Toxin: erythrogenic toxin
Associated Streptococcal infections may include:
(1) pharyngitis
(2) cellulitis or abscess
(3) wound infection
(4) puerperal sepsis
Clinical features:
(1) The patient initially presents with fever and signs of infection.
(2) Shortly thereafter the patient develops a diffuse erythematous rash, which may be subtle in a dark-skinned individual.
(2a) The rash blanches on pressure.
(2b) The rash usually starts on the upper chest and then spreads distally.
(2c) The palms and soles are usually spared.
(2d) Skin folds are a dark red (Pastia's lines)
(3) The face becomes flushed but circumoral pallor is present.
(4) The tongue initially has a white coating with red papillae ("white strawberry") but then becomes diffusely red ("red strawberry").
(5) The palate may show small hemorrhagic spots.
(6) The skin may develop a sandpaper-like feel because of sweat gland occlusion.
(7) Petechiae may be present and the patient may show capillary fragility.
(8) During recovery there is diffuse skin desquamation.
Some patients may have severe disease with high fevers and systemic symptoms (septic or toxic forms).
Differential diagnosis:
(1) scarlatiniform variant of Staphylococcal scalded skin syndrome
(2) viral exanthem
(3) drug-induced
(4) Kawasaki syndrome
