title: Scarlet fever: A not so typical exanthematous pharyngotonsillitis (based on 171 cases).
abstract: OBJECTIVE
  To describe the age, signs and clinical symptoms of children with scarlet fever at the present time, and to check whether they are equivalent to those with traditional streptococcal pharyngotonsillitis.
  
  
  METHODS
  An observational, retrospective study was conducted on the clinical records of 5500 children aged from 0 to 15 years attending a primary health care center. A record was made of the percentage of the cases in which signs and symptoms appear and the Centor score was calculated. Microbiological diagnosis of the disease was made using the rapid antigen-detection test or traditional culture.
  
  
  RESULTS
  A total of 171 out of 252 scarlet fever diagnoses were microbiologically verified in 158 patients. The median age was 3.8 years (interquartile range: 2.91-4.78), with the majority (57%) under the age of 4 years. There was fever in 89% of the processes (95% CI: 84-94%), with a temperature of >38°C in 73% (95% CI: 65-80%), enlarged lymph nodes in 70% (95% CI: 58-82%), absence of cough in 73% (95% CI: 65-80%), and tonsillar exudate in only 24% (95% CI: 17-31%). The Centor score (n=105) was ≤2 points in 86% (95% CI: 79-92%). The only difference regarding age is that episodes in patients under the age of 4 years old have significantly higher fever (>38°C) than the older ones (80% versus 63%. OR 3.13; 95% CI: 1.46-6.71).
  
  
  CONCLUSIONS
  Scarlet fever pharyngotonsillitis differs from the traditional streptococcal pharyngotonsillitis, and its evaluation using clinical prediction rules such as Centor or McIsaac is questionable. The main diagnostic key must certainly be rash, regardless of patient age.
authors.affiliation: Primary Health Care Centre "José Ramón Muñoz Fernández", Zaragoza, Spain. Electronic address: cgarciavera@gmail.com.
authors.forename: César
authors.initials: C
authors.lastname: García-Vera
authors.affiliation: University Childrens Hospital "Miguel Servet", Zaragoza, Spain.
authors.forename: Bárbara
authors.initials: B
authors.lastname: de Dios Javierre
authors.affiliation: University Childrens Hospital "Miguel Servet", Zaragoza, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Castán Larraz
authors.affiliation: Primary Health Care Centre "José Ramón Muñoz Fernández", Zaragoza, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Arana Navarro
authors.affiliation: Primary Health Care Centre "José Ramón Muñoz Fernández", Zaragoza, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cenarro Guerrero
authors.affiliation: Primary Health Care Centre "José Ramón Muñoz Fernández", Zaragoza, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ruiz Pastora
authors.affiliation: Primary Health Care Centre "José Ramón Muñoz Fernández", Zaragoza, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Sánchez Gimeno
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010612:Pharyngitis / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D012541:Scarlet Fever / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis; D014069:Tonsillitis / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology
keywords: Amigdalitis; Centor score; Child; Escala de Centor; Escarlatina; Faringitis; Niño; Pharyngitis; Scarlet fever; Tonsillitis