• Caused by Streptococcus pyogenes. B-hemolytic streptococci.
• The disease begins as a streptococcal tonsillitis with pharyngitis in which the organisms elaborate an erythrogenic toxin that attacks the blood vessels and produces the characteristic skin rash.
• The microorganism is present in the saliva/mucous spread by sneezing /coughing or direct contact with an infected person.

PATHOGENESIS

• The rash is occurs by 3 endotoxins A,B & C:previously described as erythrogenic/scarlet fever toxins.
• •It is suggested that development of scarlet fever may reflect a Hypersensitivity reaction required to exposure of skin.

CLINICAL FEATURES:
• Scarlet fever is most common in children from the ages of 3 to 12 years.
• The entry of microorganism occurs through the pharynx.
• Incubation period :3-5days.
• After this, the patient shows symptoms like severe pharyngitis & tonsillitis, chills, headache, abdominal pains and vomitting.
• Also enlargement & tenderness of cervical lymph nodes is seen.
• The diagnosis is not established until the characteristic – scarlet skin rash appears on the skin 2-3 days of illness.
• This rash is prominent in the areas of skin folds, is a result of toxic injury to the epithelium.
• Produces dilatation of small vessels and consequent hyperaemia.
• Small papules of normal colour erupt giving a characteristic sandpaper texture to the skin.
• Rash particularly in areas of skin fold is k/a Pastia lines.
• Rash subsides after 6-7 days, followed by the desquamation of palms and soles.
• Colour: Scarlet – Dusky Red

ORAL MANIFESTATIONS:
• Chief oral manifestation is referred to as stomatitis scarlatina.
• Small punctuate red macules seen on hard palate, soft palate & uvula, k/a Forcheimmer Spots.
• These are not diagnostic, as they may be present in other conditions like Rubella, Roseola & Infectious Mononucleosis
• Palate and throat are often fiery red.
• In early course of the disease, tongue exhibits white coating & the fungiform papillae are oedematous.
• This phenomenon is k/a Strawberry tongue.
• Coating is lost -the tip & lateral margins of tongue become deep red, glistening & smooth k/a Raspberry Tongue.
• In severe cases, ulceration occurs on the buccal mucosa & palate, has been reported due to secondary infection.

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DIAGNOSIS:
• A culture of throat secretions may be used to confirm the diagnosis of streptococcal infection.
• But this has been replaced by several methods of rapid detection of antigens that are specific for group A, B-hemolytic streptococci.
• Failure to respond to appropriate antibiotics should alert the clinician that the detected strep tococci may represent an intercurrent carrier state.
• Other causes of infection should be investigated.
TREATMENT & PROGNOSIS:
• Treatment of scarlet fever and the associated streptococcal pharyngitis is necessary to prevent the possibility of complications, such as peritonsillar or retropharyngeal abscess, sinusitis, or pneumonia.
• Late complications are rare: Include otitis media, acute rheumatic fever, glomerulonephritis, arthralgia, meningitis, and hepatitis.
• The treatment of choice is oral penicillin.
• Erythromycin reserved for patients who are allergic to penicillin.
• Ibuprofen can be used to reduce the fever and relieve the associated discomfort.
• The fever and symptoms show dramatic improvement within 48 hours after the initiation of treatment.
• With appropriate therapy, the prognosis is excellent.

REFERENCES:
• Shafer’s Textbook of Oral Pathology (8th Edition)
• Oral and Maxillofacial Pathology(Neville 3rd Edition)
• Myoclonic.org
• Gponline.org
• Medlineplus.gov