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Scarlet Fever

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Definition of ,presentation ,diagnosis ,differential diagnosis ,treatment

Definition of ,presentation ,diagnosis ,differential diagnosis ,treatment

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    Scarlet  Fever Scarlet Fever Presentation Transcript

    • Powerpoint Templates Scarlet Fever Prof. Saad S Al Ani Senior Pédiatric Consultant Head of Pediatric Department Khorfakkan Hospital Sharjah , UAE
    • Scarlet Fever Is an upper respiratory tract infection associated with a characteristic rash , which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin )-producing group A streptococcus in individuals who do not have antitoxin antibodies.
    • Scarlet Fever (cont.)
      • The incidence is cyclic ,
      • depending on:
      • 1. The prevalence of toxin-
      • producing strains
      • 2.The immune status of the
      • population
      • The epidemiologic features
      • which include:
      • 1.Modes of transmission
      • 2.Age distribution
      • are otherwise similar to those
      • for group A streptococcal
      • pharyngitis.
    • The rash of Scarlet Fever
      • The rash appears within 24-48 hr after onset of symptoms, although it may appear with the first signs of illness.
      • It often begins around the neck and spreads over the trunk and extremities .
      • It is a diffuse , finely papular , erythematous eruption producing a bright red discoloration of the skin, which blanches on pressure .
      • It is often more intense along the creases of the elbows, axillae, and groin.
    • The rash of Scarlet Fever (cont.)
      • The skin has a goose-pimple appearance and
      • feels rough.
      • The face is usually spared , although the
      • cheeks may be erythematous with pallor
      • around the mouth .
      • After 3-4 days , the rash begins to fade and is
      • followed by desquamation , first on the face
      • progressing downward, and often resembling
      • that seen subsequent to a mild sunburn.
      • Occasionally, sheetlike desquamation may
      • occur around the free margins of the fingernails, the palms, and the soles.
    • Scarlet Fever (cont.)
      • Examination of the pharynx of a patient with scarlet fever reveals essentially the same findings as with group A streptococcal pharyngitis .
      • In addition, the tongue is usually coated and the papillae are swollen .
      • After desquamation, the reddened papillae are prominent, giving the tongue a strawberry appearance .
    • Diagnosis
      • Typical scarlet fever is not difficult to diagnose
      • The milder form with equivocal pharyngeal
      • findings can be confused with
      • 1. Rubella
      • 2. Roseola
      • 3. Kawasaki disease
      • 4. drug eruptions.
      • Staphylococcal infections are occasionally associated with a scarlatiniform rash
      • A history of recent exposure to a group A streptococcal infection is helpful .
      • Identification of group A streptococcus in the pharynx confirms the diagnosis, if doubtful.
    • Treatment
      • For the patient with classic scarlet fever, antibiotic therapy should be started immediately ,
      • for the vast majority of patients who present with much less distinctive findings , treatment should be withheld until there is some form of bacteriologic confirmation either by:
      • 1. throat culture
      • or
      • 2.rapid antigen detection test.
    • Treatment (cont.)
      • Group A streptococcus is exquisitely sensitive to penicillin , and resistant strains have never been encountered. Penicillin is, therefore, the drug of choice (except in patients who are allergic to penicillin) for pharyngeal infections as well as for suppurative complications.
      • Treatment with oral penicillin V (250 mg/dose bid-tid PO) for 10 days is recommended but it must be taken for a full 10 days even though there is symptomatic improvement in 3-4 days. .
    • Treatment (cont.) If the parents seem unlikely to comply because of family disorganization, difficulties in comprehension, or other reasons, parenteral therapy is indicated . A single intramuscular injection of benzathine penicillin G (600,000 IU for ≤60 lb, 1.2 million IU for >60 lb, IM) is the most efficacious and often the most practical method of treatment.
    • Treatment (cont.) Erythromycin (erythromycin estolate 20-40 mg/kg/24 hr divided bid-qid PO, or erythromycin ethylsuccinate 40 mg/kg/ 24 hr divided bid-qid PO) for 10 days is the drug of choice for patients allergic to penicillin
    • Treatment (cont.)
      • A 10-day course of a narrow-spectrum oral cephalosporin is an acceptable alternative for patients allergic to penicillin.
      • because up to 15% of penicillin-allergic patients are also cephalosporin-allergic, cephalosporins should not be given to patients with an immediate-type hypersensitivity to penicillin.
    • Summary
      • Is an upper respiratory tract infection associated with a characteristic rash caused by an infection with pyrogenic exotoxin (erythrogenic toxin)- producing group A streptococcus
      • The skin has a goose-pimple appearance
      • the tongue a strawberry appearance.
      • with classic scarlet fever, antibiotic therapy should be started immediately
      • Penicillin is, therefore, the drug of choice
      • Erythromycin for patients allergic to penicillin