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Scarlet Fever
Scarlet fever results from infection with a particular strain of streptococcal bacteria. Patients with scarlet fever usually have "strep throat" but also manifest some additional signs and symptoms. Although uncommon, scarlet fever can result after streptococcal infection at a wound site (post-surgical) or even secondary to streptococcal impetigo. The typical signs and symptoms of scarlet fever will be similar to "strep throat" but with the addition of a rash that appears within two days after the onset of sore throat. The rash will first involve the neck, upper chest, and back, then spreads over the remainder of the trunk and extremities, sparing the palms and soles. The rash can be difficult to diagnose in African Americans. It usually appears as diffuse reddening of the skin that blanches on pressure and is more pronounced in the skin creases. There are numerous 1-2 mm punctate elevations that will impart a "sandpaper" texture to the skin. There can be a generalized flush to the face with a region of pallor around the mouth. Early in the illness one may notice a "strawberry tongue" appearance to the tongue (white coat with red protruding dots). The rash will usually last 4-5 days and is followed by extensive skin peeling (desquamation). The desquamation can occur as early as 3 days after the onset of illness or as late as 3-4 weeks after the illness. Scarlet fever can be confused with rubeola, rubella, toxic shock syndrome, Kawasaki disease, acute mononucleosis, or a rash secondary to a drug side effect. Treatment involves injectable penicillin (single injection) or a 10 day course of oral antibiotics (penicillin V or erythromycin are commonly used). Failure to treat streptococcal illness can result in complications such as otitis media, sinusitis, rheumatic fever, or acute glomerulonephritis.
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