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Tuesday, April 5, 2011

SCARLET FEVER

Although scarlet fever is at present a mild disease, it may not necessarily remain so, as fluctuations in its severity have been record for the past 300 years.
The primary site of ingestion in scarlet fever is usually the pharynx or the tonsils but the disease may follow streptococcal infection in other sites, e.g. in the genital tract after childbirth or in wounds. It is transmitted by air-borne infection, or more rarely by milk or ice-cream contaminated by streptococci. The incubation period is 2-4 days.
Clinical features
Scarlet fever occurs most commonly in children. It has a sudden onset and the more severe cases present with a sore throat, shivering, pyrexia, headache and vomiting.There is inflammation of the fauces; the tonsils are enlarged and may be covered with a follicular exudate. The exudate may be distinguished from the membrane seen in diphtheria by its yellow appearance and by being more easily wiped off. There is tender enlargement of the tonsillar lymph nodes. The rash, which usually appears first behind the ears on the second day, rapidly becomes generalised punctate erythema. It is most intense in the flexures of the arms and legs. The face is not affected by the rash, though it is usually flushed due to fever, and the region round the mouth is pale. The tongue is initially furred but later shows prominent red papillae. The rash fades in about 1 week and is succeeded by desquamation. A profuse growth of S.pyogenes can usually be obtained from a throat swab.
Complications
The complications are less common than formerly because of the mild form of the disease and the introduction of effective chemotherapy. Acute otitis media, cervical adenitis and sinusitis may occur. Rheumatic fever and glomerulonephritis are rare sequelae which develop 2 or 3weeks after the onset of any haemolytic streptococcal infection.
Management
The treatment of scarlet fever is the same as for streptococcal sore throat. Most patients respond rapidly to Phenoxymethypenicillin ( 250 mg for children and 500 mg for adults t.i.d for 7 days).

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