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Welcome, medical contents search April 26, 2013
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Scarlet Fever

more about Scarlet Fever

  • This condition is a raised rash, caused by bacterial infection.  The child usually has fever and sore throat as well.  The rash usually feels like sandpaper to the touch.

  • Fever appears (usually high fever at the beginning), with sore throat, red throat, pus on the tonsils, and headache.  Usually the child feels quite ill.
  • White coating on the tongue, followed by a very red appearance to the tongue
  • After the fever starts, a rash usually appears on the lower face, the chest, and in the armpits, and then spreads outward on the body.  It might start in the neck, armpits, and groin.  In a lot of children, the rash is raised and feels a bit like sandpaper.  The rash on the face is a diffuse redness, not little dots, and the redness is not present in the immediate area around the lips.  This sparing of the area around the lips is called, "circumoral pallor."
  • The rash begins within 2 days of the fever.
  • In the skin folds (in the groin, for example, or in the fold where the forearm meets the upper arm), obvious red lines may appear, which are called Pastia's lines.  These lines do not blanch when you press on them.

  • Group A, beta hemolytic Streptococcus, a bacterial infection, is the cause of scarlet fever.
  • It produces a harmful substance (a toxin) that causes the rash.
  • There are many groups in the streptococcus family, but only group A causes scarlet fever.  A medical laboratory can identify the correct group, to be sure it is group A, when a child has tonsilitis or a rash.
  • When the streptococci are spread onto a red mixture of protein and blood in a Petri dish (a plastic dish in a laboratory) the alpha hemolytic streptococci partly destroy the blood in the mixture, turning the mixture green.  The beta hemolytic streptococci totally destroy the blood in the mixture, leaving a clear, colorless hole in the protein where the red blood is eaten-away.  This is called "beta hemolysis."

  • This is an illness caused by the same streptococcus that causes a "strep throat."
  • In scarlet fever, this is a streptococcus that is capable of making the toxin that turns the skin red and sandpaper-like.  This toxin is called "erythrogenic toxin."
  • Diagnosis is generally proven by a history of exposure to scarlet fever; the level of illness; the typical spreading of the sandpaper-like rash; the red lines in the skin folds (Pastia's lines); the culturing of this particular streptococcus from the throat; large tender lymph nodes in the neck; and examination of the child's blood.
  • There are rapid tests for streptococci that allow the physician to be fairly certain of group A, beta hemolytic Streptococcus in the throat, by taking a throat swab with a special soft-tipped applicator, and mixing it in a test kit for a few minutes.  The test kits do occasionally give erroneous results.  Also, some children carry streptococci in the throat normally, and do not have either Tonsillitis or scarlet fever.
  • A physician might be more certain that the diagnosis is scarlet fever if (1) the white blood cell count is elevated in a sample of the child's blood, and (2) there is an elevated percent of a particular white blood cell called the PMN leukocyte, in a sample of the child's blood.  However, scarlet fever does not necessarily produce either of these changes in the blood count.
  • In an epidemic of scarlet fever, a physician might be fairly certain of scarlet fever by the fever, skin rash, and Tonsillitis.
  • Taking into account all of these factors, it is not possible to be absolutely certain at the outset that this is a case of scarlet fever, and some viruses may have the identical rash and symptoms.  Because of the serious nature of the illness, physicians are generally forced to make a working assumption that this is a case of scarlet fever, and forced by logic, to treat it.

  • Ages 4 to 9 years are more susceptible, but it does occur in all age groups.
  • Close contact with a child with "strep throat," who might cough or sneeze on another person (since the infection is spread by droplets of mucus)
  • "Strep throat," a Tonsillitis caused by Group A, beta hemolytic Streptococcus

  • Penicillin is the drug of choice. In certain children who are allergic to penicillin, or have other special situations, they might be given erythromycin, a cephalosporin antibiotic, clindamycin, or other antibiotic choices.
  • If the child has nausea, vomiting, or appears quite ill, the physician might choose intramuscular or intravenous antibiotic instead of a medication by mouth.

  • If the child has high fever, sore throat, tender lymph nodes in the neck, and begins to have a rash, see your physician urgently.  The complications of untreated or partially-treated scarlet fever are very serious.
  • Any of these symptoms might turn out to be a bacterial infection, and it is best to get medical advice for any of these symptoms.

  • Streptococcal Tonsillitis ("strep throat")
  • Many viral illnesses give a raised, red rash with a fever and sore throat.  An allergy to antibiotics can cause a raised, red rash.
  • Essentially the same illness can occur at the edges of any wound or burn (if the streptococcus that contaminates the wound or burn is capable of making "erythrogenic toxin").  This is called "surgical scarlet fever."

more about Scarlet Fever

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