Makindo Medical Notes

Scarlet fever (Scarlatina) is unlikely if the patient presents with coryzal symptoms, cough, or diarrhoea. Without treatment, individuals can remain infectious for two to three weeks after symptoms appear.

About

• Scarlet fever is primarily a childhood disease.
• It is most commonly seen in children aged 2 to 8 years.

Aetiology

• Caused by toxin-producing strains of Streptococcus pyogenes (Group A Streptococcus, GAS).
• Highly contagious, it spreads through close contact with infected individuals.
• Symptoms typically develop 2 to 5 days after exposure to the bacteria.

Clinical Features

• Rash:
  • Begins as papular lesions on the body, spreading to the neck and arms.
  • Accentuated in flexural creases but spares the palms and soles.
  • Has a characteristic sandpaper-like feel and is non-pruritic.
• Associated symptoms include:
  • Sore throat or tonsillitis.
  • Fever.
  • Painful cervical lymphadenopathy.
  • Strawberry tongue.

Complications

• Rarely, invasive Group A Streptococcal infections, such as:
  • Meningitis.
  • Pneumonia.
  • Septic arthritis.

Differential Diagnoses

• Measles.
• Rubella.
• Roseola.
• Kawasaki disease.
• Drug rash or allergic reactions.

Investigations

• Clinical diagnosis based on characteristic symptoms and physical examination.
• Throat swab to confirm Group A Streptococcus if needed.
• Blood tests (e.g., ASO titres) in cases with suspected complications.

Management

• Prevention:
  • Wash hands frequently.
  • Do not share eating utensils, drinking glasses, or personal items with an infected person.
  • Dispose of tissues and handkerchiefs used by infected individuals.
  • Avoid close contact with infected individuals to reduce the risk of transmission.
• Actions:
  • Seek medical advice promptly if you or your child develop symptoms.
  • Complete the full course of prescribed antibiotics to eliminate the bacteria and reduce the risk of complications.
  • Stay at home and avoid nursery, school, or work for at least 24 hours after starting antibiotics.
• Treatment:
  • First-line: Penicillin V.
  • Alternative: Amoxicillin or Azithromycin for penicillin-allergic patients.

References

• NHS - Scarlet Fever