PEDIATRICS
■ Maternal infection during first or second trimester can result in con-
genital varicella, leading to fetal scarring, limb atrophy, and CNS
abnormalities.
■ Maternal varicella infection at delivery is associated with up to 30%
fetal mortality.
Zoster
■ Postherpetic neuralgia (uncommon in children)
SCARLETFEVER
■ Caused by group A β-hemolytic streptococcus, which produces an erythro-
genic toxin
■ Streptococcal infection is typically located in the throat (strep throat), but
can also occur from skin infections such as impetigo.
SYMPTOMS/EXAM
■ Typically sore throat and fever are present for 1–2 days before the appear-
ance of the rash.
■ Enanthem: “Strawberry tongue”
■ Exanthem: Erythematous, coarse, sandpaper texture rash located typically
on the torso and face with sparing of the circumoral area (see Figure 5.13).
Desquamation occurs after the rash fades. “Pastia’s lines” is linear non-
blanching erythema of the skin fold in joints.
DIFFERENTIAL
■ Toxic shock syndrome
■ 2° syphilis
■ Infectious mononucleosis
FIGURE 5.13. Scarlet fever.
(Reproduced, with permission, from Wolff K et al. Fitzpatrick’s Dermatology in General
Medicine, 7th ed. New York: McGraw-Hill, 2008:1718.)
Scarlet fever: Strawberry
tongue, sandpaper rash,
Pastia’s lines