Clinical manifestations
Early, the tongue is usually coated and
the papillae are swollen.
After several days the white coat
desquamates, and the reddened papillae are prominent, giving the tongue a
strawberry appearance.
The rash:
- Appears after
12-48 hours
- The erythematous
exanthem is red, punctate or finely papular, and blanches on pressure, appears
initially in the axillae, groin, and neck, but
within 24 hours it becomes generalized.
Circumoral pallor:
The forehead and cheeks appears flushed
and the area around the mouth is pale.
Desquamation begins on the face towards
the end of the first week and proceeds over the trunk and finally to the hands
and feet, it may continue for as long as 6 weeks.
Complications of streptococcal
infection
Early: sinusitis, otitis media, mastoiditis, cervical adenitis, retropharyngeal
or parapharyngeal abscess, or bronchopneumonia. Hematogenous dissemination of
streptococci may cause meningitis, osteomyelitis, or septic arthritis.
Late: rheumatic fever and acute post-streptococcal
glomerulonephritis.
Treatment of streptococcal infection
The goal of therapy is to decrease symptoms and
prevent suppurative, and non-suppurative complications.
Penicillin is the drug of choice in a dose of
125-250 mg/dose 3 times a day for 10 days. A single IM injection of a long
acting benzathine penicillin (600,000 U for children <27 kg and 1,200,000 U
for children≥27 kg) may be more effective for treatment or prevention of
relapse.
· If the patient is allergic to
penicillin, he can be treated with erythromycin (40 mg/kg/24 hr) or lincomycin
(40mg/kg/24 hr).
Coated tongue
strawberry tongue
erythematous exanthem
 |
Circumoral
pallor
Desquamation of the skin
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