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Presentation
- Age 2-6 years, peak incidence is 4years
- 2-4 day incubation period, and then:
- Fever
- Malaise
- Tonsillitis
- "Strawberry tongue"
- Rash
Strawberry Tongue
- Tongue is covered in white coating
- Through this white coating, red papillae may be seen
- Then the white coating dissapears
- This leaves the tongue with a beefy, red appearance
Rash
- Typically starts on Torso
- Fine Punctate Erythema ("Pinhead")
- Then spreads to rest of the body
- Rough "Sandpaper" texture
- Desquamination occurs later in the illness – especially around fingers and toes
- Often spares the face but they often have flushed appearance with perioral pallor.
Diagnosis
- made from throat swab (but don't wait for result – start Abx immediately)
Management
- Oral Phenoxymethylpenicillin – azithromycin if penicillin allergic
- Children can return to school 24hours after starting antibiotics
- Scarlet fever is a notifiable disease
Complications
- Otitis media – this is the most common complication
- Rheumatic fever: typically occurs 20 days after infection
- Acute glomerulonephritis: typically occurs 10days after infection

Pathology
- Scarlet fever is a reaction to erythorogenic toxins produced by Group A hayemolytic streptococci (Usualy Strep Pyogenes)