaki disease
Drugs
Drug reactions (e.g. mononucleosis reaction to penicillin)
AED reactions
Management
Conservative
Notify PHE (notifiable disease)
Admit if pre-exsisting valve disease/immunocompromised or suspected severe complication of GAS
Self care (stay away from school for 24h after starting abx, wash hands thoroughly/regularly, avoid sharing utensils and towels, avoid immunocompromised people/pregnant women/DM)
Return if no better in 7d
Medical
Abx
Indication: well patient
E.g. penicillin V PO 10d
Analgesia
Indication: pain/fever
E.g. paracetamol, ibuprofen
Complications
Supperative
(infectious)
Early, due to spread
ENT
Ears: otitis media
Throat: peritonsillar/retropharyngeal abscess, cellulitis
Sinuses: sinusitis, mastoiditis
Heart
Endocarditis
Systemic
Strep toxic shock syndrome (TSS)
Skin
Necrotising fasciitis
CNS
Meningitis, cerebral abscess
Encephalomyelitis
Musculoskeletal
Osteomyelitis
Gastrointestinal
Liver abscess
Non-supperative
(autoimmune)
Late complication
Strep GN
2 weeks after infection
Present with haematuria, reduced output, peripheral oedema
O/E have peripheral edema, HTN, haematuria and proteinuria
Acute rheumatic fever
Endocarditis, leading to valve disease
Reactive arthritis
Skin manifestations
Definition
Infection of URT and systemic
caused by GAS (S pyogenes)
