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.
The Centers for Disease Control and Prevention (CDC) is looking into an increase in iGAS infections among children in the US.
Scarlet fever:
Around 90% of cases occur in children under 10 years
Usually a mild illness, but is highly infectious
Presents with a generalized, 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 CDC:
Summary
Definition
History and exam
Key diagnostic factors
- fever or low body temperature
- tachypnea
- tachycardia
- bradycardia (neonates and infants)
- altered mental state or behavior
- decreased peripheral perfusion
- change in usual pattern of activity or feeding in a neonate
- dry diapers/decreased urine output
- mottling of the skin, ashen appearance, cyanosis
- low oxygen saturation
- vasoplegia
- nonblanching purpuric rash
Other diagnostic factors
- hypotension
- specific focal signs and symptoms reflecting underlying pathology
Risk factors
- immunodeficiency
- comorbidities
- male sex
- younger age (especially neonates)
- perinatal risk factors for infection (neonates)
- healthcare-associated factors (neonates)
- recent surgery or other invasive procedures
- breached skin integrity
Diagnostic investigations
1st investigations to order
- CBC with differential
- serum glucose
- blood culture
- urinalysis
- urine culture
- blood gases
- serum lactate
- serum electrolytes
- serum creatinine
- LFTs
- coagulation studies
- C-reactive protein (CRP)
- chest x-ray
Investigations to consider
- lumbar puncture
- meningococcal polymerase chain reaction analysis
- bronchoalveolar lavage culture
- herpes simplex virus (HSV) polymerase chain reaction (blood and cerebrospinal fluid)
Emerging tests
- serum procalcitonin
- emerging biomarkers
- PhenoTest™ BC Kit
Treatment algorithm
presumed or confirmed sepsis
Contributors
Authors
Akash Deep, MD, FRCPCH
Director and Professor of Paediatric Critical Care
Paediatric Intensive Care Unit
King’s College Hospital
London
UK
Disclosures
AD declares that he has no competing interests.
Chris Duncan, BMBS, BMedSci, MRCP, FFICM, FEWM, PGCert
Professorial Fellow
Intensive Care Medicine
Nepean Hospital
Sydney
Australia
Disclosures
CD declares that he has no competing interests.
Acknowledgements
Dr Akash Deep and Dr Chris Duncan would like to gratefully acknowledge Dr Jeremy Tong and Dr Adrian Plunkett, previous contributors to this topic.
Disclosures
JT and AP are authors involved in the Pediatric Sepsis Six initiative, cited in this topic.
Peer reviewers
Saul N. Faust, MA, MBBS, FRCPCH, PhD, FHEA
Professor of Paediatric Immunology & Infectious Diseases
Director, NIHR Wellcome Trust Clinical Research Facility
University of Southampton
Southampton
UK
Disclosures
SNF declares that he has no competing interests.
Mohan Pammi, MBBS, MD, MRCPCH
Assistant Professor
Texas Children's Hospital and Baylor College of Medicine
Houston
TX
Disclosures
MP declares that he has no competing interests.
Jerry J. Zimmerman, MD, PhD
Faculty, Pediatric Critical Care Medicine
Seattle Children's Hospital
University of Washington School of Medicine
Seattle
WA
Disclosures
JJZ receives research grant support from NIH/NICHD and ImmuneXpress; travel reimbursement from the Society of Critical Care Medicine to attend board meetings; and royalties from Elsevier for action as a co-editor for the textbook Pediatric Critical Care.
Differentials
- Coronavirus disease 2019 (COVID-19)
- Pediatric inflammatory multisystem syndrome
- Congenital heart disease
More DifferentialsGuidelines
- Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2021
- Neonatal infection: antibiotics for prevention and treatment
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