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Scarlet Fever
Classification and external resources
ICD-10 A38.
ICD-9 034
DiseasesDB 29032
MedlinePlus 000974
eMedicine derm/383 emerg/402, emerg/518
MeSH D012541

Scarlet fever is a disease caused by exotoxin released by Streptococcus pyogenes. The term scarlatina may be used interchangeably with scarlet fever, though it is commonly used to indicate the less acute form of scarlet fever that is often seen since the beginning of the twentieth century.[1]

It is characterized by:

  • is fine, red, and rough-textured; it blanches upon pressure
  • appears 12–48 hours after the fever
  • generally starts on the chest, armpits, and behind the ears
  • spares the face (although some circumoral pallor is characteristic)
  • is worse in the skin folds. These are called Pastia lines (where the rash runs together in the arm pits and groins) appear and can persist after the rash is gone
  • may spread to cover the uvula.
  • The rash begins to fade three to four days after onset and desquamation (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later."[2] Peeling also occurs in axilla, groin, and tips of the fingers and toes.[3]

Diagnosis of scarlet fever is clinical. The blood test shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and elevation of antistreptolysin O titer. Blood culture is rarely positive, but the streptococci can usually be demonstrated in throat culture. The complications of scarlet fever include septic complications due to spread of streptococcus in blood and immune-mediated complications due to an aberrant immune response. Septic complications, today rare, include ear and sinus infection, streptococcal pneumonia, empyema thoracis, meningitis and full-blown sepsis, upon which the condition may be called malignant scarlet fever.

Immune complications include acute glomerulonephritis, rheumatic fever and erythema nodosum. The secondary scarlatinous disease, or secondary malignant syndrome of scarlet fever, includes renewed fever, renewed angina, septic ear, nose, and throat complications and kidney infection or rheumatic fever and is seen around the eighteenth day of untreated scarlet fever.

Scarlet Fever's pebbly, dry rash.

Symptoms

The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps, and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks (on very dark skin, the streaks may appear darker than the rest of the skin). Areas of rash usually turn white (or paler brown, with dark complected skin) when you press on them. By the sixth day of the infection the rash usually fades, but the affected skin may begin to peel.

Aside there are usually other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever at or above 101 °F (38.3 °C), and swollen glands in the neck. Scarlet fever can also occur with a low fever. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. A person with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever occurs because of a throat infection, the fever typically stops within 3 to 5 days, and the sore throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by rash may begin to peel. This peeling may last 10 days. The infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the person may not get a sore throat.

Treatment

Husband and wife Gladys Henry Dick and George Frederick Dick developed a vaccine in 1924 that was later eclipsed by penicillin in the 1940s. Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any strep throat. In case of penicillin allergy, clindamycin or erythromycin can be used with success. Patients should no longer be infectious after taking antibiotics for 24 hours. Persons who have been exposed to scarlet fever should be watched carefully for a full week for symptoms, especially if aged 3 to young adult. It's very important to be tested (throat culture) and if positive, seek treatment. For reasons unknown, toddlers rarely contract scarlet fever.

References

  1. ^ Scarletina (Scarlet Fever)
  2. ^ Dyne P and McCartan K (October 19, 2005). "Pediatrics, Scarlet Fever". eMedicine. emerg/402. 
  3. ^ Balentine J and Kessler D (March 7, 2006). "Scarlet Fever". eMedicine. emerg/518. 
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