II. Pathophysiology

  1. Occurs in Group A beta-hemolytic streptococcal (GAS) infection (typically Streptococcal Pharyngitis)
  2. Some GAS strains produce streptococcal pyrogenic exotoxin
    1. Patients with Hypersensitivity to the toxin may develop a rash

III. Epidemiology

  1. Occurs in 10% of Streptococcal Pharyngitis cases

IV. Symptoms

  1. Fever
    1. Peaks on Day 2
    2. Returns to normal on Day 5-7
  2. Chills
  3. Headache
  4. Vomiting
  5. Pharyngitis

V. Signs

  1. Forehead and cheeks appear flushed
  2. Circumoral pallor and sparing of rash
  3. Pharyngitis
    1. Tonsils are hyperemic and edematous, with exudate
    2. Throat is inflamed and covered by a membrane
    3. Palatal Petechiae may be present
  4. Strawberry Tongue
    1. Fine Papules on Tongue surface
    2. Tongue dorsum may appear with a white exudate and projecting edematous papillae
  5. Sandpaper Rash
    1. Onset with 12-72 hours after fever
    2. Coalescing, blanching erythematous Macules (may appear Sunburn-like)
    3. Fine papular or punctate lesions
      1. Texture of coarse sandpaper
    4. Rash distribution
      1. Starts on upper trunk
      2. Rash distribution generalizes within 24 hours
    5. Rash may affect flexor creases (Pastia lines) in the axillae, antecubital, groin and neck
      1. Pastia lines due not typically blanche
    6. Rash spares the palms and soles
      1. However, Desquamation of palms and soles may occur
  6. Desquamation
    1. Follows rash fading after several weeks
    2. Desquamation of face, skin folds, hands and feet
    3. Desquamation may last up to 6 weeks

VI. Labs

  1. Streptococcal Rapid Antigen Test
  2. Throat Culture
    1. Used to confirm a negative rapid Antigen test
  3. Antistreptolysin O titer (ASO Titer)
    1. Confirms diagnosis, but not typically helpful in acute disease

VII. Differential Diagnosis

  1. Staphylococcal Scalded Skin Syndrome
  2. Kawasaki's Disease
    1. Also with Desquamation of palms and soles as well as strawberry Tongue

VIII. Management

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Ontology: Scarlet Fever (C0036285)

Definition (NCI) A streptococcal infection, mainly occuring among children, that is characterized by a red skin rash, sore throat, and fever.
Definition (MSH) Infection with group A streptococci that is characterized by tonsillitis and pharyngitis. An erythematous rash is commonly present.
Concepts Disease or Syndrome (T047)
MSH D012541
ICD9 034.1
ICD10 A38 , A38.9
SnomedCT 154303009, 30242009
LNC LA17017-7
English Fevers, Scarlet, Scarlet Fever, Scarlet Fevers, Fever, Scarlet, scarlet fever, scarlet fever (diagnosis), Scarletina, Scarlet fever, NOS, Scarlet Fever [Disease/Finding], Scarlatina, Scarlet fever, Scarlet fever (disorder), febris; rubra, rubra; febris, scarlatina
Spanish escarlatina, escarlatina (trastorno), fiebre escarlata (trastorno), fiebre escarlata, Fiebre Escarlata, Fiebre escarlatina, Escarlatina
Dutch scarlatina, scarlatine, febris; rubra, rubra; febris, roodvonk, Roodvonk, Scarlatina
Japanese 猩紅熱, ショウコウネツ
Swedish Scharlakansfeber
Czech spála, Spála, druhá dětská nemoc, scarlatina
Finnish Tulirokko
Korean 성홍열
Polish Płonica, Szkarlatyna
Hungarian Skarlátos láz, skarlát, Scarlatina
Norwegian Skarlagensfeber, Scarlatina
Portuguese Febre Escarlate, Escarlatina
French Scarlatine
German Scarlatina, Scharlach
Italian Scarlattina