Scarlet fever: Difference between revisions
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*Caused by | ==Background== | ||
*Prodrome of fever, sore throat, vomiting, | *Caused by [[Group A Strep]] | ||
*Rash | |||
**Enanthem | ==Clinical Features== | ||
***Tonsils/pharynx are red and covered | [[File:Scarlet_fever_1.2.jpg|thumb|"Slapped cheeks" and "white mustache" (circumoral pallor) typical of scarlet fever.]] | ||
[[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) | |||
***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 | ||
**Exanthem | **Exanthem | ||
***Begins 1-2days after onset of illness | |||
***Starts on neck, axillae, groin, spreads to trunk and extremities | ***Starts on neck, axillae, groin, spreads to trunk and extremities | ||
***Red, finely punctate, sandpaper feel | ***Red, finely punctate, sandpaper feel | ||
***Pastia lines: linear petechial eruptions in antecubital/axilla | |||
***Desquamation follows | ***Desquamation follows | ||
==Differential Diagnosis== | |||
{{Peds Rash DDX}} | |||
{{Erythematous rash DDX}} | |||
==Evaluation== | |||
*Clinical diagnosis, based on history and physical exam | |||
==Management== | |||
*Treatment (to reduce rheumatic fever / nephritis) | *Treatment (to reduce rheumatic fever / nephritis) | ||
**Penicillin VK 50mg/kg BID x 10d OR | **[[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 | **If allergic to penicillin → [[Azithromycin]] 10mg/kg on day 1, 5mg/g days 2-5 | ||
==Disposition== | |||
*Discharge | |||
==See Also== | ==See Also== | ||
[[Pediatric Rash]] | *[[Pediatric Rash]] | ||
*[[Acute rheumatic fever]] | |||
==References== | |||
<References/> | |||
[[Category:ID]] | [[Category:ID]] | ||
[[Category: | [[Category:Pediatrics]] | ||
[[Category: | [[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