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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| {{Infobox_Disease | | {{Scarlet fever}} |
| | Name = Scarlet fever
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| | Image =
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| | Caption =
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| | DiseasesDB = 29032
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| | ICD10 = {{ICD10|A|38||a|30}}
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| | ICD9 = {{ICD9|034}}
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| | ICDO =
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| | OMIM =
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| | MedlinePlus = 000974
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| | eMedicineSubj =
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| | eMedicineTopic =
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| | eMedicine_mult =
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| | MeshID =
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| {{SI}}
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| {{CMG}} | | {{CMG}} |
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| ==Overview==
| | {{SK}} Scarlatina |
| '''Scarlet fever''' is an [[exotoxin]]-mediated disease that occurs most often in association with a sore throat and rarely with [[impetigo]] or other streptococcal infections. It is characterized by sore throat, fever, a 'strawberry' tongue, and a fine sandpaper [[rash]] over the upper body that may spread to cover almost the entire body. Scarlet fever is ''not'' [[rheumatic fever]], but may progress into that condition as the infection develops (rheumatic fever is an [[autoimmune disease]] that can occur after infection with Group A strep).
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| == Cause== | | ==[[Scarlet fever overview|Overview]]== |
| [[Streptococcus pyogenes]] (group A strep) is responsible for scarlet fever. It can also cause simple angina, erysipelas and serious toxin-mediated syndromes like [[necrotizing fasciitis]] and the so-called streptococal toxic shock-like syndrome. The virulence of group A strep seems to be increasing lately. The exanthem of scarlatina is thought to be due to erythrogenic toxin production by specific streptococcal strains in a nonimmune patient. Along with erythrogenic toxins, the Group A strep produces several toxins and enzymes. Two of the most important are the streptolysins O and S. Streptolysin O, an hemolytic, thermolabile and immunogenic toxin, is the base of an assay for scarlatina and erysipelas - the [[anti-streptolysin O titer]]. | |
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| ==History== | | ==[[Scarlet fever historical perspective|Historical Perspective]]== |
| This disease was also once known as Scarlatina (from the Italian ''scarlattina''). Many novels depicting life before the 19th century (see ''Scarlet fever in literature'' below) describe scarlet fever as an acute disease being followed by many months spent in convalescence. The convalescence was probably due to complications with rheumatic fever. Prior to an understanding of how streptococcus was spread, it was also not uncommon to destroy or burn the personal effects of a person afflicted with scarlet fever to prevent transmission to other people.
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| ==Signs and symptoms== | | ==[[Scarlet fever pathophysiology|Pathophysiology]]== |
| [[Image:Scarlet fever 1.jpg|thumb|left|140px|The "slapped cheeks" and "white mustache" of scarlet fever.]] | |
| [[Image:Scarlet fever 2.jpg|thumb|left|140px|The scarlet fever rash.]]
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| [[Image:Scharlach.JPG|thumb|left|Tongue with a strawberry appearance.]]
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| Early symptoms indicating the onset of scarlet fever can include:
| | ==[[Scarlet fever causes|Causes]]== |
| <ref name="Balentine">{{cite journal | author=Balentine J and Kessler D | title=Scarlet Fever | journal=[[eMedicine]] | id={{EMedicine2|emerg|518}} | date=March 7, 2006}}</ref>
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| <ref name="Dyne">{{cite journal | author=Dyne P and McCartan K | title=Pediatrics, Scarlet Fever | journal=[[eMedicine]] | id={{EMedicine2|emerg|402}} | date=October 19, 2005}}</ref>
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| *[[Fever]] of 38 to 40 degrees C.(101-104 degrees F.)
| | ==[[Scarlet fever differential diagnosis|Differentiating Scarlet fever from other Diseases]]== |
| *[[Fatigue (physical)|Fatigue]]
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| *[[Sore throat]]
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| *[[Headache]]
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| *Nausea or [[Vomiting]]
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| *Abdominal pain
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| *Flushed face with perioral pallor (circumoral pallor)
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| *[[Tachycardia]] (rapid pulse)
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| *[[Lymphadenopathy]] (enlarged [[lymph node]]s)
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| *Punctate red macules on the hard and soft palate and uvula (ie, Forchheimer spots).
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| *Bright red tongue with a "strawberry" appearance
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| *Characteristic rash, which:
| | ==[[Scarlet fever epidemiology and demographics|Epidemiology and Demographics]]== |
| :*is fine, red, and rough-textured; it [[wikt:blanch|blanches]] upon pressure
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| :*appears 12–48 hours after the fever
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| :*generally starts on the chest, axilla (armpits), and behind the ears
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| :*is worse in the [[skin fold]]s
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| :*Pastia lines (where the rash becomes confluent in the arm pits and groins) appear and persist after the rash is gone
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| *The rash begins to fade three to four days after onset and [[desquamation]] (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later and can last up to a month."<ref name="Dyne"/> Peeling also occurs in axilla, groin, and tips of the fingers and toes.<ref name="Balentine"/>
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| Diagnosis of scarlet fever is clinical. The blood tests shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high ESR and CRP , and elevation of antistreptolysin O titer. Blood culture is rarely positive, but the streptococci can usually be demonstrated in throat culture. The complications of scarlet fever include septic complications due to spread of streptococcus in blood and immune-mediated complications due to an aberrant immune response. Septic complications, today rare, include otitis, sinusitis, streptococcal pneumonia, empyema thoracis, meningitis and full-blown septicaemia ( malignant scarlet fever).
| | ==[[Scarlet fever risk factors|Risk Factors]]== |
| Immune complications include acute glomerulonephritis, rheumatic fever and erythema nodosum. The secondary scarlatinous disease (or secondary malignant syndrome of scarlet fever) included renewed fever, renewed angina, septic ORL complications and nephritis or rheumatic fever and is seen around the 18th day of untreated scarlet fever.
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| | ==[[Scarlet fever natural history|Natural History, Complications and Prognosis]]== |
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| | ==Diagnosis== |
| | [[Scarlet fever history and symptoms|History and Symptoms]] | [[Scarlet fever physical examination|Physical Examination]] | [[Scarlet fever laboratory tests|Laboratory Findings]] | [[Scarlet fever other imaging findings|Imaging Findings]] | [[Scarlet fever other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
| Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any strep throat. In case of penicillin allergy, clindamycin or erythromycin can be used with success.
| | [[Scarlet fever medical therapy|Medical Therapy]] | [[Scarlet fever primary prevention|Primary Prevention]] | [[Scarlet fever secondary prevention|Secondary Prevention]] | [[Scarlet fever cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Scarlet fever future or investigational therapies|Future or Investigational Therapies]] |
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| Antibiotic treatment is usually given. It has however never been shown to reduce the chance that rheumatic fever develops.
| | ==Case Studies== |
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| ==References== | | [[Scarlet fever case study one|Case #1]] |
| <div class="references-small">
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| <references />
| | ==Resources== |
| </div>
| | [http://www.cdc.gov/Features/ScarletFever/ CDC Scarlet Fever] |
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| | [[Category:Disease]] |
| [[Category:Pediatrics]] | | [[Category:Pediatrics]] |
| [[Category:Dermatology]] | | [[Category:Dermatology]] |
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| [[Category:Bacterial diseases]] | | [[Category:Bacterial diseases]] |
| [[Category:Infectious disease]]
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| [[Category:Mature chapter]] | | [[Category:Mature chapter]] |
| [[Category:Overview complete]] | | [[Category:Overview complete]] |
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