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Pathology of Scarlet Fever (Scarlatina)

Dr Sampurna Roy MD




Scarlet fever, which results from an acute pharyngitis or tonsillitis caused by group A streptococci, is characterized by a rash produced by the erythrogenic toxin.

Streptococcal Infection

The incubation period of 2 to 5 days is followed by chills and fever, fiery red pharyngeal mucosa, small crypt abscesses in enlarged tonsils, and a bright red tongue with edematous papillae ("raspberry tongue").

One to 3 days later there appears a diffuse, punctate, erythematous rash, most prominent over the trunk and inner aspects of the limbs and involving the face, except for a small area around the mouth (“circumoral pallor”).

When the pharyngitis and rash subside, near the end of the first week, desquamation begins.

Microscopically, an acute suppurative exudate on the pharynx and oropharynx contains streptococci.

There is also an acute inflammatory reaction in the lymph nodes.

Hyperkeratosis of the reddened skin accounts for scaling during defervescence.

The characteristic 1 week duration of scarlet fever is not  shortened by antibiotic therapy, but suppurative complications, such as otitis media, sinusitis, and mastoiditis, are prevented.

Scarlet fever is known for late nonsuppurative sequelae, which are also prevented by prompt treatment.

The precise cause and pathogenesis of scarlet fever were not evident until the Dicks demonstrated in 1924 that an erythrogenic toxin obtained from broth filtrate of certain beta-hemolytic streptococci would , on injection into a susceptible individual, produce a typical erythematous reaction.

As a result of widespread application of the Dick test, it became apparent that only a minority of adults were susceptible to scarlet fever and that the number who were “immune” was far greater than the number who had  actually had the disease previously.

Complications of Scarlet fever are divisible into three major categories:

1. The results of bacterial dissemination locally - otitis media, sinusitis, cervical adenitis, acute suppurative mastoiditis, and retropharyngeal abscess.

2. The result of bacterial dissemination generally -  metastatic foci of infection throughout the body or frank septicemia.

3. The manifestations of extraordinary reactions to toxins (this may be brought about by hypersensitivity) - interstitial nephritis or myocarditis, pericarditis, nonsuppurative  arthritis, and glomerulonephritis.

Further reading:

Association of the shuffling of Streptococcus pyogenes clones and the fluctuation of scarlet fever cases between 2000 and 2006 in central Taiwan

Scarlet Fever Epidemic, Hong Kong, 2011

Streptococcus pyogenes and re-emergence of scarlet fever as a public health problem

An Integrated Syndromic Surveillance System for Monitoring Scarlet Fever in Taiwan

Scarlet Fever in an adult.

Molecular Epidemiological Characteristics of Streptococcus pyogenes Strains Involved in an Outbreak of Scarlet Fever in China, 2011.

[Study on the epidemiological characteristics and incidence trend of scarlet fever in Shanghai, 2005-2012].

Scarlet fever is caused by a Limited Number of Streptococcus pyogenes Lineages and is Associated with the Exotoxin Genes ssa, speA and speC.

Scarlet fever in Poland in 2011.

Molecular analysis of a novel Toll/interleukin-1 receptor (TIR)-domain containing virulence protein of Y. pseudotuberculosis among Far East scarlet-like fever serotype I strains.

[Early detection on the onset of scarlet fever epidemics in Beijing, using the Cumulative Sum].

[Scarlet fever outbreak in a public school in Granada in 2012.]

Spectral analysis based on fast Fourier transformation (FFT) of surveillance data: the case of scarlet fever in China.

Characteristics of group A Streptococcus strains circulating during scarlet fever epidemic, Beijing, China, 2011.

[A wavelet analysis on the onset cycle of scarlet fever in Beijing and its relationship with theory of five evolutive phases and six climatic factors].

Molecular characterization of Group A streptococcal isolates causing scarlet fever and pharyngitis among young children: A retrospective study from a northern Taiwan medical center.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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