Has been a major morbidity and mortality

In prepenicillin era; in epidemics

The incidence and severity decreased over years with changed streptococcal virulence in response to newer antibiotics.

Rash develops in fewer than 10% of cases of "strep throat."

Age 4-8 years peak

By the time children are 10-years-old, 80% have developed lifelong protective antibodies against streptococcal pyrogenic exotoxins.

Scarlet fever is rare in children younger than 2 years, because of the presence of maternal antiexotoxin antibodies and lack of prior sensitization.

Scarlet fever is easy to diagnose..

Seen in kids not exposed often to streptococcal infections; thus not having any antibacterial or antitoxin immunity.

Circumoral Pallor

Pastia sign

Pin hole peeling

If rash is illdefined with mild tonsil = Rubella

If rash is confluent = closer to measles

If exudative tonsillitis = closer to staph

Macular rash = drug rash

Tender nodes = adenitis

Nondiscrete LN = closer to diptheria

If no strept = incomplete Kawasaki

Mild = ambulatory, fever is major symptom

Moderate = toxic look, with some dysphagia

Severe = bedridden

Septic Scarlet fever = local sepsis/ perf

Toxic Scarlet fever = systemic sepsis

Extrafaucial scarlet fever

ENT purulent –it is, pneumonia , meningitis

Adenitis

Vulvovaginitis

R Nephritis

R Myocarditis

R Polyarthritis

Hemolytic strepts respond promptly to benzyl penicillin and Benzathine Penicillin

10 days oral penicillin

Use of any other drug indicates lack of knowledge on part of the prescriber

Other penicillins.. Less effective for hemoStrept

Tetracyclines and cephalosporins .. Less potent

Erythromycin .. Resistance coming up

Sulfa drugs = incomplete eradication

All these drugs are good for prophylaxis and less effective for eradication of strept.