Updated: 12/25/2021

Scarlet Fever

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  • Snapshot
    • An 8-year-old girl presents to the pediatrician’s office for a recent illness. She has a sore throat and a diffuse rash that has started to peel. On physical exam, she has a diffuse sandpaper-like rash on her trunk and extremities that spares her palms and soles. The physician also notes circumoral pallor. Concerned about complications of this condition, her physician prescribes a 10-day course of amoxicillin.
  • Introduction
    • Clinical definition
      • acute bacterial infection with diffuse erythematous eruption associated with pharyngitis
  • Epidemiology
    • Demographics
      • children
    • Risk factors
      • exposure to Streptococcus pyogenes or other erythrogenic strains
  • ETIOLOGY
    • Pathogenesis
      • delayed-type hypersensitivity to S. pyogenes exotoxin A
    • Associated conditions
      • streptococcal pharyngitis
  • Presentation
    • Symptoms
      • sore throat
      • fever
    • Physical exam
      • strawberry tongue
      • circumoral pallor
      • diffuse blanching erythema
      • sandpaper-like rash with small papules
        • spreads from the groin and armpits and to the trunk and extremities
        • spares the palms and soles
      • the rash is followed by desquamation
  • Studies
    • Labs
      • rapid streptococcal testing
      • throat culture may reveal streptococcal pharyngitis
  • Differential
    • Kawasaki disease
      • distinguishing factors
        • hand and foot rash
        • prolonged fever
        • conjunctival injection
        • no association with streptococcal pharyngitis
    • Staphylococcal scalded skin syndrome
      • distinguishing factors
        • + Nikolsky sign
  • DIAGNOSIS
    • Making the diagnosis
      • based on clinical presentation
  • Treatment
    • Management approach
      • identical to the treatment approach in patients with streptococcal pharyngitis
      • additional treatment for the rash is not needed
    • Medical
      • penicillin
        • indications
          • for all patients
          • prevention of acute rheumatic fever
        • drugs
          • penicillin V
          • amoxicillin
      • alternatives to penicillin
        • indications
          • for patients with penicillin allergies
          • prevention of acute rheumatic fever
        • drugs
          • cephalosporins
          • clindamycin
          • macrolides
  • Complications
    • Acute rheumatic fever
    • Rheumatic heart disease
  • Prognosis
    • Rash usually fades within a week
    • Desquamation may last several weeks

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