Scarlet fever

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Scarlet Red
Isnt all well read !


Japanese RED boy = kawasaki disease
Asian RED boy = scarlet fever
African RED boy = Kwashiorkar ?

Scarlet fever
Has been a major morbidity and mortality
In prepenicillin era; in epidemics
The incidence and severity decreased over years with changed streptococcal virulence in response to newer antibiotics.
Rash develops in fewer than 10% of cases of "strep throat."


incidence
Age 4-8 years peak
By the time children are 10-years-old, 80% have developed lifelong protective antibodies against streptococcal pyrogenic exotoxins.
Scarlet fever is rare in children younger than 2 years, because of the presence of maternal antiexotoxin antibodies and lack of prior sensitization.

Despite incomplete Kawasaki label
Scarlet fever is easy to diagnose..
Seen in kids not exposed often to streptococcal infections; thus not having any antibacterial or antitoxin immunity.


Diagnostic is red ..
Red tonsils red tongue and red rash !
White – red- strawberry tongue
Starts on face, nonpunctate; on trunk it is punctate erythematous boiled lobster appearance
And evidence of Hemolytic Streptococci

Other signs: falsly diagnostic
Circumoral Pallor
Pastia sign
Pin hole peeling


Differentials
If rash is illdefined with mild tonsil = Rubella
If rash is confluent = closer to measles
If exudative tonsillitis = closer to staph
Macular rash = drug rash
Tender nodes = adenitis
Nondiscrete LN = closer to diptheria
If no strept = incomplete Kawasaki


Clinical variants
Mild = ambulatory, fever is major symptom
Moderate = toxic look, with some dysphagia
Severe = bedridden
Septic Scarlet fever = local sepsis/ perf
Toxic Scarlet fever = systemic sepsis
Extrafaucial scarlet fever


complications
ENT purulent –it is, pneumonia , meningitis
Adenitis
Vulvovaginitis
R Nephritis
R Myocarditis
R Polyarthritis


Risk following an untreated streptococcal infection

Acute rheumatic fever : 3% in epidemic 0.3% in endemic scenarios
Glomerulonephritis 10-15%


Easy to treat…
Hemolytic strepts respond promptly to benzyl penicillin and Benzathine Penicillin
10 days oral penicillin

Use of any other drug indicates lack of knowledge on part of the prescriber

Why not….
Other penicillins.. Less effective for hemoStrept
Tetracyclines and cephalosporins .. Less potent
Erythromycin .. Resistance coming up
Sulfa drugs = incomplete eradication
All these drugs are good for prophylaxis and less effective for eradication of strept.


Dr Kondekar Santosh venketraman is a MD pediatrician at seth GS medical college and
KEM HOSPITAL MUMBAI INDIA