Scarlet fever: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Prodrome of fever, [[sore throat]], [[vomiting]], [[ | [[File:Scarlet_fever_1.2.jpg|thumb|"Slapped cheeks" and "white mustache" (circumoral pallor) typical of scarlet fever.]] | ||
*Rash | [[File:Skarlatina.jpg|thumb|[[Strawberry tongue]].]] | ||
[[File:Scharlach.jpg|thumb|Red "[[strawberry tongue]]" in a patient with [[scarlet fever]].]] | |||
[[File:Pos strep.jpg|thumb|Culture positive strep pharyngitis with typical tonsillar exudate]] | |||
[[File:Scarlet Fever.jpg|thumb|Characteristic red cheeks and rash of scarlet fever.]] | |||
[[File:Scarlet fever 2.jpg|thumb|Scarlet fever rash.]] | |||
*Prodrome of [[fever]], [[sore throat]], [[vomiting]], [[abdominal pain]] followed by rash 1-2d later | |||
*[[Rash]] | |||
**Enanthem (rash involving mucous membrane) | **Enanthem (rash involving mucous membrane) | ||
***Tonsils/pharynx are red and covered | ***Tonsils/pharynx are red and covered with exudate | ||
***Tongue may have initial exudate followed by erythema ("strawberry tongue) | ***Tongue may have initial exudate followed by erythema ("strawberry tongue) | ||
***Soft palate have bright-red spots | ***Soft palate have bright-red spots | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Peds Rash DDX}} | {{Peds Rash DDX}} | ||
{{Erythematous rash DDX}} | |||
== | ==Evaluation== | ||
*Clinical diagnosis, based on history and physical exam | *Clinical diagnosis, based on history and physical exam | ||
==Management== | ==Management== | ||
*Treatment (to reduce rheumatic fever / nephritis) | *Treatment (to reduce rheumatic fever / nephritis) | ||
**[[Penicillin VK]] 50mg/kg BID x 10d '''OR''' [[Amoxicillin]] | **[[Penicillin VK]] 50mg/kg BID x 10d '''OR''' [[Amoxicillin]] 50mg/kg/d in 2 divided doses or one time dose x10d<ref>https://www.cdc.gov/groupastrep/diseases-hcp/scarlet-fever.html</ref> | ||
**If allergic to | **If allergic to penicillin → [[Azithromycin]] 10mg/kg on day 1, 5mg/g days 2-5 | ||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Pediatric Rash]] | *[[Pediatric Rash]] | ||
*[[Acute rheumatic fever]] | |||
==References== | ==References== | ||
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[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Pediatrics]] | ||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
Latest revision as of 23:27, 5 November 2025
Background
- Caused by Group A Strep
Clinical Features
- Prodrome of fever, sore throat, vomiting, abdominal pain followed by rash 1-2d later
- Rash
- Enanthem (rash involving mucous membrane)
- Tonsils/pharynx are red and covered with exudate
- Tongue may have initial exudate followed by erythema ("strawberry tongue)
- Soft palate have bright-red spots
- Exanthem
- Begins 1-2days after onset of illness
- Starts on neck, axillae, groin, spreads to trunk and extremities
- Red, finely punctate, sandpaper feel
- Pastia lines: linear petechial eruptions in antecubital/axilla
- Desquamation follows
- Enanthem (rash involving mucous membrane)
Differential Diagnosis
Pediatric Rash
- Atopic dermatitis
- Bed bugs
- Contact dermatitis
- Drug rash
- Erythema infectiosum (Fifth disease)
- Hand-foot-and-mouth disease
- Henoch-schonlein purpura (HSP)
- Herpangina
- Herpes simplex virus (HSV)
- Infectious mononucleosis
- Meningitis
- Measles
- Molluscum contagiosum
- Roseola infantum
- Rubella (German measles)
- Scabies
- Scarlet fever
- Smallpox
- Varicella (Chickenpox)
Erythematous rash
- Positive Nikolsky’s sign
- Febrile
- Staphylococcal scalded skin syndrome (children)
- Toxic epidermal necrolysis/SJS (adults)
- Afebrile
- Febrile
- Negative Nikolsky’s sign
- Febrile
- Afebrile
Evaluation
- Clinical diagnosis, based on history and physical exam
Management
- Treatment (to reduce rheumatic fever / nephritis)
- Penicillin VK 50mg/kg BID x 10d OR Amoxicillin 50mg/kg/d in 2 divided doses or one time dose x10d[1]
- If allergic to penicillin → Azithromycin 10mg/kg on day 1, 5mg/g days 2-5
Disposition
- Discharge