|Home| |Questions| |Parent Guide| |News| |Search| |Clinicians| |Get Published| |Resources| |Forums| |Dr. Ravel|

Pediatric Dental Health 

March 16, 2005

Sore Throat and Scarlet Fever

Sore throat is a common problem in children, especially between the ages of 5 and 10. Sore throat is a leading cause of visits to the doctor, and is responsible for approximately 10 percent of children’s medical visits.

Sore throat can be caused by either viruses or bacteria. About 25 percent of sore throat is caused by strep bacteria - usually group A beta-hemolytic streptococci (GABHS). GABHS “strep” throat is spread via respiratory droplets, through close contact with another person who has streptococcal pharyngitis.



WHAT CAUSES SCARLET FEVER?
  • Most streptococci excrete hemolyzing enzymes and toxins.
  • Scarlet fever is an exotoxin-mediated disease arising from group A beta-hemolytic streptococcal infection.
  • Release of erythrogenic toxin causes the pathognomonic rash of scarlet fever.



    WHAT IS SCARLET FEVER?
  • The condition is characterized by the scarlatiniform rash.
  • Peak incidence of scarlet fever occurs in persons aged 4-8 years.
  • Suppurative complications such as peritonsillar abscess, sinusitis, bronchopneumonia, and meningitis can occur.
  • Problems associated with immune mediated sequelae, rheumatic fever, or glomerulonephritis can also occur.



    SIGNS AND SYMPTOMS OF SCARLET FEVER
  • Sudden fever with sore throat.
  • Flushed face with circumoral pallor.
  • Tonsils - edematous, erythematous, and covered with an exudates.
  • Petechiae on the soft palate.
  • Anterior cervical lymphadenopathy.
  • On day 1 or 2, a white strawberry tongue.
  • By day 4 or 5, a raspberry tongue.
  • The body rash appears 12-24 hours after onset of illness.

    There is also the possibility of Kawasaki Disease as a differential diagnosis. Not always is it scarlet fever when pediatricians think it is. KD can mimic scarlet fever and there is a huge difference - and KD should be treated ASAP.

    KD kids need to be treated immediately with IVIG products.



    LABORATORY TESTS FOR SCARLET FEVER
  • Throat culture remains the criterion standard for confirmation of group A streptococcal upper respiratory infection.
  • Group A streptococci virtually always is found on throat culture during acute infection.
  • Throat cultures are approximately 90% sensitive for presence of group A beta-hemolytic streptococci in the pharynx.



    TREATMENT FOR SCARLET FEVER
  • The goals when treating scarlet fever are to (1) prevent acute rheumatic fever, (2) reduce the spread of infection, (3) prevent suppurative complications, and (4) shorten the course of illness.
  • Treatment should be started as soon as possible to reduce the occurrence of rheumatic fever.
  • Penicillin remains the drug of choice. It inhibits biosynthesis of cell-wall peptidoglycan.
  • Rx: Penicillin VK , Sig: 25-50 mg/kg/d PO tid/qid



    PREVENTION OF SCARLET FEVER
  • Transmission usually occurs via airborne respiratory particles that can be spread from infected patients and asymptomatic carriers. The infection rate increases in overcrowded situations (schools, institutional settings).
  • Patients are contagious during the acute illness and during the subclinical phase.



    TIPS FOR PARENTS
  • To minimize contagion, a minimum of 24 hours of antibiotic therapy is indicated before a child should return to school.
  • Patients must complete the entire course of antibiotics even if symptoms resolve.
  • Adequate fluid intake is of vital importance for the prevention of dehydration. Cool liquids are preferred.
  • Give children’s acetaminophen for sore throat, and when fever exceeds 102 degrees F (39 degrees C).
  • Call your child’s physician if there is drooling, difficulty swallowing, or difficulty breathing.



    EXTERNAL LINK:
    An article in the American Family Physician discusses pharyngitis (sore throat). The article describes the epidemiology, pathogenesis, differential diagnosis, diagnosis, and laboratory evaluation of pharyngitis. It also stresses that identifying the cause of pharyngitis, especially group A beta-hemolytic streptococcus (GABHS), is important to prevent potential life-threatening complications.

    Vincent MT, Celestin N, Hussain AN: Pharyngitis. American Family Physician. 2004 Mar 15;69(6):1465-70.


    Copyright ©2005 Daniel Ravel DDS, FAAPD


|Licensing| |Tell A Friend| |Link To Us| |Disclaimer| |Copyright| |About Us| |Privacy|


Advertisements