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“Improving Recognition and Management of Scarlet Fever in Primary Care and Emergency Settings”
Dar’ya Grozovskaya posted Sep 24, 2022 4:42 PM
There has been an increase in the incidence of scarlet fever with most cases presenting in General Practice and Emergency Departments (NIH, 2020). Cases present with a distinctive macro-papular rash, usually in children (NIH, 2020). Early diagnosis by recognizing the ‘tell-tale’ signs of scarlet fever could help reduce the risk of complications and prevent further spread, especially in children (NIH, 2020).
Many of the presenting symptoms associated with scarlet fever are similar to those caused by other common infections in this age group, such as infection with Epstein-Barr virus, adenovirus or other respiratory viruses (AAFP, 2018). Scarlet fever is mainly a clinical diagnosis. Diagnostic aids such as the Centor Score (modified McIsaac Score) can be used to help guide diagnosis (AAFP, 2018). The Centor Score comprises four clinical signs and symptoms, which are used to estimate the probability of GAS pharyngitis (AAFP, 2018). The performance of the score is robust and it performs consistently across different healthcare settings in a variety of countries (AAFP, 2018).
As in this case, scarlet fever typically presents with high fevers, an erythematous sore throat, strawberry-like tongue and a sand-paper like rash (CDC, 2020). This rash almost always originates from the groin and spreads bilaterally up the trunk to the axilla, at 7–10 days the rash spreads to the extremities and desquamates (CDC, 2020). Desquamation can be noted only on the palms and soles, not the trunk. There are no signs of upper respiratory inflammation, differentiating scarlet fever from measles and rubella (CDC, 2020). Scarlet fever is caused by an infective Group A Streptococcal (GAS) bacteria. The Centor Score is calculated due to the presence of certain clinical signs and how they correlate towards estimating post-test risk of infection (CDC, 2020).
Beta lactam antibiotics are the preferred treatment for GAS infection due to their clinical efficacy, safety record in children, and low cost (IDSA, 2018). Penicillin seems to consistently clinically outperform cephalosporins and macrolides in treating Group-A Beta Haemolytic Streptococcus. Its low cost supports its selection as a first choice treatment (IDSA, 2018).
Referral
Association of American Family Physician (AAFP). (2018). Diagnosis and management of group A streptococcal pharyngitis. Practice guidelines. American Family Physician Journal, 67(4), pp 880-884.
Centers for Disease Control and Prevention (CDC). (2022). Group A Streptococcal (GAS) disease. Strep throat guide for physicians. https://www.cdc.gov/groupastrep/diseases-hcp/strep-throat.html
Infectious Diseases Society of America (IDSA). (2018). Clinical practice guidelines by the infectious diseases society of America: 2018 Update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. https://www.idsociety.org/globalassets/idsa/practice-guidelines/2018-seasonal-influenza.pdf
National Institute of Health (NIH). (2020). National Library of Medicine. College of Family Physicians. Guideline for management of acute sore throat. Clinical Microbiolobcigy Infections, 18(1), pp 1–28.
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