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
- child or adolescent age
- winter or spring season (in bacterial pharyngitis)
- summer/fall season (in enteroviral pharyngitis)
- rhinorrhea, nasal congestion, and cough (in viral infection)
- sore throat
- pharyngeal exudate
- cervical adenopathy
- fever
- headache
- nausea, vomiting, and abdominal pain
- conjunctivitis (in measles)
- maculopapular rash (in measles)
- Koplik spots (in measles)
- scarlatiniform rash (in group A Streptococcus [GAS] pharyngitis)
Other diagnostic factors
- sexual activity or abuse (in HIV, gonorrheal, or chlamydial infection)
- treatment failure of penicillin
- pharyngeal ulceration (in tularemia)
- pharyngeal gray membrane (in diphtheria)
Risk factors
- nasal colonization with group A Streptococcus (GAS)
- GAS-infected contact
- sexual activity or abuse
- ingestion of nondomestic meats
- immunocompromised host
- use of inhaled corticosteroids
- lack of immunization or vaccine failure
- irradiation
Diagnostic investigations
1st investigations to order
- rapid antigen test for group A Streptococcus (GAS)
- nucleic acid amplification (via polymerase chain reaction) for group A Streptococcus (GAS)
Investigations to consider
- culture of throat swab for group A Streptococcus (GAS)
- culture of throat swab for gonococcus or chlamydia
- serum monospot for Epstein-Barr virus infection
Treatment algorithm
all patients
Contributors
Authors
Jeffrey R. Donowitz, MD
Pediatrician
Pediatric Infectious Diseases
Children’s Hospital of Richmond
Virginia Commonwealth University
Richmond
VA
Disclosures
JRD declares that he has no competing interests.
Acknowledgements
Dr Jeffrey R. Donowitz would like to gratefully acknowledge Dr William A. Petri, Jr, a previous contributor to this topic.
Disclosures
WAP declares that he has no competing interests.
Peer reviewers
Richard Roberts, MD, JD, FAAFP, FCLM
Professor of Family Medicine
University of Wisconsin School of Medicine and Public Health
Madison
WI
Disclosures
RR declares that he has no competing interests.
Remco de Bree, MD, PhD
Otolaryngologist
Head and Neck Surgeon
VU University Medical Center
Amsterdam
The Netherlands
Disclosures
RdB declares that he has no competing interests.
Differentials
- Epiglottitis
- Retropharyngeal, peritonsillar, and lateral abscess
- Infectious mononucleosis
More DifferentialsGuidelines
- Pharyngitis (strep throat)
- Group A streptococcal (GAS) pharyngitis: a practical guide to diagnosis and treatment
More GuidelinesPatient leaflets
Sore throat
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