1. Scarlet Fever Laura Guzman & Daniela Hernandez

2.  What is Scarlet Fever?  Etiology  Epidemiology  Mode of transmission  Clinical Manifestations  Diagnostic  Treatment  Prevention  Bibliography

3. What is Scarlet Fever?  Scarlet Fever is an upper respiratory infection caused by a group A streptococcus bacteria.  This bacteria makes a toxin that can cause a red rash, hence the name “scarlet” fever.  Scarlatina is due to a throat infection caused by a bacterium (germ) called streptococcus.  There are various strains (types) of streptococcus.  They cause different infections and a strain called group A streptococcus causes scarlet fever.  The fever rash occurs when the streptococcal bacteria release poisons toxins that make the skin go red.  Most common in children aged 3-15 years, the most common age being 4 years. It more frequently occurs in the late winter or in early spring.

4. Etiology o Scarlatina is a streptococcal disease. o Gram-positive cocci that grow in chains. o Group A streptococci are normal inhabitants of the nasopharynx (pharynx). o Coccal-shaped bacterium Streptococcus pyogenes, the pathogen that causes scarlet fever, also known as group A. streptococci (GAS). o Group A streptococci can cause pharyngitis, skin infections (including erysipelas pyoderma and cellulitis), pneumonia, bacteremia, and lymphadenitis. o The incubation period ranges from 12 hours to 7 days. o Patients are contagious during the acute illness and during the subclinical phase. o Person-to-person spread by means of respiratory droplets is the most common mode of transmission.

5. Epidemiology  As many as 10% of the population contracts group A streptococcal pharyngitis. Of this group, as many as 10% then develop scarlet fever.  The infection rate increases in overcrowded places.  Immunity, which is type specific, may be induced by a carrier state or overt infection.  Predominantly occurs in children aged 5-15 years, though it can also occur in older children and adults.  By the time children are 10 years old, 80% have developed lifelong protective antibodies against streptococcal pyrogenic exotoxins.  Scarlatina is rare in children younger than 2 years because of the presence of maternal antiexotoxin antibodies and lack of prior sensitization.  February 2014: a total of 868 notifications of scarlet fever with onset dates during weeks 5 to 8 of 2014 were made to Public Health England (PHE) compared to an average of 444 for the same period over the past four years.  Ever since 1990, these are the highest notification totals for this time of year.

6. Mode of transmission o Transmission mostly occurs from person to person but can also be from indirect contact. o You can get scarlet fever through direct contact with mucus from the throat, fluid from the nose, or saliva of an infected person

7. Clinical Manifestations  Its emergence tends to be quite harsh, usually heralded by sudden onset of fever associated with sore throat, headache, nausea, vomiting, abdominal pain, myalgias, and malaise.  Signs of Scarlatina can be Tachycardia and/or Lymphadenopathy  The characteristic rash appears 12-48 hours after onset of fever, first on the neck and then extending to the trunk and extremities.  The patient may have tachycardia. Tender anterior cervical lymphadenopathy may be present.

8. Most cases of scarlet fever have no complications at all. However, in the early stages, there is a small risk that you might get one of the following: Meningitis Throat abscess Acute rheumatic fever Pneumonia Inflammation of the sinuses (sinusitis) COMPLICATIONS

9. Diagnostic Physical examination Throat culture positive for Group A Strep Rapid Antigen Detection (Throat swab)

10. Treatment There is no vaccine, but the disease is effectively treated with antibiotics. Treatment is to speed recovery and to prevent possible complications. Antibiotics: A 10-day course of penicillin is usually advised. Other antibiotics are advised if you are allergic to penicillin. It is important to finish the course of antibiotics:  This makes sure all the bacteria are killed and reduces the chance of complications.

11. Prevention If your child has Scarlet Fever, do not let him go to school and keep them away from other people until they have been on a course of antibiotics Avoid sharing utensils, cups and glasses, coletes, baths, bed linen or towels. All tissues should be disposed immediately Wash hands frequently to avoid contracting or acquiring Scarlatina

12. Bibliography  Vorvick, L. J. (Ed.). (2012, May 15). Scarlet Fever. Retrieved May 1, 2014, from The New York Times website: http://www.nytimes.com/health/guides/disease/ scarlet-fever/overview.html  Kenny, T., Dr. (2013, May 31). Scarlet Fever. Retrieved May 1, 2014, from Patient website: http://www.patient.co.uk/health/scarlet-fever- leaflet  Scarlet Fever. (2013, March 28). Retrieved May 1, 2014, from NHS Choice website: http://www.nhs.uk/conditions/Scarlet-fever/Pages/Introduction.aspx  Klein, MD, J. (2012, July). Scarlet Fever. Retrieved May 2, 2014, from http://kidshealth.org/parent/infections/bacterial_viral/scarlet_fever.html  Zabawski Jr, DO, E. J., & James, MD, W. D. (2014, April 30). Emedicine - Scarlet Fever. Retrieved April 30, 2014, from http://emedicine.medscape.com/article/1053253-overview#a0156