June 20, 2011 by dailybolusoflr
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
Linda Regan, MD FACEP
Program Director, Emergency Medicine Residency
Johns Hopkins Medical Institutions