scarlet fever /skär″lit/ [OFr, escarlate + L, febris, fever] , an acute contagious disease of childhood caused by an erythrotoxin-producing strain of group A hemolytic Streptococcus. Also called scarlatina. ▪ OBSERVATIONS: Signs and symptoms appear 1 to 3 days after exposure to the agent, starting with an abrupt high fever, chills, tachycardia, nausea, vomiting, headache, abdominal pain, malaise, and a sore throat. The tonsils become enlarged, reddened, and covered with patchy exudate. The pharynx is red and edematous. The tongue is coated and white with red, swollen papillae (white strawberry tongue) until the white coat sloughs off about the fourth day, leaving a red strawberry tongue and red punctate lesions on the palate. A rapidly erupting rash appears 1 to 2 days after the onset of the sore throat. The rash displays as pinhead-size red lesions, which rapidly cover the body except for the face. The rash concentrates in the axial folds, on the neck, and in the groin and lasts 4 to 10 days. The face is flushed on the cheeks with a circumoral pallor. After a week, desquamation and peeling begin on the palms and soles. Diagnosis is made from clinical signs and a positive Schultz-Charlton reaction skin test or a positive throat culture. Complications include otitis media; sinusitis; peritonsillar abscess; and severe, disseminated toxic or septic disease (fulminating scarlet fever), which may cause septicemia and hepatic damage. ▪ INTERVENTIONS: Treatment is aimed at eradicating the streptococcal infection through administration of antibiotics. Antipyretics are given for fever, and analgesics are given for sore throat pain. ▪ PATIENT CARE CONSIDERATIONS: Nursing measures are largely supportive and include bed rest during the febrile phase; adequate fluids; gargles, throat lozenges, and throat washes for sore throat; and room humidification for comfort. Respiratory precautions should be instituted until 24 hours after initiation of antibiotics because of the edema in the pharynx and tonsils. Environmentally imposed restraints are used until 24 hours after the initiation of antibiotics to reduce the spread of this communicable disease. Distractive techniques with appropriate developmental activities are used to relieve pain and social isolation. Careful handwashing techniques are used to decrease risk of infection.
