Scarlet fever: A not so typical exanthematous pharyngotonsillitis (based on 171 cases) / Escarlatina: una faringoamigdalitis exantemática no tan típica (a propósito de 171 casos)

AIM: 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. Study DESIGN: 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

OBJETIVO: Describir la edad, signos y síntomas clínicos de niños con escarlatina en la actualidad y comprobar si corresponden a los de la clásica faringoamigdalitis estreptocócica. Diseño del estudio: Estudio observacional, retrospectivo, sobre registros clínicos (5.500 niños de 0 a 15 años pertenecientes a un centro de atención primaria). Porcentaje de casos en los que aparecen los signos y síntomas y cálculo del escore de Centor. Diagnóstico microbiológico realizado mediante test rápido de detección de antígeno o cultivo tradicional. RESULTADOS: De 252 diagnósticos de escarlatina se confirmaron microbiológicamente 171, en 158 pacientes. La mediana de la edad fue de 3,8 años (rango intercuartílico: 2,9-4,8), la mayoría (57%) menores de 4 años. Hubo fiebre en un 89% de episodios (IC 95: 84 a 94%), mayor de 38°C en el 73% (IC 95: 65 a 80%), adenopatías en un 70% (IC 95%: 58 a 82%), ausencia de tos en un 73% (IC 95: 65 a 80%), y exudado amigdalar sólo en un 24% (IC 95: 17 a 31%). El escore de Centor (n=105) fue ≤ 2 puntos en un 86% (IC 95: 79 a 92%). Los niños <4 años tienen significativamente más fiebre (> de 38°C) que los mayores (80% frente a 63%. OR 3,13; IC 95: 1,46 a 6,71). CONCLUSIÓN: La faringoamigdalitis de la escarlatina difiere de la clásica estreptocócica y ha de ser cuestionada su valoración a través de reglas de predicción como las de Centor o McIsaac. La clave diagnóstica principal continúa siendo la erupción cutánea independientemente de la edad del paciente

Scarlet fever: A not so typical exanthematous pharyngotonsillitis (based on 171 cases).

AIM: 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. STUDY DESIGN: 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). CONCLUSION: 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.