Scarlet fever
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| Scarlet fever Classification and external resources | |
| ICD-10 | A38. |
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| ICD-9 | 034 |
| DiseasesDB | 29032 |
| MedlinePlus | 000974 |
| eMedicine | derm/383 emerg/402, emerg/518 |
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Most recent articles on Scarlet fever Most cited articles on Scarlet fever | |
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Ongoing Trials on Scarlet fever at Clinical Trials.gov Trial results on Scarlet fever Clinical Trials on Scarlet fever at Google
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US National Guidelines Clearinghouse on Scarlet fever NICE Guidance on Scarlet fever
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Scarlet fever is an exotoxin-mediated disease that occurs most often in association with a sore throat and rarely with impetigo or other streptococcal infections. It is characterized by sore throat, fever, a 'strawberry' tongue, and a fine sandpaper rash over the upper body that may spread to cover almost the entire body. Scarlet fever is not rheumatic fever, but may progress into that condition as the infection develops (rheumatic fever is an autoimmune disease that can occur after infection with Group A strep).
Cause
Streptococcus pyogenes (group A strep) is responsible for scarlet fever. It can also cause simple angina, erysipelas and serious toxin-mediated syndromes like necrotizing fasciitis and the so-called streptococal toxic shock-like syndrome. The virulence of group A strep seems to be increasing lately. The exanthem of scarlatina is thought to be due to erythrogenic toxin production by specific streptococcal strains in a nonimmune patient. Along with erythrogenic toxins, the Group A strep produces several toxins and enzymes. Two of the most important are the streptolysins O and S. Streptolysin O, an hemolytic, thermolabile and immunogenic toxin, is the base of an assay for scarlatina and erysipelas - the anti-streptolysin O titer.
History
This disease was also once known as Scarlatina (from the Italian scarlattina). Many novels depicting life before the 19th century (see Scarlet fever in literature below) describe scarlet fever as an acute disease being followed by many months spent in convalescence. The convalescence was probably due to complications with rheumatic fever. Prior to an understanding of how streptococcus was spread, it was also not uncommon to destroy or burn the personal effects of a person afflicted with scarlet fever to prevent transmission to other people.
Signs and symptoms
Early symptoms indicating the onset of scarlet fever can include: [1] [1]
- Fever of 38 to 40 degrees C.(101-104 degrees F.)
- Fatigue
- Sore throat
- Headache
- Nausea or Vomiting
- Abdominal pain
- Flushed face with perioral pallor (circumoral pallor)
- Tachycardia (rapid pulse)
- Lymphadenopathy (enlarged lymph nodes)
- Punctate red macules on the hard and soft palate and uvula (ie, Forchheimer spots).
- Bright red tongue with a "strawberry" appearance
- Characteristic rash, which:
- is fine, red, and rough-textured; it blanches upon pressure
- appears 12–48 hours after the fever
- generally starts on the chest, axilla (armpits), and behind the ears
- is worse in the skin folds
- Pastia lines (where the rash becomes confluent in the arm pits and groins) appear and persist after the rash is gone
- The rash begins to fade three to four days after onset and desquamation (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later and can last up to a month."[1] Peeling also occurs in axilla, groin, and tips of the fingers and toes.[1]
Diagnosis of scarlet fever is clinical. The blood tests shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high ESR and CRP , and elevation of antistreptolysin O titer. Blood culture is rarely positive, but the streptococci can usually be demonstrated in throat culture. The complications of scarlet fever include septic complications due to spread of streptococcus in blood and immune-mediated complications due to an aberrant immune response. Septic complications, today rare, include otitis, sinusitis, streptococcal pneumonia, empyema thoracis, meningitis and full-blown septicaemia ( malignant scarlet fever). Immune complications include acute glomerulonephritis, rheumatic fever and erythema nodosum. The secondary scarlatinous disease (or secondary malignant syndrome of scarlet fever) included renewed fever, renewed angina, septic ORL complications and nephritis or rheumatic fever and is seen around the 18th day of untreated scarlet fever.
Treatment
Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any strep throat. In case of penicillin allergy, clindamycin or erythromycin can be used with success.
Antibiotic treatment is usually given. It has however never been shown to reduce the chance that rheumatic fever develops.
References
Exanthema | |
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| Viral | Measles (1st disease) - Rubella (3rd disease) - Duke's disease (4th disease) - Slap cheek (5th disease) - Roseola (6th disease) |
| Bacterial | Scarlet fever (2nd disease) |
WikiDoc Research Resources for Scarlet fever | |
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| Articles on Scarlet fever | Most recent articles on Scarlet fever • Most cited articles on Scarlet fever • Review articles on Scarlet fever • Articles on Scarlet fever in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Scarlet fever | Powerpoint slides on Scarlet fever • Images of Scarlet fever • Photos of Scarlet fever • Podcasts & MP3s on Scarlet fever • Videos on Scarlet fever |
| Evidence Based Medicine Regarding Scarlet fever | Cochrane Collaboration on Scarlet fever • Bandolier on Scarlet fever • TRIP on Scarlet fever |
| Cost Effectiveness of Scarlet fever | Cost Effectiveness of Scarlet fever |
| Clinical Trials Involving Scarlet fever | Ongoing Trials on Scarlet fever at Clinical Trials.gov • Trial results on Scarlet fever • Clinical Trials on Scarlet fever at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Scarlet fever | US National Guidelines Clearinghouse on Scarlet fever • NICE Guidance on Scarlet fever • NHS PRODIGY Guidance • FDA on Scarlet fever • CDC on Scarlet fever |
| Textbook Information on Scarlet fever | Books and Textbook Information on Scarlet fever |
| Pharmacology Resources on Scarlet fever | Dosing of Scarlet fever • Drug interactions with Scarlet fever • Side effects of Scarlet fever • Allergic reactions to Scarlet fever • Overdose information on Scarlet fever • Carcinogenicity information on Scarlet fever • Scarlet fever in pregnancy • Pharmacokinetics of Scarlet fever • |
| Genetics, Pharmacogenomics, and Proteinomics of Scarlet fever | Genetics of Scarlet fever • Pharmacogenomics of Scarlet fever • Proteomics of Scarlet fever |
| Newstories on Scarlet fever | Scarlet fever in the news • Be alerted to news on Scarlet fever • News trends on Scarlet fever |
| Commentary on Scarlet fever | Blogs on Scarlet fever |
| Patient Resources on Scarlet fever | Patient resources on Scarlet fever • Discussion groups on Scarlet fever • Patient Handouts on Scarlet fever • Directions to Hospitals Treating Scarlet fever • Risk calculators and risk factors for Scarlet fever |
| Healthcare Provider Resources on Scarlet fever | Symptoms of Scarlet fever • Causes & Risk Factors for Scarlet fever • Diagnostic studies for Scarlet fever • Treatment of Scarlet fever |
| Continuing Medical Education (CME) Programs on Scarlet fever | CME Programs on Scarlet fever |
| International Resources on Scarlet fever | Scarlet fever en Espanol • Scarlet fever en Francais |
| Business Resources on Scarlet fever | Scarlet fever in the Marketplace • Patents on Scarlet fever |
| Informatics Resources on Scarlet fever | List of terms related to Scarlet fever |
bg:Скарлатина da:Skarlagensfeber de:Scharlach (Krankheit) fr:Scarlatine id:Skarlatina it:Scarlattina lv:skarlatīna nl:Roodvonk ja:猩紅熱 ku:Sûretafi:Tulirokko sv:Scharlakansfeber
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
