Re-emergence of Scarlet Fever in Children.pptx

Re-emergence of Scarlet Fever in Children in Indian Context

1. Scarlet Fever BPS

2. Scarlet Fever – Is the Colour Changing? Dr Ashwani Sood Dr Daruru Ranganath Dr Gnanamurthy N Dr Kishore Bandura Dr Rajendra Salagare Dr S.Balasubramanian

3. Dr Ashwani Sood – 9418300888- [email protected] Dr Daruru Ranganath -9885500242- [email protected] Dr Gnanamurthy N- Dr Kishore Bandura- 9845058262- [email protected] Dr Rajendra Salagare - 9448472550- [email protected] [email protected] 9845050736

4. Focus in This Discussion Why this session at all? Few Case Scenarios Dilemmas in Diagnosis & Treatment Expert Inputs Summary & Key Points

5. Why this session at all?

6. Let us start with an open question Are you all seeing more cases of Scarlet Fever this year than ever before? If yes, why ?

7. Why this session at all? The need for increased awareness DD of Fever & Rash – Need for refreshing our knowledge To fill up the gaps in our knowledge of clinical & lab diagnosis & treatment of Scarlet Fever

8. Case Scenario 1 A 3 yr old boy – Fever & Throat Pain – 3 days Seen by a GP Given Azithromycin 100 mg od for 2 days Develops rashes Parents worried it could be Measles or Drug Rash

9. Questions to Experts What are the diagnostic possibilities? Is this Scarlet Fever?

10. What is the Differential Diagnosis? The differential diagnosis of scarlet fever includes Kawasaki disease, toxic shock syndrome (TSS), staphylococcal scalded skin syndrome (SSSS), rubella, rubeola, mononucleosis, fifth disease, acute lupus erythematosis , juvenile arthritis, other viral exanthems, and drug reactions. Similar cutaneous findings can be seen with pharyngeal infections associated with Staphylococcus aureus, Arcanobacterium haemolyticum , Haemophilus influenzae, and Clostridium species.

11. DD Exfoliative dermatitis • Erythema multiforme • Mononucleosis • Erythema infectiosum (fifth disease) • Kawasaki disease Rubeola (measles) • Pharyngitis • Pneumonia • Rubella (German measles) • Pityriasis rosea • Scabies Staphylococcal scalded skin syndrome • Syphilis • Toxic epidermal necrolysis • Toxic shock syndrome • Drug hypersensitivity • Unspecified viral exanthem

12. Characteristics of Scarlatina Rash • Appears 12-24 hours after the onset of the illness, first on the trunk and then extending rapidly over the entire body to finally involve the extremities • Usually spreads from head to toe • Diffusely erythematous • In some children, rash is more palpable than visible • Usually has the texture of coarse sandpaper • Erythema blanches with pressure • Skin may be pruritic but is not usually painful • A few days after the rash becomes generalized over the body, it becomes more intense along the skin folds and produces lines of confluent petechiae, known as Pastia's lines (which are caused by increased capillary fragility) • Three or four days after the onset of the rash, it begins to fade, and the desquamation phase begins, with peeling of flakes from the face; peeling from the palms and around the fingers occurs about 1 week later; desquamation lasts for about 1 month after the onset of the disease

13. Complications Cervical adenitis Otitis media or otitis mastoiditis Ethmoiditis Sinusitis Peritonsillar abscess Pneumonia Septicemia Meningitis Osteomyelitis Septic arthritis Rheumatic fever Acute renal failure from post-streptococcal glomerulonephritis

14. Case Scenario 2 A 5 yr old – Fever & Odonyphagia 2 days T Max 103*F H/O Cleft Palate surgery at 1 yr Also develops rashes in the trunk

15. Case Scenario 2 A 5 yr old – Fever & Odonyphagia 2 days T Max 103*F H/O Cleft Palate surgery at 1 yr Also develops rashes in the trunk

16. Questions to Experts Is this Bacterial or Viral Pharyngitis? How do you differentiate between the 2? Is this Scarlet Fever?

17. Case Scenario 3 A 6 yr old – Exfoliation of palms & soles – 2 days H/O Fever & Throat pain – 5 days back What are the possibilities? Is this Scarlet Fever?

18. Some Open Questions to Experts How do you confirm Scarlet Fever?

19. Some Open Questions to Experts What are the DDs for Scarlet Fever? How do we differentiate Scarlet Fever & Kawasaki Disease?

20. Strawberry Tongue What are the various conditions causing Strawberry Tongue?

21. Palatal Petechiae – Significance?

22. A Child with fever & sore throat TC 22000 L80 P20 Pl 1.4 What is the likely diagnosis? What is this sign?

23. What lab tests do you do if you are suspecting Scarlet Fever?

24. Some Open Questions to Experts Role of RADT in the diagnosis of Scarlet Fever? ASO – is it useful? Throat Swab Culture – Interpretation & Limitations?

25. What is the usefulness of Modified Mcissac Score/ Centor Score?

26. Some Open Questions to Experts Which is your Antibiotic Choice, dose & duration? Is there a role for delayed initiation of Antibiotic Therapy? What about complications of Scarlet Fever?

27. Final Open Question What are the challenges in the diagnosis of Scarlet Fever you face?

28. Take Home Messages Be aware of Scarlet Fever RADT & Throat Swab Cultures essential for confirmation of diagnosis Do not rely on Centor Score for diagnsosis of scarlet fever Delayed antibiotic therapy when in doubt in a satble child is acceptable & rational Amoxycillin is the drug of choice not Amoxyclav or Azithromycin or Cefpodoxime

29. Thank You Very Much Please Mail Feedback to [email protected]