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 old
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:
Fever is generally defined as a temperature of ≥38.0°C (100.4°F) and is one of the most common reasons why children and their carers seek medical attention. Endogenous or exogenous pyrogens trigger release of prostaglandins, most notably prostaglandin E2, which in turn signals the hypothalamus to elevate the body's thermoregulatory set-point by regulating endocrinological, autonomic, and behavioural responses. However, normal body temperature varies substantially by factors such as the time of day, degree of physical exertion, and ambient temperature.
While the underlying cause of fever is often discernible by history or physical examination, many children have unexplained fever despite initial evaluation. The distinction between patients who have 'fever without source' and 'fever of unknown origin' is important. The vast majority of children who present acutely with fever without source (or fever of unclear source) have underlying infections, typically requiring urgent evaluation and empirical treatment (especially in young children). In contrast, fever of unknown origin is not well defined in children. It has been historically used to describe a subacute presentation of a single illness of at least 3 weeks' duration during which a fever >38.3°C (100.9°F) is present for most days and the diagnosis is unclear after 1 week of intense investigation. The most common causes are infections, inflammatory/vasculitic disorders, and malignancies. These children require a more deliberate, comprehensive, and prolonged evaluation, and frequently do not need urgent empirical therapy. There is an increased emphasis on unusual presentations of common illness and on esoteric causes.
This topic addresses acute and subacute causes of fever in which no cause is readily discernible based on the history and physical examination.
- Urinary tract infection
- Coronavirus disease 2019 (COVID-19)
- Acute otitis media
- Bacteraemia (occult)
- Septic arthritis
- Cat-scratch disease
- Viral syndromes
- Infectious mononucleosis
- Cytomegalovirus infection
- Malaria infection
- Lyme disease
- Kawasaki disease
- Juvenile idiopathic arthritis (JIA)
- Systemic lupus erythematosus
- Rheumatic fever
- Crohn's disease
- Ulcerative colitis
- Non-Hodgkin's lymphoma
- Drug-related fever
- Vaccine reaction
- Scarlet fever
- Typhoid (enteric fever)
- Hepatic abscess
- Cerebral abscess
- Streptococcal toxic shock syndrome
- Staphylococcal toxic shock syndrome
- Herpes simplex virus (HSV) infection
- Human immunodeficiency virus (HIV) infection
- Rocky Mountain spotted fever
- Hodgkin's lymphoma
- Thyroid storm
- Serotonin syndrome
- Serum sickness/serum sickness-like reaction
- Factitious fever
- Factitious disorder imposed on another (formerly Munchausen syndrome by proxy)
- Heat-related illness
- Paediatric autonomic disorders
- Dengue fever
- Fever in under 5s: assessment and initial management
- Evaluation and management of well-appearing febrile infants 8 to 60 days old
Urinary tract infections in childrenMore Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer