Summary
Definition
History and exam
Key diagnostic factors
- scarlatiniform rash
- fever (>100.4°F [>38.0°C])
- sore throat
- tonsillopharyngeal inflammation
- tonsillopharyngeal exudate
- palatal petechiae
- anterior cervical adenitis
- no cough
- pyoderma
Other diagnostic factors
- strawberry tongue
- skin desquamation
- headache
- nausea
- vomiting
- abdominal pain
Risk factors
- group A streptococcus (GAS) pharyngitis
- close contact with a person with scarlet fever or other group A streptococcus (GAS) presentation
- age 1-10 years
- winter and spring seasons
- crowded environment
- close contact with children ages 1-10 years
- nonpharyngitis group A streptococcus (GAS) infection
Diagnostic tests
1st tests to order
- rapid antigen detection test (RADT) for group A streptococcus (GAS)
Tests to consider
- bacterial culture (throat, skin, wound)
- polymerase chain reaction for group A streptococcus (GAS)
Treatment algorithm
all patients
Contributors
Authors
Alexandra Brugler Yonts, MD
Attending Physician
Pediatric Infectious Diseases
Children's National Hospital
Assistant Professor of Pediatrics
The George Washington University School of Medicine and Health Sciences
Washington
DC
Disclosures
ABY is employed full-time as a Pediatric Infectious Diseases physician by Children's National Hospital. As an Investigator, her department has received institutional grant money (not in the form of salary support) for clinical trials (unrelated to the article topic) sponsored by Pfizer and ContraFect, for which there is no contractual agreement to disseminate product information. ABY has given one lecture to a local noncommercial, nonprofit, pediatrics organization (Northern Virginia Pediatric Society) at their quarterly meeting and briefly discussed the topic of streptococcal pharyngitis diagnosis and management (but did not discuss the article topic specifically). ABY has given educational talks to outside organizations unrelated to the article topic. ABY has received digital media equipment for use during a media briefing panel on the topic of the impact of the COVID-19 pandemic on children, which was organized by SciLine, a service based out of the American Association for the Advancement of Science.
Peer reviewers
Monika Dietrich, MD, FAAP
Assistant Professor of Pediatrics
Section of Pediatric Infectious Disease
Children's Hospital New Orleans
Tulane University School of Medicine
Tulane
New Orleans
LA
Disclosures
MD declares that she has no competing interests.
Theresa Lamagni, BSc MSc PhD
Head of Gram Positive Infection
Healthcare-Associated Infection & Antimicrobial Resistance Division
UK Health Security Agency (UKHSA)
London
UK
Disclosures
TL declares that she has no competing interests.
Differentials
- Kawasaki disease
- Erythema infectiosum (parvovirus B19, fifth disease)
- Rubella
More DifferentialsGuidelines
- Scarlet fever: information for clinicians
- Group A streptococcal (GAS) pharyngitis: a practical guide to diagnosis and treatment
More GuidelinesPatient information
Sore throat
Tonsillitis
More Patient informationCalculators
Sore Throat (Pharyngitis) Evaluation and Treatment Criteria (McIsaac)
More Calculators- Log in or subscribe to access all of BMJ Best Practice
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