Scarlet Fever


  • Group A Beta-Hemolytic Strep (Strep Pyogenes) (see Strep Pyogenes)
    • Epidemiolgoy
      • Most common etiology
      • Usually associated with pharyngitis
    • Physiology
      • Release of Exotoxin A
    • Diagnosis
      • Elevated anti-streptolysin-O (ASO)
      • Elevated DNase B
  • Staph Aureus (see Staph Aureus): elaborates erythrotoxin
    • Epidemiology
      • Rare etiology
    • Physiology
      • Release of Pyogenic Exotoxin
    • Diagnosis
      • Normal anti-streptolysin-O (ASO)
      • Normal DNase B


  • Blanching Erytematous Rash (see Exanthems)
    • Diffuse Erythema (blanching): begins on neck and upper trunk
    • Red Follicular Puncta
    • Linear Antecubital Fossa Petechiae
    • Desquamation of involved skin/palms/soles: occurs 5-20 days after onset of eruption
  • Pharyngitis
  • “White Strawberry Tongue” (seen early): white coating with red papillae
  • “Red Strawberry Tongue” (seen later): red tongue with red papillae
  • Palatal Petechiae
  • Facial Flush with Circumoral Pallor


  • Enterotoxin B Is the Predominant Toxin Involved in Staphylococcal Scarlet Fever in Taiwan. Clinical Infectious Diseases 2004;38:1498–502