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PATIENT STORY

A 7-year-old boy is brought to the family physician's office with a rough red rash on his trunk (Figures 36-1 and 36-2) along with fever and a sore throat. The sandpaper rash and signs consistent with strep pharyngitis lead the physician to diagnose scarlet fever. The physician explains the diagnosis to the mother, and oral Pen VK is prescribed. The boy feels markedly better by the next day, and the mother continues to give the penicillin for the full 10 days as directed to prevent rheumatic fever.

FIGURE 36-1

Sandpaper rash on the trunk and in the axilla of a 7-year-old boy with scarlet fever. (Reproduced with permission from Richard P. Usatine, MD.)

FIGURE 36-2

Scarlatiniform rash comprising small papules and erythema on the trunk of a febrile child with strep pharyngitis. (Reproduced with permission from Richard P. Usatine, MD.)

INTRODUCTION

Scarlet fever is an illness caused by toxin-producing group A β-hemolytic streptococci. Most commonly, scarlet fever evolves from an exudative pharyngitis.

Strawberry tongue may be observed in patients with scarlet fever, and usually develops within the first 2 to 3 days of illness. A white or yellowish coating usually precedes the classic red tongue with white papillae (Figure 36-3).

FIGURE 36-3

Sandpaper rash (scarlatiniform) seen prominently on the hand of a child recovering from strep pharyngitis. (Reproduced with permission from Richard P. Usatine, MD.)

EPIDEMIOLOGY

  • Scarlet fever is predominately seen in school-age children with no gender predilection.

  • Majority related to strep pharyngitis, with 1 in 10 developing scarlet fever (Figures 36-1, 36-2, and 36-4).

  • Prevalent in late fall to early spring.

  • Strawberry tongue (see Figure 36-4) is most commonly seen in children in association with scarlet fever or Kawasaki disease.

  • Can be present with other group A Streptococcus (strep) infections.

  • In cases of strep, a white membrane through which the papillae are seen can initially cover the tongue, followed by desquamation of the membrane (with the appearance as in Figure 36-4).

FIGURE 36-4

Strawberry tongue in a child with scarlet fever caused by strep pharyngitis; note marked erythema and prominent papillae. (Reproduced with permission from Richard P. Usatine, MD.)

ETIOLOGY AND PATHOPHYSIOLOGY

  • Transmission of Streptococcus occurs via respiratory secretions.

  • Virulent Streptococcus pyogenes (group A streptococcus or GAS) incubate more than 2 to 7 days. M protein serotypes of GAS are typically more invasive with greater potential for progression ...

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