High rates of group A streptococcus infection in England
In a UK Health Security Agency (UKHSA) report, notifications of scarlet fever and invasive group A streptococcus (iGAS) disease in England are higher than expected for this time of year.
Prompt treatment of children with scarlet fever with antibiotics is recommended to reduce risk of possible complications and limit onward transmission. If there is uncertainty about the diagnosis, obtain a throat swab prior to commencing antibiotics. Children with scarlet fever should stay at home until 24 hours of antibiotic treatment has been received.
Scarlet fever:
Around 90% of cases occur in children under 10 years
Usually a mild illness, but is highly infectious
Presents with a generalised, erythematous rash, which feels like sandpaper
Often preceded by sore throat (pharyngitis, tonsillitis)
Pharyngeal erythema with exudates, palatal petechiae, and a red, swollen (strawberry) tongue are suggestive features.
Invasive group A streptococcal infection:
The relatively higher rates of iGAS in children this season may reflect increased rates of a preceding viral infection (including respiratory viruses and chickenpox)
Clinicians are advised to maintain a high index of suspicion, as early recognition and prompt initiation of specific and supportive therapy for patients with iGAS infection can be life-saving.
Further information from UKHSA:
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- pain on swallowing
- fever (>38°C [>100.5°F])
- tonsillar exudate
Other diagnostic factors
- sudden onset of sore throat
- headache
- abdominal pain
- nausea and vomiting
- presence of cough or runny nose
- tonsillar erythema
- tonsillar enlargement
- enlarged anterior cervical lymph nodes
Risk factors
- age between 5 and 15 years
- contact with infected people in enclosed spaces (e.g., child care centres, schools, prison)
Diagnostic investigations
1st investigations to order
- throat culture
- rapid streptococcal antigen test
Investigations to consider
- serological testing for streptococci
- WBC count and differential
- heterophile antibodies
- vaginal and cervical, or penile, and rectal cultures
- HIV viral load assay
- lateral cervical view x-ray, exposed for soft tissue
Treatment algorithm
acute tonsillitis not due to group A beta-haemolytic streptococcal infection
acute tonsillitis due to group A beta-haemolytic streptococcal infection
recurrent episodes of tonsillitis
Contributors
Authors
Christos Georgalas, PhD, DLO, FRCS (ORL-HNS)
Professor of Surgery - Head and Neck
University of Nicosia
Cyprus
Disclosures
CG declares that he has no competing interests.
Eleftherios Margaritis, PhD, MSc, MD
Otolaryngologist - Head and Neck Surgeon
Collaborator in Otolaryngology
ENT Department
Hippokration University Hospital
Athens
Greece
Disclosures
EM declares that he has no competing interests.
Peer reviewers
Itzhak Brook, MD, MSc
Professor of Pediatrics and Medicine
Georgetown University
Washington
DC
Disclosures
IB declares that he has no competing interests.
Chris Del Mar, MB BChir, FRACGP MD, MA, FAFPHM
Dean
Faculty of Health Sciences and Medicine
Bond University
Gold Coast
Queensland
Australia
Disclosures
CDM is an author of a number of references cited in this topic.
Differentials
- Infectious mononucleosis
- Epiglottitis
- Peri-tonsillar abscess (quinsy)
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