Clinical Manifestations

The initial symptoms of scarlet fever are the same as those of streptococcal sore throat: sudden onset of soreness on swallowing, accompanied by fever and headache. Vomiting and nausea are often early symptoms in young children. The characteristically erythemateous and punctuate rash appears within 2 days, at first on the upper chest and back, then spreading to the rest of the body. In white patients the rash does not commonly appear on the face, but in about half of all black patients it does. The rash is accompanied by the characteristic raspberry tongue. In general, the rash is variable in its manifestations. Desquamation usually occurs, beginning sometimes as early as the fifth day, sometimes as late as 4 to 5 weeks after the onset of the disease. A range of complications, principally affecting young children, add to the dangers of the disease. These include anemia, otitis media, rheumatic fever, and meningitis. In rare cases, scarlet fever appears in severe septic or toxic forms.

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