Pediatric Scarlet Fever Clinical Presentation

  • Author: Pamela L Dyne, MD; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Jul 9, 2010
 

History

Scarlet fever is characterized by the following findings:

  • Sore throat[2]
  • Headache
  • Vomiting
  • Abdominal pain
  • Fever

The rash appears 1-2 days after onset of illness, first on the neck and then extending to the trunk and extremities.

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Physical

  • The patient usually appears moderately ill.
  • Fever may be present.
  • The patient may have tachycardia.
  • Tonsils are edematous, erythematous, and covered with a yellow, gray, or white exudate.
  • Petechiae are noted on the soft palate.
  • Tender anterior cervical lymphadenopathy may be present.
  • Flushed face with perioral pallor is observed.
  • Scarlatiniform rash is noted.
    • Exanthem texture is usually of coarse sandpaper, and the erythema blanches with pressure.
    • The skin can be pruritic but usually is not painful.
    • A few days following generalization of the rash, it becomes more intense along skin folds and produces lines of confluent petechiae known as the Pastia sign. These lines are caused by increased capillary fragility.
    • The rash begins to fade 3-4 days after onset, and the desquamation phase 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.
  • Appearance of the tongue consists of the following:
    • During the first 2 days of the disease, the tongue has a white coat through which the red and edematous papillae project. This is referred to as a white strawberry tongue.
    • After 2 days, the tongue also desquamates, resulting in a red tongue with prominent papillae called the red strawberry tongue.
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Causes

Scarlet fever results from an erythrogenic toxin produced by group A streptococci.

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Contributor Information and Disclosures
Author

Pamela L Dyne, MD  Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Peter Bloomfield, MD, MPH  Clinical Instructor, Department of Emergency Medicine, Olive View-UCLA Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes  MBBS, FACEM, Director of Emergency Medicine, Calvary Hospital, Canberra, ACT; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Kelli N McCartan, MD, to the development and writing of this article.

References

  1. Yang SG, Dong HJ, Li FR, Xie SY, Cao HC, Xia SC. 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].

  2. [Guideline] Finnish Medical Society Duodecim. Sore throat and tonsillitis. EBM Guidelines. Evidence-Based Medicine. Feb 2 2007;Helsinki, Finland: Wiley Interscience. John Wiley & Sons:[Full Text].

  3. Gidaris D, Zafeiriou D, Mavridis P, Gombakis N. Scarlet Fever and hepatitis: a case report. Hippokratia. Jul 2008;12(3):186-7. [Medline].

  4. Chiesa C, Pacifico L, Nanni F, Orefici G. Recurrent attacks of scarlet fever. Arch Pediatr Adolesc Med. Jun 1994;148(6):656-60. [Medline].

  5. Davis H, Karasic R. Pediatric infectious disease. In: Atlas of Pediatric Physical Diagnosis. 3rd ed. 1997:355-7.

  6. Fisher RG, Boyce TG. Rash syndromes. In: Moffet's Pediatric Infectious Diseases: A Problem-Oriented Approach. Lippincott Williams & Wilkins; 2005:374-6.

  7. Gerber MA. Diagnosis and treatment of pharyngitis in children. Pediatr Clin North Am. Jun 2005;52(3):729-47, vi. [Medline].

  8. Gerber MA. Group A streptococcus. In: Nelson Textbook of Pediatrics. Philadelphia, Pa: WB Saunders Co; 2004:870-4.

  9. Hamour A, Bonnington A, Wilkins EG. Severe community acquired pneumonia associated with a desquamating rash due to group A beta-haemolytic streptococcus. J Infect. Jul 1994;29(1):77-81. [Medline].

  10. Kaplan EL, Gerber MA. Group A, group C and group G beta-hemolytic streptococcal infections. In: Textbook of Pediatric Infectious Diseases. Philadelphia: PA: Saunders; 2004:1142-56.

  11. Kleiegman RM, Feigin RD. Streptococcal infections. In: Nelson Textbook of Pediatrics. 14th ed. Philadelphia, Pa: WB Saunders Co; 1992:698-703.

 
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The exudative pharyngitis typical of scarlet fever. Although the tongue is somewhat out of focus, the whitish coating observed early in scarlet fever is visible.
Desquamation of the palms is a frequently observed self-limited manifestation of scarlet fever present in the healing period following resolution of the infection and acute eruption.
 
 
 
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