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General Medicine

Scarlet Fever

Christina Scartozzi, DO Reviewed 04/2024
 


BASICS

DESCRIPTION

  • A disease (typically in childhood) characterized by fever, pharyngitis, and rash caused by group A β-hemolytic Streptococcus pyogenes (GAS) that produces erythrogenic toxin

  • Incubation...

DIAGNOSIS

HISTORY

Prodrome 1 to 2 days 

  • Sore throat

  • Headache

  • Myalgias

  • Malaise

  • Fever (>38°C [100.4°F])

  • Vomiting

  • Abdominal pain (may mimic acute abdomen)

  • Rash—scarlatiniform erythematous punctate eruption

  • Coug...

TREATMENT

GENERAL MEASURES

Supportive care; analgesic/antipyretic such as acetaminophen or NSAID, for moderate to severe symptoms or to control fever. Symptomatic treatment can include medicated throat...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Follow-up throat culture not needed unless symptomatic 

Patient Monitoring

GAS is uniformly susceptible to penicillin, treatment failures are typically due to: 

  • Poor...

REFERENCES

1
Shulman  ST, Bisno  AL, Clegg  HW, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infe...

ADDITIONAL READING

Mohapatra RK, Kutikuppala LVS, Mishra S, et al. Rising global incidence of invasive group A streptococcus infection and scarlet fever in the COVID-19 era—our knowledge th...

SEE ALSO

  • Pharyngitis

  • Algorithm: Pharyngitis

CODES

ICD10

  • A38.9 Scarlet fever, uncomplicated

  • J02.0 Streptococcal pharyngitis

  • A38.0 Scarlet fever with otitis media

  • A38.8 Scarlet fever with other complications

SNOMED

  • 30242009 Scarlet fever (disorder)

  • 1863...

CLINICAL PEARLS

  • Consider scarlet fever in the differential diagnosis of children with fever and an exanthematous rash.

  • Key clinical findings include strawberry tongue, circumoral pallor, and a coarse s...

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FIG. 11.10. Streptococcal pharyngitis. Streptococcal pharyngitis is characterized by an erythematous posterior pharynx (A), palatal petechiae (B), and a white strawberry tongue (C). Each of these findings suggests streptococcal, not viral, infection. Many cases are not as obvious.

 

FIG. 11.10. Streptococcal pharyngitis. Streptococcal pharyngitis is characterized by an erythematous posterior pharynx (A), palatal petech...

FIG. 11.10. Streptococcal pharyngitis. Streptococcal pharyngitis is characterized by an erythematous posterior pharynx (A), palatal petechiae (B), and a white strawberry tongue (C). Each of these findings suggests streptococcal, not viral, infection. Many cases are not as obvious.

 

FIG. 11.10. Streptococcal pharyngitis. Streptococcal pharyngitis is characterized by an erythematous posterior pharynx (A), palatal petech...

FIG. 11.10. Streptococcal pharyngitis. Streptococcal pharyngitis is characterized by an erythematous posterior pharynx (A), palatal petechiae (B), and a white strawberry tongue (C). Each of these findings suggests streptococcal, not viral, infection. Many cases are not as obvious.

 

FIG. 11.10. Streptococcal pharyngitis. Streptococcal pharyngitis is characterized by an erythematous posterior pharynx (A), palatal petech...

FIG. 11.55. Pharyngitis in infectious mononucleosis. This girl has inflamed, bilaterally swollen tonsils with a diffuse exudate, as is often seen with infectious mononucleosis.

 

FIG. 11.55. Pharyngitis in infectious mononucleosis. This girl has inflamed, bilaterally swollen tonsils with a diffuse exudate, as is oft...

<bold>Figure 61-4</bold> Rash seen with scarlet fever. Note the diffuse distribution of this rash that is more intensein the lower abdomen and groin.

 

<bold>Figure 61-4</bold> Rash seen with scarlet fever. Note the diffuse distribution of this rash that is more intensein the l...

<bold>Figure 61-5</bold> Palmar erythema. Note the intense palmer redness seen in a child with Scarlet fever.

 

<bold>Figure 61-5</bold> Palmar erythema. Note the intense palmer redness seen in a child with Scarlet fever.

 

Palatal petechiae strongly suggestive of sterptococcal pharyngitis

 

Palatal petechiae strongly suggestive of sterptococcal pharyngitis

 

Palatal petechiae strongly suggestive of sterptococcal pharyngitis

 

Palatal petechiae strongly suggestive of sterptococcal pharyngitis

 

Tonsillar exudate. May be present in viral tonsillitis as well as group A strep infection.

 

Tonsillar exudate. May be present in viral tonsillitis as well as group A strep infection.

 
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