clinical features
Last reviewed 06/2022
- typically the first symptoms of scarlet fever develops after an incubation period of 2 to 4 days and includes:
- tonsillitis
- fever (usually above 38.3º C/101º F or higher)
- headache, malaise, nausea and vomiting (1)
- characteristic fine red rash
- develops twelve to forty eight hours after the onset of these symptoms
- first appears on the chest and stomach and later covers the entire body and limbs and consists of many small papules on diffuse erythema that blanches on pressure (1,2)
- often more marked over the skinfolds where transverse lines containing tiny petichae may be seen
- area around the mouth is spared
- the skin may feel rough like sandpaper
- the rash lasts for a period of two to three days, after which desquamation occurs that is most prominent on the soles of the feet and the palms of the hands (1)
- examination of the throat generally reveals that the pharynx is diffusely reddened, with enlarged and red tonsils covered with a white exudate. The tongue may be initially furred with enlarged papillae - an appearance described as a 'white strawberry t ongue', lost after two or three days to become strawberry tongue.
- usually there is enlargement of regional lymph nodes (1)
- flushed red face with paleness around the mouth (1)
- note that although, in general the tonsil or pharynx is the site of infection, occasionally other foci e.g. surgical wounds may occur
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