scarlet fever

Question 1

what is the causative organism of scarlet fever?

Answer 1

streptococcus pyogenes (group A strep)

Question 2

describe the presentation of scarlet fever

Answer 2

-incubation 1-7 days
- rapid onset of fever, chills, vomiting, headache, toxic appearance (strep throat symptoms: HA, and pain, ST, and fever)
-tonsils are erythematous and white exudates
-tongue:
> white strawberry tongue: prominent edematous papillae
>red strawberry tongue

Question 3

describe the presentation of scarlet fever

Answer 3

exanthem:

• onset concurrent with fever
• fine, mildly erythematous papules (sandpaper-like)
• starts in AXILLA, groin and trunk (most prominent in axilla)
• within 24 hours it generalizes, spares face
• most intense @ pressure sites
• occas. petechiae on mucosal surfaces (esp. soft palate)
• cheeks/forehead flushed, circumoral pallor (white around mouth)

Question 4

what are some associated characteristics/symptoms of scarlet fever?

Answer 4

• miliary sudamina: small vesicular lesions on abdomen, hands, and feel in severe cases
• pastia lines: linear hyperpigmentation in deep creases, esp. antecubital fossa (does NOT blanche)
• desquamation: occasionally desquamation occurs after the rash clears

Question 5

what would you do in order to evaluate/diagnose scarlet fever?

Answer 5

-primarily diagnosed by classic clinical picture
- GAS (group A strep) cultured from pharynx or wound
>rapid strep is only 70% sensitive, culture needed in addition to rapid strep

Question 6

what are some complications of scarlet fever?

Answer 6

if missed, GAS can vegetate on the cardiac valves and cause valvular damage

Question 7

what are treatment options for scarlet fever?

Answer 7

• antibiotic is ESSENTIAL! PEN VK is drug of choice (penicillin)
• amoxicillin is used in pediatrics (PEN V x 10d)
  > cephalexin (keflex) can also be used
• IM benzathine PCN (single injection)
• erythromycin (x 10d)