Definition:
Scarlet fever is an exotoxin illness characterized by a red “strawberry-like” tongue, sore throat, fever, and a rash on the upper body that may spread to other parts of the body. A distinction must be made between scarlet fever and rheumatic fever, although the former can progress into the latter.
Diagnosis:
Scarlet fever can be diagnosed clinically. Blood tests can be conducted to screen for leukocytosis with neutrophilia, elevated eosinophils, high erythrocyte sedimentation rate (ESR), increased C-reactive protein (CRP), and elevated antistreptolysin O titer.
Blood culture will often be negative; however, specific throat culture might reveal streptococci.
Treatment:
Treatment for scarlet fever commonly follows the course of strep throat therapy. Antibiotics (penicillin) are used to treat the illness, while appropriate medications are used to target its symptoms. If affected patients are allergic to penicillin, alternative treatments such as clindamycin or erythromycin may be advised.
Symptoms and Signs:
At the onset, scarlet fever presents with fever, headaches, fatigue, sore throat, vomiting, nausea, abdominal pain, flushed face, paleness around the mouth, a rapid pulse rate (tachycardia), enlarged lymph nodes (lymphadenopathy), forchheimer, and a characteristic bright red tongue that has been described as “strawberry” in appearance.
Within 12-48 hours from the onset of the fever, a characteristic rash appears. This rash is usually fine, reddish in color, and rough in texture. It first appears at the chest, armpits, and behind the ears, and tends to be more severe in skin folds. Even after the rash disappears, pastia lines remain.
Three to four days after the onset, the rash begins to fade. The affected skin area then starts to peel.
Scarlet fever can lead to chronic complications, including acute septic problems (e.g. ear/sinus infections, pneumonia, meningitis, etc.) and immune-related complications (e.g. rheumatic fever, erythema nodosum, acute glomerulonephritis, etc.).
Causes:
Scarlet fever is caused by streptococcus pyogenes or group A streptococcus, which can also cause erysipelas, simple agine, and other toxin-mediated syndromes.
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