A 7-year-old boy is brought to the pediatrician’s office with a rough red rash on his trunk (Figures 28-1 and 28-2) along with fever and a sore throat. The sandpaper rash and signs that are consistent with strep pharyngitis lead the physician to diagnose scarlet fever. The physician explains the diagnosis to the mother and oral penicillin V is prescribed. The boy feels markedly better by the next day and the mother continues to give the penicillin for the full 10 days, as directed, to prevent rheumatic fever.
Scarlet fever is an illness caused by toxin-producing group A β-hemolytic streptococcus (strep) infection. Most commonly, scarlet fever evolves from an exudative pharyngitis.
Strawberry tongue may be observed in patients with scarlet fever and usually develops within the first 2 to 3 days of illness. A white or yellowish coating usually precedes the classic red tongue with white papillae (Figure 28-3).
Scarlet fever is predominately seen in school-age children with no gender predilection.
Majority related to strep pharyngitis, with 1 in 10 developing scarlet fever (Figures 28-1, 28-2, and 28-4).
Prevalent in late fall to early spring.
Strawberry tongue (Figure 28-4) is most commonly seen in children in association with scarlet fever or Kawasaki disease.
Can be present with other group A strep infection.
In cases of strep, a white membrane through which the papillae are seen can initially cover the tongue followed by desquamation of the membrane (with the appearance as in Figure 28-4).
Transmission of Streptococcus pyogenes (Group A) (GAS) occurs via respiratory secretions.
Virulent GAS incubates over 2 to 7 days. M protein serotypes of GAS are typically more invasive, with greater potential for progression to rheumatic fever or acute glomerulonephritis if untreated.1
Fever and rash are related to pyrogenic A–C and erythrogenic exotoxins produced by GAS.2
Infection can originate from other sites like skin (e.g., cellulitis) and seed blood (bacteremia) or organ systems (e.g., pneumonia).
Strawberry tongue results from a general inflammatory response during the early course of the disease.
