Has Victorian connotations as fatal epidemics of Scarlet fever swept through slums in the pre-antibiotic era.
Group A streptococcus pyogenes is still carried in up to 20% of young children’s throats. Disease peaks in winter and spring (cool conditions, and more time indoors?). Spread easily through saliva.
Scarlet fever (“scarlatina” is usually used for mild cases) is when an exotoxin is produced, that causes fever and rash. Characteristic features are:
- Strawberry tongue – progresses from white coated, to red, beefy tongue as coating lifts.
- Perioral pallor
- Fiery, widespread rash – rough “sandpaper” feel characteristic
- Pastia’s lines – lines of petechiae in creases esp wrists, elbows
- Palatal petechiae (“Forchheimer spots”) – not specific, also measles.
- As rash fades, desquamation can occur, particularly on fingers/toes. Should only happen once in lifetime, as antibodies form to toxin!?
No longer notifiable in Scotland, cf England/Wales.
Complications can still be severe of course, as with any group A strep disease:
- Toxic shock, invasive disease
- Mastoiditis, retropharyngeal abscess
- Rheumatic fever, Sydenham’s chorea
- Post streptococcal acute glomerulonephritis
Exclude from nursery/school until 24hrs after starting antibiotics.
No resistance to penicillin and low MIC so preferred. 10 day course of Penicillin V recommended (for clearance from throat, as opposed to clinical improvement), for penicillin allergy 10 days clarithromycin or 5 days azithromycin (from age 6 months).
Other antibiotics eg clindamycin may be preferred however if invasive disease.