Contents

Search

scarlet fever (2nd disease)

Etiology: Group A Streptococcus Epidemiology: 1) most common in children 2-10 years of age 2) generally follows group A Streptococcal pharyngitis 3) increase in scarlet fever in England 2014-2016 [3] 4) a new emm1 strain (M1UK) of Streptococcus pyogenes associated with outbreak of scarlet fever in 2014-2016 in the UK produces 9X more streptococcal pyrogenic exotoxin A than other emm1 strains [4] Pathology: - streptococcal pyrogenic exotoxin A - streptococcal pyrogenic exotoxin B - streptococcal pyrogenic exotoxin C Clinical manifestations: 1) diffuse, blanchable erythema beginning on face, spreading to trunk & extremities 2) circumoral pallor 3) sandpaper texture to skin 4) accentuation of linear erythema in skin folds (Pastia's lines) 5) exanthem of white tongue evolving into red 'strawberry' tongue 6) desquamation in 2nd week 7) fever 8) pharyngitis 9) headache Laboratory: - rapid screen for group A Streptococcus Management: - see Group A beta-hemolytic Streptococcus

Related

Dukes disease (4th disease) erythema infectiosum (5th disease) measles (1st disease) roseola (exanthem subitum, 6th disease) rubella (German measles, 3rd disease)

General

Streptococcal infection; streptococcosis childhood exanthem (numbered diseases)

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 93
  2. Brinker A Scarlet Fever N Engl J Med 2017; 376:1972. May 18, 2017 PMID: 28514617 Free full text http://www.nejm.org/doi/full/10.1056/NEJMicm1612308
  3. Lamagni T, Guy R, Chand M et al. Resurgence of scarlet fever in England, 2014-16: A population- based surveillance study. Lancet Infect Dis 2017 Nov 27 PMID: 29191628 - Walker MJ, Brouwer S. Scarlet fever makes a comeback. Lancet Infect Dis 2017 Nov 27 PMID: 29191627
  4. Lynskey NN, Jauneikaite E, Li HK et al Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population- based molecular epidemiological study. Lancet Infectious Diseases. Sept 10, 2019 PMID: 31519541 Free Article https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30446-3/fulltext - Brouwer S, Lacey JA, You Y, Davies MR, Walker MJ. Scarlet fever changes its spots. Lancet Infectious Diseases. Sept 10, 2019 PMID: 31519542 Free Article https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30494-3/fulltext