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Scarlet Fever

Group A Beta Haemolytic Streptococci (GABHS)

A fine scarlet red erythematous blanching rash, initially starting on the trunk before spreading to the limbs with the appearance of patchy sunburn.

The most striking characteristics of the rash is its grainy sandpaper-like texture, a pathognomic feature
You may also notice sparing around the perioral area (circumoral pallor), linear areas of pigmentation in skin creases (Pastia lines) and, after 7-10 days, desquamation of the face and hands

Scarlet Fever can also cause a strawberry tongue

The streptococci release a pyrogenic exotoxin toxin.

It usually evolves from tonsillar or pharyngeal infection with the Group A strep

However it can also follow GABHS infection of the skin (erysipelas) or lungs.

Respiratory Droplet

Phenoxymethylpenicillin (Penicillin V) orally twice a day for 10 days.

In the pre-antibiotic era Scarlet Fever had a significant mortality rate, however mortality is less than 1% if antibiotics are commenced.

Complications include pneumonia, septicaemia, myocarditis, acute rheumatic fever and post streptococcal glomerulonephritis.

Kawasaki disease also presents with a fever (for at least 5 days), strawberry tongue, a rash, late desquamation and cervical lymphadentitis. However there tends to be one dominant cervical lymph node > 1.5cm, red eyes due to non-suppurative conjunctivitis and bright red, cracked lips.

Toxic shock syndrome may also produce a strawberry tongue, but lacks the perioral sparring and sandpaper texture to the rash and implies a degree of haemodynamic instability.

Slapped cheek syndrome (Fifth disease) from parvovirus B19 also produces a facial then truncal rash, however the child is well appearing, fever is less of a feature and the strawberry tongue and sandpaper quality to the rash is absent.