Lightning Learning: Scarlet Fever

Lightning Learning: Scarlet Fever

“Commonly affecting 2-4 infants per 1000 between 4-6 weeks of age when the pyloric muscle becomes thickened and obstructs the passage of milk into the bowel.”
— advice is based on local guidelines & procedures


There are on average 1-2K cases of scarlet fever each winter in the UK. Children between 4-8 years are amongst the most affected. It is caused by Streptococcus pyogenes (Group-A). This invasive bacteria can spread causing…

1) Peritonsillar abscess

2) Septicaemia

3) Meningitis

4) Pneumonia

5) Osteomyelitis

Post-streptococcal complications also include…

6) Rheumatic fever

7) Glomerulonephritis

Peak occurrence is seasonal from December to April annually.


1) 24-hour prodrome: Sore throat, fever, headache, muscle ache, tummy ache, nausea & vomiting.

Followed by…

2) Skin signs: Red, generalised, pinhead rash spreading from the trunk, with a sandpaper-like texture which in the flexures causes “Pastia’s lines.”

3) Oropharyngeal signs: White coated or Strawberry tongue. including flushed cheeks, perioral pallor, inflamed tonsils +/- exudate.


What Next?

  • Consider throat swab
  • Prescribe antibiotic without delay (10 day course Pen V or macrolide)
  • Advise on self care (rest, fluids, hygiene, paracetamol)
  • Advise exclusion from nursery, school, work for at least 24 hours
  • Notify public health England

Further Reading…

The Spectrum of Head Injuries

The Spectrum of Head Injuries

In Situ Simulation: Bridging the Gap between Learning and Practice

In Situ Simulation: Bridging the Gap between Learning and Practice