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A 7-year-old boy is brought to the family physician's office with a rough red rash on his trunk (Figures 36-1 and 36-2) along with fever and a sore throat. The sandpaper rash and signs consistent with strep pharyngitis lead the physician to diagnose scarlet fever. The physician explains the diagnosis to the mother, and oral Pen VK is prescribed. The boy feels markedly better by the next day, and the mother continues to give the penicillin for the full 10 days as directed to prevent rheumatic fever.
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Scarlet fever is an illness caused by toxin-producing group A β-hemolytic streptococci. Most commonly, scarlet fever evolves from an exudative pharyngitis.
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Strawberry tongue may be observed in patients with scarlet fever, and usually develops within the first 2 to 3 days of illness. A white or yellowish coating usually precedes the classic red tongue with white papillae (Figure 36-3).
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Scarlet fever is predominately seen in school-age children with no gender predilection.
Majority related to strep pharyngitis, with 1 in 10 developing scarlet fever (Figures 36-1, 36-2, and 36-4).
Prevalent in late fall to early spring.
Strawberry tongue (see Figure 36-4) is most commonly seen in children in association with scarlet fever or Kawasaki disease.
Can be present with other group A Streptococcus (strep) infections.
In cases of strep, a white membrane through which the papillae are seen can initially cover the tongue, followed by desquamation of the membrane (with the appearance as in Figure 36-4).
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ETIOLOGY AND PATHOPHYSIOLOGY
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Transmission of Streptococcus occurs via respiratory secretions.
Virulent Streptococcus pyogenes (group A streptococcus or GAS) incubate more than 2 to 7 days. M protein serotypes of GAS are typically more invasive with greater potential for progression to rheumatic fever or ...