Scarlet Beta- Punctate Children Acute Rapid

fever hemolytic Strepto erythema infection of strep test,

coccus pyogenes beginning tonsils or wound or
on trunk skin; linear throat
and petechiae in culture,
spreading antecubital antistreptol
to and axillary ysin O
extremitie folds titers
s, (Pastia's
becoming sign); rash
confluent; appearing 2
flushed to 3 days
face with after
perioral infection;
pallor; initially,
rash “white
fading in strawberry
4 to 5 tongue” but
days and by fourth or
followed fifth day,
 by “red
desquama strawberry
tion tongue”

Toxic Staphylococcus Diffuse All ages, High fever, Clinical

shock aureus “sunburn“ but most hypotension criteria,
syndro rash that common and vaginal
me desquama in involvement and wound
tes over 1 menstrua of three or cultures
to 2 ting more organ
weeks females systems;
about 50
percent of
cases
occurring in
menstruating
women
around onset
of menses;
postoperative
patients at
increased
risk;
condition out
of proportion
to wound
appearance

Kawasa Idiopathic Erythema Children Winter and Specific

ki's tous rash less than spring; high clinical
disease on hands 8 years fevers, criteria
and feet; of age, cervical
morbillifo with lymphadenop
rm, peak athy,
scarlatinif incidence arthritis,
orm rash at 1 year; arthralgias,
on trunk boys cardiac
and affected involvement,
perineum; more mucous
hyperemi often membrane
c lips than girls involvement;
can be
complicated
by coronary
artery
 abnormalities
in 20 to 25
percent of
cases

Rubeol Measles virus Macular- Most Prodrome Serology

a papular common consisting of
rash that in symptoms of
may children upper
become 5 to 9 respiratory
confluent; years of tract
begins on age, infection,
face, neck nonimmu coryza, bark-
and ne like cough,
shoulders persons malaise,
and photophobia
spreads and fever;
centrifuga Koplik's
lly and spots
inferiorly; (prodromal
fades in 4 stage);
to 6 days development
of exanthem
on fourth
febrile day;
late winter
through early
spring

