STREPTOCOCCUS, GROUP A, SCARLET FEVER -
A Whitehaven mother is warning other parents to be vigilant after her daughter fell ill with the "uncommon" childhood disease, scarlet fever [a bacterial infection caused by Group A beta-hemolytic streptococci, i.e., _Streptococcus pyogenes_]. The 4-year-old daughter contracted the highly infectious illness, but it was days before the disease was identified. "I am concerned because I know [my 4-year-old] won't be the only one," the mother said. "People these days presume scarlet fever is as extinct as the dinosaurs, but it is very real, and I've had one poorly little girl because of it."
Over the past 5 months, there have been 29 reported cases of scarlet fever in
"[The 4-year-old] was untreated for almost 3 days from the 1st sign, which was a temperature, until she complained her tongue was sore. After looking at her tongue, I looked at pictures online then rang the Cuedoc and explained her symptoms. I was given an appointment within 2 hours of ringing, and when [the 4-year-old] was examined, they looked in her mouth and knew right away it was scarlet fever. She was immediately started on penicillin." She is now recovering at home.
A Cumbria County Council public health spokesperson said: "Scarlet fever used to be a very serious disease, but most cases today are mild. This is because scarlet fever can easily be treated with antibiotic tablets. You should see your GP as soon as possible if you suspect you or your child has scarlet fever."
Scarlet fever often starts with a sore throat, headache and a high temperature, with a rash developing 12 to 48 hours later. Red blotches are the 1st sign of the rash. These turn into a fine pink-red rash that feels like sandpaper to the touch and looks like sunburn. The rash usually starts in one place, but soon spreads to other parts of the body. It commonly affects the ears, neck, chest, elbows, inner thighs and groin, and may be itchy. Unlike slapped cheek syndrome, the scarlet fever rash does not normally spread to the face.
"The rash usually fades after about a week," the spokesperson said, "but the outer layers of skin, usually on the hands and feet, may peel for several weeks afterwards. In milder cases, sometimes called scarlatina, the rash may be the only symptom.
"Your GP can usually diagnose scarlet fever by looking at the characteristic rash and other symptoms, although a sample of saliva will need to be taken from the back of the throat (throat swab) and tested in a laboratory to confirm the diagnosis. There's no evidence that catching scarlet fever when pregnant will put your baby at risk.
However, heavily pregnant women should tell healthcare staff if they have been in contact with someone who has scarlet fever. If your child has scarlet fever, do not let them go to school and keep them away from other people until they have been on a course of antibiotics for at least 24 hours. All tissues and cloths that someone with scarlet fever has coughed or sneezed into should be washed or disposed of immediately."
Communicated by: ProMED-mail
"Scarlet fever is an infection caused by _Streptococcus pyogenes_, also known as group A streptococcus (GAS), a Gram positive coccus that grows in chains. Scarlet fever is usually associated with concurrent streptococcal pharyngitis but may be associated with a streptococcal infection at other sites. An erythrogenic [red-producing] exotoxin released by the strains of _S. pyogenes_ that cause scarlet fever leads to the red rash that is characteristic of the illness. The incidence of pharyngeal disease is highest in school-aged children (5-15 years), during winter and spring, and in a setting of crowding and close contact. Person-to-person spread from infected patients by means of respiratory droplets is the most common mode of transmission.
It can rarely be spread through contaminated food "Persons who have GAS sore throat or skin infections are most likely to spread the infection; those who carry the bacteria but have no symptoms are less contagious. A history of GAS sore throat or scarlet fever in the community, neighborhood, or school may increase the likelihood of infection.
"The incubation period (the time between becoming infected and having symptoms) is short, generally 1-2 days. The illness typically begins with a fever, sore throat, and an initially white, then bright red tongue with prominent red papillae, the so-called "strawberry" tongue, followed 12-48 hours later by a rash. The rash usually 1st appears on the neck and chest, then spreads over the body, and is more intense in skin folds, the so-called Pastia lines. The rash is described as "sandpapery" to touch. The face may be flushed with perioral [around the mouth] pallor. The rash can last for more than a week and is followed by desquamation (peeling) of the skin around the palms, fingertips, toes and groin area."
"Diagnosis of scarlet fever is clinical. Blood cultures are rarely positive, but GAS can usually be demonstrated in the throat by culture or rapid streptococcal test. Complications of scarlet fever include local spread of the streptococcal throat infection to involve regional lymph nodes, retropharyngeal [behind the throat] tissues, middle ear, and sinuses and immune-mediated diseases such as acute rheumatic fever (ARF) and post-streptococcal glomerulonephritis [kidney inflammation]. Septic complications due to spread of GAS in blood, such as meningitis, pyogenic arthritis, and endocarditis [inflammation of the inner lining of the heart muscle, including the heart valves] occur rarely."
"Treatment of scarlet fever is no different than that of GAS pharyngitis, that is, oral penicillin, erythromycin, or clindamycin for 10 days, or one intramuscular dose of penicillin G benzathine. With proper antibiotic treatment, complications are uncommon: penicillin therapy for treatment of GAS pharyngitis within 9 days of onset of symptoms has been shown to decrease the incidence of ARF; unlike ARF, antimicrobial therapy does not prevent acute post-streptococcal glomerulonephritis."
"Early recognition and treatment of GAS pharyngitis is essential to prevent spread of group A streptococcal infections. Patients should no longer be infectious after taking antibiotics for 24 hours."
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