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.
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:
Tonsillitis can be difficult to distinguish from viral pharyngitis as both present with similar clinical symptoms.
Most patients do not seek medical help.
Most cases resolve spontaneously within a few days and do not require antibiotics, although analgesia is recommended for symptom relief. Antibiotics are used to treat group A streptococcal infection that make up between 5% to 15% of cases of pharyngitis in adults and 15% to 30% of cases in children.
There is some evidence that tonsillectomy may be effective in selected children with recurrent severe acute tonsillitis.
Tonsillitis is inflammation of the tonsils; specifically it is an infection of the parenchyma of the palatine tonsils. This definition does not include tonsillitis as part of infectious mononucleosis (also known as glandular fever). Tonsillitis may occur in isolation or as part of a generalised pharyngitis. The clinical distinction between tonsillitis and pharyngitis is unclear in the literature, and the condition is often referred to simply as 'acute sore throat'.
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
- abdominal pain
- nausea and vomiting
- presence of cough or runny nose
- tonsillar erythema
- tonsillar enlargement
- enlarged anterior cervical lymph nodes
- age between 5 and 15 years
- contact with infected people in enclosed spaces (e.g., child care centres, schools, prison)
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
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
- Infectious mononucleosis
- Peri-tonsillar abscess (quinsy)
- Clinical practice guideline: tonsillectomy in children (update)
- Sore throat (acute): antimicrobial prescribing
TonsillitisMore Patient leaflets
Sore Throat (Pharyngitis) Evaluation and Treatment Criteria (McIsaac)More Calculators
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer