0071643192.pdf

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