References:
- Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.
| Agent | BACTERIUM. Streptococcus pyogenes A facultative gram-positive coccus |
| Reservoir | Human |
| Vector | None |
| Vehicle | Infected secretions Occasionally food |
| Incubation Period | 1 to 4 days |
| Diagnostic Tests | Typical clinical features associated with group A streptococcal pharyngitis. |
| Typical Adult Therapy | Benzathine Penicillin G 1.2 million units IM as single dose |
| Typical Pediatric Therapy | Benzathine Penicillin G : Weight <14kg: 300,000 units IM Weight 14 to 28kg: 600,000 units IM Weight >28kg: 1.2 million units IM |
| Clinical Hints | Overt pharyngitis followed within 24 to 48 hours by florid erythematous rash. |
| Synonyms | Escarlatina, Lanhousha, Scarlattina, Scharlach |
Signs of streptococcal pharyngitis (fever, pharyngeal exudate and pain) are followed by the appearance of a rash within 12 to 24 hours.
- The exanthem appears initially on the trunk and spreads rapidly over the body to finally involve the extremities.
- The exanthem has the texture of sandpaper, and blanches with pressure.
- Pruritis may be present.
- Facial flushing and circumoral pallor are characteristic.
The patient appears ill, with fever, tachycardia, pharyngitis, tender adenopathy and palatal petechiae.
- Within a few days, the rash becomes more intense along skin folds, producing lines of confluent petechiae (Pastia sign).
- The rash begins to fade within 3 to 4 days, with desquamation evident over the face, palms and fingers.
- Skin peeling may persist for as long as a month.
During the first 2 days of illness, the tongue has a white coat through which the red and edematous papillae project (‘white strawberry tongue’).
- The tongue later desquamates and becomes markedly reddened (‘red strawberry tongue’).
Complications are those associated with the streptococcal infection itself • spread to regional, retropharyngeal tissues, middle ears, and sinuses; acute rheumatic fever or post-streptococcal glomerulonephritis.
- Septic complications such as meningitis, pyogenic arthritis, and endocarditis, are occasionally encountered.