sandpaper rash with fever without sorethroat

[Painter1]

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so i know this infamous sandpaper rash is assoicated with scarlet fever, but what if you have a classic sandpaper rash and fever, but no sorethroat and a normal pharangeal(sp?) exam? do you still throat cx or even tx with pcn? i ask as i remember somewhere someone mentioned that you treat; however, my understanding now is that viral syndromes can also cause sandpaper rashes.

?

 

[TexasRose]

so i know this infamous sandpaper rash is assoicated with scarlet fever, but what if you have a classic sandpaper rash and fever, but no sorethroat and a normal pharangeal(sp?) exam? do you still throat cx or even tx with pcn? i ask as i remember somewhere someone mentioned that you treat; however, my understanding now is that viral syndromes can also cause sandpaper rashes.

?

I'd check a rapid strep, can also check ASO titers. If the ASO titers are high, you'd consider treating.

 

[Stitch]

I'd check a rapid strep, can also check ASO titers. If the ASO titers are high, you'd consider treating.

I wouldn't rely on ASO titers; they remain positive for months after strep infection. A rapid strep or culture is enough to treat, though some treat clinically, especially if it fits with a 'classic' appearance and distribution.

Incidentally, this thread is a duplicate of the on the ED forum.

 

[edmadison]

Don't forget to look at their butt in these cases. You can see scarletina associated with strep butt.

Ed

 

[TexasRose]

I wouldn't rely on ASO titers; they remain positive for months after strep infection. A rapid strep or culture is enough to treat, though some treat clinically, especially if it fits with a 'classic' appearance and distribution.

Incidentally, this thread is a duplicate of the on the ED forum.

Hmm, didn't mean to sound like ASO titers were the standard. I've just seen them used as supporting evidence when a rapid strep was neg but the suspicion was high.

 

[bks524]

EBM may say otherwise, but I say its strep and give them PCN. Just remember Strep test is high specificity and relatively low sensitivity and I saw a million kids in the ER with rash, fever, tachycardia, belly pain and no complaints of sore throat-nearly always strep culture positive (carrier vs active infection ?)

 

[amarula]

if the butt looks ok (ie- no evidence of perianal strep) and mucus membranes are clear; then i say eczema vs. viral exanthem