Rubella Rubella virus Pink Young Prodrome Serology

macules adults, uncommon,
and nonimmu especially in
papules ne children;
that persons petechiae on
develop soft palate
on (Forschheim
forehead er's spots); in
and adults:
spread anorexia,
inferiorly malaise,
and to conjunctivitis
extremitie , headache
s within and
one day; symptoms of
fading of mild upper
macules respiratory
and infection
papules in
reverse
order by
third day
1. Euzeby JP. List of Prokaryotic names with Standing in Nomenclature—Genus
Streptococcus. Available at http://www.bacterio.cict.fr/s/streptococcus.html
(Accessed 5 June 2017).
2. Todd JK. Streptococca infection. In: Gershon AA, Hotez PJ, Katz Sl.
Krugman’s: Infectious Diseases of Children Eleventh Ed. Philadelphia:
Mosby; 2004. p. 641 – 54
3. Ebell MH, Smith MA, Barry HC, Ives K, Carey M. The rational clinical
examination. Does this patient have strep throat? JAMA. 2000; 284(22):2912–
2918
4. Danchin MH, Rogers S, Kelpie L, Selvaraj G, Curtis N, Carlin JB, et al.
Burden of acute sore throat and group A streptococcal pharyngitis in school-
aged children and their families in Australia. Pediatrics. 2007;120(5):950–957
5. Dublin TD, Rogers EF, Perkins JE, Graves FW. Milk-borne Outbreaks Due to
Serologically Typed Hemolytic Streptococci. American Journal of Public
Health and the Nation's Health. 1943;33(2):157–166
6. Rolleston JD. The History of Scarlet Fever. The BMJ. 1928;2(3542):926–929
7. Yang P, Peng X, Zhang D, Wu S, Liu Y, Cui S, et al. Characteristics of group
A Streptococcus strains circulating during scarlet fever epidemic, Beijing,
China, 2011. Emerging Infectious Diseases; 2013;19(6):909–915.
8. Wong S, Yuen K. Streptococcus pyogenes and re-emergence of scarlet fever
as a public health problem. Emerging Microbes & Infections. 2012;1(7):e2.
9. Holten E, Ubhi H, Patel M. Scarlet Fever: acute management and infection
control. The Pharmaceutical Journal. 2015
10. Rominch, Amundson J. Understanding Zoonotic Diseases. Canada: Delmar
Learning Corporation; 2008. p. 196-205
11. Schwartz B, Facklam RR, Breiman RF. Changing Epidemiology of group A
streptococcal infection in the USA. Lancet 1990; 336:1167
12. Richardson BW. Facts relating to scarlet fever. Assoc Med J 1853; 1: 502–507
13. Promedmail. Available at http://www.promedmail.org (accessed 5 June 2017)
14. Centre for Health Protection, Department of Health. Number of notifications
for notifiable infectious diseases in 2011. Hong Kong. Available at
http://www.chp.gov.hk/en/data/1/10/26/43/455.html (accessed 5 June 2017).
15. Public Health England. Group A streptococcal infections: update on seasonal
activity 2014/15. Health Protection Report 2015;9(5): Infection (News)
Report. London: PHE 2015.
16. Weiss K, Laverdie`re M, Lovgren M, Delorme J, Poirier L, Be ́liveau C.
Group A Streptococcus carriage among close contacts of patients with
invasive infections. Am J Epidemiol 1999; 149: 863–868.
17. Brown WA, Allison VD. Infection of the air of scarlet-fever wards with
Streptococcus pyogenes. J Hyg (Lond) 1937; 37: 1–13.
18. Rammelkamp CH Jr, Morris AJ, Catanzaro FJ, Wannamaker LW, Chamovitz
R, Marple EC. Transmission of group A streptococci. III. The effect of drying
on the infectivity of the organism for man. J Hyg (Lond) 1958; 56: 280–287.
19. Wagenvoort JH, Penders RJ, Davies BI, Lutticken R. Similar environmental
survival patterns of Streptococcus pyogenes strains of different epidemiologic
backgrounds and clinical severity. Eur J Clin Microbiol Infect Dis 2005; 24:
65–67.
20. Juel Henningsen E, Ernst J. Milk epidemic of angina, originating from a cow
with mastitis and due to Streptococcus pyogenes (Lancefield group A). J Hyg
(Lond) 1938; 38: 384–391.
21. Katzenell U, Shemer J, Bar-Dayan Y. Streptococcal contamination of food: an
unusual cause of epidemic pharyngitis. Epidemiol Infect 2001; 127: 179–184.
22. Dick GF, Dick GH. Landmark article Jan 26, 1924: The etiology of scarlet
fever. JAMA. 1983;250(22):3096
23. Spaulding AR, Salgado-Pabón W, Kohler PL, Horswill AR, Leung DY,
Schlievert PM. Staphylococcal and streptococcal superantigen exotoxins.
Clinical Microbiology Reviews. 2013;26(3):422–447
24. Davies MR, Holden MT, Coupland P, Chen JH, Venturini C, Barnett TC, et
al. Emergence of scarlet fever Streptococcus pyogenes emm12 clones in Hong
Kong is associated with toxin acquisition and multidrug resistance. Nature
Genetics. 2015;47:84–87
25. Bohach GA, Fast DJ, Nelson RD, Schlievert PM. Staphylococcal and
streptococcal pyrogenic toxins involved in toxic shock syndrome and relate
illnesses. Crit Rev Microbiol. 1990;17:251–272.
26. Proft T, Fraser JD. Streptococcal Superantigens: Biological properties and
potential role in disease. In: Ferretti JJ, Stevens DL, Fischetti VA.
 Streptococcus pyogenes: Basic biology to clinical manifestations. Oklahoma
City: University of Oklahoma Health Sciences Center; 2017. p. 445-464
27. Todd EW, Lancefield RC. Variants of hemolytic streptococci; their relation to
type specific substance, virulence, and toxin. The Journal of Experimental
Medicine. 1928;48(6):751–767
28. Kaplan MH, Johnson DR, Cleary PP. Group A streptococcal serotypes
