Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!

A 7-year-old boy is brought to the family physician's office with a rough red rash on his trunk (Figures 34-1 and 34-2) 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 34-1

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

Figure 34-2

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

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 34-3).

Figure 34-3

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

  • 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 34-1, 34-2, and 34-4).
  • Prevalent in late fall to early spring.
  • Strawberry tongue (Figure 34-4) is most commonly seen in children in association with scarlet fever or Kawasaki disease.
  • Can be present with other group A Streptococcus (strep) infection.
  • 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 34-4).

Figure 34-4

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

  • 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 to rheumatic fever or acute glomerulonephritis if untreated.1
  • Fever and rash are related to pyrogenic A-C and erythrogenic exotoxins produced by GAS.2
  • Infection may originate from other sites like skin (e.g., cellulitis), and seed blood (bacteremia) or ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.