eMedicine Specialties > Dermatology > Bacterial Infections

Scarlet Fever: Differential Diagnoses & Workup

Author: Edward J Zabawski Jr, DO, RPh, Dermatologist, Spencer Dermatology Group
Contributor Information and Disclosures

Updated: Apr 28, 2009

Differential Diagnoses

Drug Eruptions
Lupus Erythematosus, Acute
Measles, Rubeola
Rubella
Toxic Shock Syndrome

Other Problems to Be Considered

Fifth disease
Rubeola
Epstein-Barr virus (infectious mononucleosis)
Enterovirus
Hepatitis B infection
Human immunodeficiency virus
S moniliformis infection (rat bite fever)
Toxic shock syndrome
Secondary syphilis
Juvenile rheumatoid arthritis
Atropine toxicity

Workup

Laboratory Studies

  • Cultures of the infected oropharynx or other infected areas should be obtained.
  • CBC count commonly reveals a leukocytosis. Urinalysis and liver function tests may reveal changes associated with complications of scarlet fever. Said tests are part of a complete medical workup.
  • An increase in antistreptolysin O titers can be observed but is a late finding and usually of value only in retrospect.
  • Patients whose bacterial source may suggest another process (eg, a patient with a suppurative leg wound who may have osteomyelitis) should be evaluated accordingly.

Histologic Findings

The microscopic findings of the eruption of scarlet fever are nonspecific and have an appearance similar to that of other exanthematous eruptions. A sparse perivascular infiltrate usually consisting of lymphocytes primarily with a slight amount of spongiosis in the epidermis is present. Slight parakeratosis may be present, which probably correlates with the sandpaperlike texture of the skin.

More on Scarlet Fever

Overview: Scarlet Fever
Differential Diagnoses & Workup: Scarlet Fever
Treatment & Medication: Scarlet Fever
Follow-up: Scarlet Fever
Multimedia: Scarlet Fever
References
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References

  1. Dong H, Xu G, Li S, et al. Beta-haemolytic group A streptococci emm75 carrying altered pyrogenic exotoxin A linked to scarlet fever in adults. J Infect. Apr 2008;56(4):261-7. [Medline].

  2. Yang SG, Dong HJ, Li FR, Xie SY, Cao HC, Xia SC, et al. Report and analysis of a scarlet fever outbreak among adults through food-borne transmission in China. J Infect. Nov 2007;55(5):419-24. [Medline].

  3. Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev. Jul 2000;13(3):470-511. [Medline].

  4. Sandrini J, Beucher AB, Kouatchet A, Lavigne C. [Scarlet fever with multisystem organ failure and hypertrophic gastritis.]. Rev Med Interne. May 2009;30(5):456-9. [Medline].

  5. Gomez-Carrasco JA, Lassaletta A, Ruano D. [Acute hepatitis may form part of scarlet fever]. An Pediatr (Barc). Apr 2004;60(4):382-3. [Medline].

  6. Guven A. Hepatitis and hematuria in scarlet fever. Indian J Pediatr. Nov 2002;69(11):985-6. [Medline].

  7. Lau SK, Woo PC, Yuen KY. Toxic scarlet fever complicating cellulitis: early clinical diagnosis is crucial to prevent a fatal outcome. New Microbiol. Apr 2004;27(2):203-6. [Medline].

  8. Leslie DL, Kozma L, Martin A, et al. Neuropsychiatric Disorders Associated With Streptococcal Infection: A Case-Control Study Among Privately Insured Children. J Am Acad Child Adolesc Psychiatry. Aug 21 2008;[Medline].

  9. Gaston DA, Zurowski SM. Arcanobacterium haemolyticum pharyngitis and exanthem. Three case reports and literature review. Arch Dermatol. Jan 1996;132(1):61-4. [Medline].

  10. Sanz JC, Bascones Mde L, Martin F, Saez-Nieto JA. [Recurrent scarlet fever due to recent reinfection caused by strains unrelated to Streptococcus pyogenes.]. Enferm Infecc Microbiol Clin. Jun-Jul 2005;23(6):388-9. [Medline].

  11. Swartz MN, Weinberg AN. Infections due to Gram-Positive Bacteria. In: Dermatology in General Medicine. Vol 2. 4th ed. New York, NY: McGraw-Hill; 1993:2318-20.

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Further Reading

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Contributor Information and Disclosures

Author

Edward J Zabawski Jr, DO, RPh, Dermatologist, Spencer Dermatology Group
Disclosure: Nothing to disclose.

Medical Editor

Craig A Elmets, MD, Director of Dermatology, Departments of Dermatology, Pathology, and Environmental Health Sciences; Professor, The Kirklin Clinic, University of Alabama at Birmingham
Craig A Elmets, MD is a member of the following medical societies: American Academy of Dermatology, American Association of Immunologists, American College of Physicians, American Federation for Medical Research, and Society for Investigative Dermatology
Disclosure: Palomar Medical Technologies Stock None; Amgen Consulting fee Review panel membership; Astellas Consulting fee Review panel membership; Massachusetts Medical Society Salary Employment; Abbott Laboratories Grant/research funds Independent contractor

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Lester F Libow, MD, Dermatopathologist, South Texas Dermatopathology Laboratory
Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis  investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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