Makindo Medical Notes

🌸 Scarlet fever (Scarlatina) is unlikely if the patient has cough, coryzal symptoms, or diarrhoea. ⏳ Without treatment, individuals may remain infectious for 2–3 weeks. 💊 Antibiotics reduce the infectious period to ~24 hours after treatment begins.

📖 About

• 👶 Primarily a childhood disease, most common between ages 2–8 years.
• 📈 UK notifications have increased in recent years, with outbreaks in schools and nurseries.

🦠 Aetiology

• Caused by toxin-producing strains of Streptococcus pyogenes (Group A Streptococcus, GAS).
• 💨 Spread via respiratory droplets or direct contact with infected secretions.
• ⏱️ Incubation: usually 2–5 days.

🔍 Clinical Features

• 🌸 Rash:
  • Fine, punctate, papular rash starting on the trunk → spreads to neck & arms.
  • Accentuated in flexures (Pastia’s lines).
  • Spares palms & soles; feels like sandpaper.
• 👅 Strawberry tongue: red, swollen papillae, sometimes with a white coating initially.
• 🔥 Fever, sore throat/tonsillitis, malaise.
• 🤕 Tender anterior cervical lymphadenopathy.

⚠️ Complications

• Suppurative: Otitis media, peritonsillar abscess, sinusitis.
• Invasive GAS disease: Pneumonia, meningitis, septic arthritis, necrotising fasciitis.
• Post-infectious: Rheumatic fever, post-streptococcal glomerulonephritis.

🧾 Differential Diagnoses

• Measles (cough, coryza, conjunctivitis, Koplik spots).
• Rubella (milder, post-auricular nodes).
• Roseola (high fever then rash).
• Kawasaki disease (persistent fever >5 days, mucosal changes, coronary risk).
• Drug eruptions or allergic rashes.

🧪 Investigations

• 🔎 Usually a clinical diagnosis — classic rash + sore throat.
• Throat swab for Group A Strep (if diagnostic uncertainty).
• Bloods (ASO titre, inflammatory markers) only if complications suspected.

💊 Management

• Prevention:
  • 🧼 Regular hand washing.
  • 🚫 No sharing of utensils, bottles, or towels.
  • 🗑️ Dispose of used tissues promptly.
  • 🏫 Exclude from school/work until 24h after starting antibiotics.
• Treatment:
  • 📌 First-line: Penicillin V for 10 days.
  • 💊 Alternatives: Amoxicillin or Azithromycin if penicillin-allergic.
• Actions:
  • Seek medical advice promptly if suspected.
  • Complete the full antibiotic course to prevent complications.
  • Reassure that with prompt treatment, prognosis is excellent.

📚 References

• NHS – Scarlet Fever
• UKHSA Guidance: Scarlet Fever in Schools/Nurseries