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
WHAT CAUSES SCARLET
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
WHAT IS SCARLET
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.
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.
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
Throat cultures are approximately 90% sensitive for presence of group A
beta-hemolytic streptococci in the pharynx.
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
Rx: Penicillin VK , Sig: 25-50 mg/kg/d PO tid/qid
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
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
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.
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.