Evaluation of fever in children

Last reviewed: 7 Jan 2023
Last updated: 26 Jan 2023
25 Jan 2023

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 old

  • 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:

Original source of update

Summary

Differentials

Common

  • Urinary tract infection
  • Pneumonia
  • Coronavirus disease 2019 (COVID-19)
  • Acute otitis media
  • Tonsillitis
  • Sinusitis
  • Meningitis
  • Bacteremia (occult)
  • Sepsis
  • Septic arthritis
  • Osteomyelitis
  • Cat-scratch disease
  • Viral syndromes
  • Infectious mononucleosis
  • Cytomegalovirus infection
  • Malaria infection
  • Lyme disease
  • Tuberculosis
  • Kawasaki disease
  • Juvenile idiopathic arthritis (JIA)
  • Systemic lupus erythematosus
  • Rheumatic fever
  • Crohn disease
  • Ulcerative colitis
  • Leukemia
  • Non-Hodgkin lymphoma
  • Drug-related fever
  • Vaccine reaction
  • Scarlet fever
Full details

Uncommon

  • Typhoid infection (enteric fever)
  • Infective endocarditis
  • Hepatic abscess
  • Cerebral abscess
  • Streptococcal toxic shock syndrome
  • Staphylococcal toxic shock syndrome
  • Tularemia
  • Brucellosis
  • Leptospirosis
  • Encephalitis
  • Myocarditis
  • Herpes simplex virus (HSV) infection
  • Human immunodeficiency virus (HIV) infection
  • Toxoplasmosis
  • Rocky Mountain spotted fever
  • Sarcoidosis
  • Hodgkin 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
  • Pediatric autonomic disorders
  • Dengue fever
Full details

Contributors

Authors

Paul Ishimine, MD
Paul Ishimine

Director

Pediatric Emergency Medicine

Department of Emergency Medicine

UC San Diego Health System

Fellowship Director

Pediatric Emergency Medicine

Rady Children's Hospital, San Diego

Clinical Professor of Emergency Medicine and Pediatrics

University of California

San Diego School of Medicine

San Diego

CA

Disclosures

PI declares that he has no competing interests.

Peer reviewers

Linton Yee, MD

Associate Professor

Departments of Pediatrics and Surgery

Director of Pediatric Emergency Medicine Education

Duke University School of Medicine

Durham

NC

Disclosures

LY declares that he has no competing interests.

Philip Spandorfer, MD, MSCE

Pediatric Emergency Medicine

Children's Healthcare of Atlanta at Scottish Rite

Atlanta

GA

Disclosures

PS declares that he has no competing interests.

Esse Menson, null

Consultant in Paediatric Infectious Diseases

Evelina Children's Hospital

London

UK

Disclosures

EM declares that she has no competing interests.

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