isolated from patients and sibling contacts during the resurgence of rheumatic
fever in the United states in the mid-1980's. J Infect Dis. 1989;159:101–103
29. Public Health England. Group A streptococcal infections: update on seasonal
activity 2014/15. Health Protection Report 2015;9(5): Infection (News)
Report. London: PHE 2015
30. The Working Group on Severe Streptococcal Infections. Defining the group A
streptococcal toxic shock syndrome. Rationale and consensus definition.
JAMA 1993; 269: 390–391.
31. Lepoutre A, Doloy A, Bidet P et al. Microbiologists of the Epibac Network.
Epidemiology of invasive Streptococcus pyogenes infections in France in
2007. J Clin Microbiol 2011; 49: 4094–4100.
32. Rolleston JD. Concurrent scarlet fever and chicken-pox. Proc R Soc Med
1911; 4.p.14–16.
33. Christie AB. Epidemiology and Clinical Practice. In: Infectious Diseases. 2nd
ed. Edinburgh: Churchill Livingstone, 1974.
34. GAMBAR 4,5
35. Block SL. Streptococcal pharyngitis: guidelines, treatment issues, and
sequelae. Pediatric Annals. 2014;43(1):11–16. PubMed PMID: 24450315.
36. GAMBAR 8 ADAM
37. GAMBAR 9 3 LIDAH
38. Scottish Intercollegiate Guidelines Network. Management of sore throat and
indications for tonsillectomy. A national clinical guideline. SIGN Guideline
117. Edinburgh: SIGN; 2010
39. Gerber MA, Shulman ST. Rapid diagnosis of pharyngitis caused by group A
streptococci. Clin Microbiol Rev 2004; 17: 571–580
40. Centor RM, Witherspoon JM, Dalton HP, Brody CE, Link K. The diagnosis of
strep throat in adults in the emergency room.Med Decis Making. 1981
41. Fitzpatrick TB, et al. Color atlas and synopsis of clinical dermatology:
common and serious diseases. 3d ed. New York: McGraw-Hill, Health
Professions Division, 1997.
42. Kaye ET, Kaye KM. Fever and rash. In: Fauci AS, et al., eds. Harrison’s
Principles of internal medicine. 14th ed. New York: McGraw-Hill, Health
Professions Division, 1998.
43. Wessels MR. Pharyngitis and Scarlet Fever. In: Ferretti JJ, Stevens DL,
Fischetti VA. Streptococcus pyogenes: Basic biology to clinical
manifestations. Oklahoma City: University of Oklahoma Health Sciences
Center; 2017. p. 705 – 716
44. Hulman TS, Bisno AL & Clegg HW. Clinical practice guideline for the
diagnosis and management of group A streptococcal pharyngitis: 2012 update
by the Infectious Diseases Society of America. Clinical Infectious
Diseases 2012;15:55:e86–102
45. Casey JR, Pichichero ME. Meta-analysis of cephalosporin versus penicillin
treatment of group A streptococcal tonsillopharyngitis in
children. Pediatrics 2004;113:866–882.
46. Cunningham MW. Pathogenesis of Group A Streptococcal Infections. Clin
Microbiol Rev. 2000 Jul; 13(3): 470 – 511
47. Centers for Disease Control and Prevention. Post – Streptococcal
Glomerulonephritis [Internet]. CDC.Gov.2016. Available from:
https://www.cdc.gov/groupastrep/diseases-public/post-streptococcal.html
(Accessed 05 June 2017)
 Scarlet Fever merupakan penyakit infeksius yang disebabkan oleh toksin yang
dihasilkan oleh Group A Streptococcus (GAS). GAS dapat berkolonisasi pada
tenggorok maupun kulit. Scarlet fever pada umumnya seringkali dikaitkan dengan
terjadinya faringitis tetapi dapat juga berkait dengan penyakit kulit lainnya yang
disebabkan oleh GAS. GAS lebih sering pada anak – anak dibandingkan dewasa.
Sebelum tahun 2000, scarlet fever seringkali menjadi wabah pada perkotaan di Eropa
dan Amerika. Dengan ditemukannya pengobatan Penicillin, kasus Scarlet Fever
menjadi jarang ditemukkan.. Tetapi, wabah Scarlet Fever kembali ditemukkan
sekarang terutama di Hongkong dan Inggris yang salah satunya disebabkan oleh
resistensi obat karena penggunaan antibiotik yang tidak tepat. Gejala klinis pada
umumnya akan dimulai dengan fase prodromal yang disertai terbukti adanya
tonsillitis ataupun faringitis yang biasa dapat dinilai dengan penilaian Centor Score.
Lalu lidah akan berbulul dengan papil yang membesar seperti white strawberry
tounge yang lama kelamaan akan menjadi merah dan terjadi inflamasi seperti red
strawberry tounge/raspberry tounge. Terdapat juga ruam punctate erythema yang
muncul pada hari ke dua yang pada awalnya akan muncul dari muka dimana pipi akan
menjadi kemerahan tetapi sekitar bibir akan tampak pucat (cirumolar pallor) dan akan
menyebar ke leher, badan bagian atas lalu ke ekstrimitas dengan teksur sandpaper.
Terdapat juga Pastia’s sign pada daerah fossa antekubiti maupun aksila. Setelah satu
minggu, ruam akan selesai dan kulit akan terjadi deskuamasi. Penggunaan penicillin
dengan tetap menjadi pilihan utama untuk tatalaksana pada scarlet fever dan tentunya
hand hygiene juga perlu diperhatikan untuk mengurangi resikonya terjadi infeksi
GAS. Komplikasi pada scarlet fever jika tidak diberi tatalaksana yang baik adalah
Streptococcal Toxic Shock Syndrome, Post Streptococcal Glomerulonephritis, serta
Rheumatic Fever yang dapat berakibat fatal. Maka dari itu, kita sebagai petugas
kesehatan pentingnya mengetahui tanda awal dari gejala, pemberian antibiotik yang
tepat untuk mengurangi resistensi serta memperhatikan hand hygiene untuk mencegah
terjadi penyebaran infeksi nosokomial oleh GAS.