From the Guidelines
Yes, scarletina typically presents with fever, usually from 101°F to 104°F, as part of its clinical manifestations. Scarletina, also known as scarlet fever, is caused by group A Streptococcus (GAS) and its presentation can be similar to other upper respiratory tract infections, making diagnosis challenging 1. The clinical findings suggestive of GAS as the cause of an episode of acute pharyngitis, such as sore throat, pain on swallowing, fever, and headache, are not specific enough to diagnose GAS pharyngitis on their own 1. Some key points to consider when diagnosing scarletina include:
- Clinical findings highly suggestive of a viral cause of an episode of acute pharyngitis, such as coryza, hoarseness, cough, diarrhea, conjunctivitis, and a characteristic viral enanthem and/or exanthem, can help rule out scarletina 1
- A history of close contact with a well-documented case of GAS pharyngitis and awareness of a high prevalence of GAS infections in the community can aid in making the diagnosis 1
- Accurate differentiation of GAS pharyngitis from pharyngitis caused by other pathogens based on history and clinical findings is often difficult, and some form of microbiological confirmation is required for the diagnosis of GAS pharyngitis 1. The fever in scarletina is a result of the bacterial toxins triggering an immune response that raises the body's temperature as a defense mechanism. Prompt antibiotic treatment is crucial to prevent complications such as rheumatic fever or kidney inflammation 1.
From the Research
Clinical Presentation of Scarletina
- Scarletina, also known as scarlet fever, is a disease that presents with various clinical manifestations, including fever 2, 3, 4.
- The presence of fever is a common symptom, with studies indicating that it occurs in approximately 89% of cases, with a temperature of >38°C in 73% of cases 4.
- Fever is often accompanied by other symptoms such as an intense pain in the throat, pain on swallowing, an inflamed pharynx, enlarged and erythematous tonsils, and enlarged tender anterior cervical lymph nodes 5.
Age-Related Differences in Clinical Presentation
- The clinical presentation of scarletina may vary depending on the age of the patient, with younger patients (under the age of 4 years) experiencing higher fever (>38°C) than older patients 4.
- The study by 4 found that episodes in patients under the age of 4 years old have significantly higher fever (>38°C) than the older ones (80% versus 63%).
Diagnostic Considerations
- The diagnosis of scarletina is often based on the presence of a distinctive rash, which is a key diagnostic feature of the disease 6, 3, 4.
- The use of clinical prediction rules such as the Centor score or McIsaac score may be questionable in the evaluation of scarletina, as the disease may present with atypical symptoms 4.
- Microbiological diagnosis using rapid antigen-detection tests or traditional culture may be necessary to confirm the diagnosis of scarletina 5, 4.