Excerpt from Scarlet Fever

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Background

Scarlet fever is an infection caused by toxin-producing group A beta hemolytic streptococci (GABHS) found in secretions and discharge from the nose, ears, throat, and skin. It may follow streptococcal wound infections or burns, as well as upper respiratory tract infections.

Pathophysiology

As the name implies, an erythematous eruption is associated with a febrile illness. The circulating toxin, often referred to as erythemogenic toxin, causes the rash as a consequence of local production of inflammatory mediators and alteration of the cutaneous cytokine milieu. This results in a sparse inflammatory response and dilatation of blood vessels leading to the characteristic scarlet color of the rash.

Mortality/Morbidity

Historically, scarlet fever resulted in death in 15-20% of those affected. Since the advent of antibiotic therapy, the mortality rate is less than 1%. Morbidity and mortality is usually minimal. Known complications, such as septicemia, hepatitis, or rheumatic fever, should be considered on a case-by-case basis as determined by the presence of clinical history and examination findings suggestive of those diseases. Localized soft tissue infections may suggest the presence of underlying osteomyelitis, but scarlet fever may occur from cellulitis alone. When scarlet fever has been determined to be due to a soft tissue infection over or near bone, evaluation for bony involvement should be considered.

Race

No racial or ethnic predilection is reported for group A streptococcal infection.

Age

The infection usually occurs in children, with peak age incidence from 1-10 years. However, it can occur in older children and adults.

Please click here to view the full topic text: Scarlet Fever