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Paediatrics: Exanthem 2: group A streptococcus

Scarlet fever is an erythematous rash that may occur with streptococcal pharyngitis.

Exanthem 2: group A streptococcus

 

Scarlet fever is an erythematous rash that may occur with streptococcal pharyngitis. Other patterns of infection caused by group A streptococcus include toxic shock syndrome and necrotizing fasciitis.

 

Signs and symptoms

 

Prodrome: infection is spread by respiratory secretions and droplets, or by self-infection from nasal carriage. During the incubation period (2–5 days) the child may have fever, vomiting, and abdominal pain.

 

Exanthematous phase: ‘sandpaper-like’ diffuse rash in the neck and chest area (with perioral pallor) spreading to the flexor creases. The pharynx is erythematous and there may be exudative tonsillitis, palatal petechiae, uvular oedema, and strawberry tongue.

 

Other features: tender anterior cervical lymphadenopathy.

 

Diagnosis

 

Throat swab: culture and growth of the organism in a symptomatic individual (note also asymptomatic carriage common)

 

Serum: antistreptolysin O (ASO) and anti-DNase B titres – one or both may rise in acute infection.

 

Management

 

Antibiotics: penicillin V for 10 days. This will prevent the development of rheumatic fever (but not glomerulonephritis) and may reduce the length of illness. Antibiotics should be started within 9 days of acute illness.

 

Isolation: children should be isolated until 24hr after the start of antibiotics.

 

Complications

 

·  Include peritonsillar abscess, retropharyngeal abscess, acute glomeulone-phritis, and rheumatic fever.

 

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Paediatrics: Infectious diseases : Paediatrics: Exanthem 2: group A streptococcus |


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