Daily Bolus of LR: Scarlet Fever

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June 20, 2011 by dailybolusoflr

Scarlet Fever


Scarlet fever is caused by a Group A streptococcus infection, the same organism that causes strep throat.

It is often referred to as ‘scarlatina’


Who gets it?

·         Children typically under the age of 18


How do they present?

·         Abrupt onset of fever, chills, malaise, and sore throat (pharynx is red +/- erythematous lesions or petichiae)

·         Next a rash- usually within 12 to 48 hours – that begins on the chest/neck and spreads rapidly, often covering the whole body.  The rash has a rough texture, like sandpaper.

o   It is often most pronounced in folds of skin, such as the elbows and axilla (pastia’s lines)

·         It is often thought that children look like they have circumoral pallor, usually do to the lack of rash around the mouth

·         Strawberry tongue (red, raised bumps on the tongue) is noted- note the tongue may be beefy red or white with red raised dots

·         At the end of the illness, the rash typically desquamates, typically 3-4 days after the onset  

·         You can see some of the rash, desquamation and strawberry tongue here:



What do you do?

·         Patients should be treated with an anti-streptococcal antibiotic, aimed at preventing the long term complications of rheumatic fever and acute glomerulonephritis

·         As in strep throat, oral penicillin VK 4x/day for 10 days or IM Benzathine penicillin are first line

·         In patients allergic to penicillin, erythromycin can be given for 10 days



Ref: Rosen’s


Linda Regan, MD FACEP

Program Director, Emergency Medicine Residency

Johns Hopkins Medical Institutions


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