Scarlet fever results from infection with a strain of the organism which produces an erythrogenic toxin.
Its incubation period is 2 to 4 days. After that the child develops tonsillitis, fever, headache and malaise. The rash develops within 12 hours of the onset and rapidly becomes generalized.
It consists of a fine punctate erythema which blanches on pressure. The face is spared, but the cheeks are flushed so that the child is indeed ‘scarlet’, apart from the area around the mouth. The tongue has a thick white coating through which the inflamed papillae project, the ‘white strawberry tongue’.
By day 4 or 5 the tongue peels, leaving a ‘red strawberry’ appearance. The skin rash fades after a few days, or sooner if penicillin is given, followed by desquamation, especially on the hands and feet. This may persist for sometime and is useful in making a retrospective diagnosis.
Treatment with penicillin leads to a rapid recovery, but a 10 day course os necessary to eradicate the streptococcal infection.
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