Scarlet fever, most common complication of step throat

Donya Betancourt, Pediatrician, Sanur, Bali, drdonya@hotmail.com

After talking about strep throat last week, we will now discuss scarlet fever, the best known complication of strep throat which causes a rash in sensitive individuals.

The signs are high fever, sore throat, headache and rash which consists of fine red bumps with a sandpaper-like consistency. They usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body.

Rash is the most striking symptom of scarlet fever and usually appears on the second day of strep throat.

There are usually other symptoms that help to confirm the diagnosis, such as a reddened sore throat and tonsils that are swollen and have pustule on them.

Early in the infection, the tongue may have a whitish or yellowish coating like "strawberry" tongue, but later in the infection it may turn red, and its surface may begin to peel.

The fever typically stops within three to five days, and the sore throat passes soon afterward. The rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by the rash may begin to peel. This peeling may last 10 days.

With antibiotic treatment, the infection itself is usually cured within a week, but it may take a few weeks for tonsils and swollen glands to return to normal.

You should know Group A streptococcal infections that cause scarlet fever are contagious. Strep bacteria can be passed through contact with nasal or throat fluids of someone with a strep throat infection. They can also be passed by touching the infected skin of someone who has strep impetigo, or by sharing towels, clothing or bed linen. So it is wise to isolate him or her from other family members.

Keep drinking glass and eating utensils separate, and wash these items thoroughly in very hot water using strong or antibacterial soap. Wash your own hands frequently as you care for the child. Severe complications of strep throat, which usually do not happen unless the infection is left untreated, are rheumatic fever, rheumatic heart disease and acute glomerulonephritis.

Rheumatic fever is a serious inflammatory condition that can affect many parts of the body including the heart, joints, nervous system and skin. Post-streptococcal glomerulonephritis is inflammation of the glomeruli (the blood filters of the kidney), again occurring after a strep infection.

Most cases of strep throat do not lead to rheumatic fever. Although rheumatic fever can occur at any age, the most frequent incidence is in children between the ages of five and 15 years.

What is important to note is that in more than half of all cases, rheumatic fever may damage the heart valves and interfere with normal blood flow through the heart. There is no cure for rheumatic fever but it can be prevented by prompt and thorough treatment of a strep throat infection with antibiotics.

Carditis is an inflammation of the heart from infection, which causes tissue degeneration, most frequently heart valve tissue. After the acute attack has subsided, many children are left with damaged heart valves called rheumatic heart disease.

Polyarthritis is painful arthritis, most often affecting the ankles, wrists, knees and elbows, and migrating from joint to joint.

Chorea is a neurologic syndrome that may appear after a latent period of several months. Chorea is seen as rapid, purposeless, involuntary movements in the extremities and the face. This symptom usually disappears over weeks or months.

Subcutaneous nodules are firm, painless lumps that occur over bony surfaces just under the skin. Erythema marginatum is a rash that appears mostly on the trunk and extremities as broad, pink or faint red, non-itchy patches on the skin. How can the doctor diagnose acute rheumatic fever and what is glomerulonephritis, we will discuss next week.