Differential Diagnosis of Scarlet Fever

G. Tanan

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Onset Sore throat, shivering, sometimes vomiting.

Catarrhal cold, intoxication which gets stronger within 2-4 days.

Rash, inconsequential catarrhal symptoms.

Fever, acute intoxication.

Pain in abdominal area, joints, watery stool.

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Fever ≥38.3 °C ~40 °C ≤38 oC (may last for a week)

38°–40 °C

Symptoms Scarlet Fever Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Time Rashes appear within 48 hours. Symptoms of acute tonsillitis with regional lymphadenitis.

Headache, malaise, coryza the 1st day, Koplik’s spots the 2nd day, remains through the 3rd, 4th & 5th days. Rash comes out late on the 3rd or early on the 4th.

Little or no malaise, headache, slight fever, slight sore throat, the rash is out from 2nd to 3rd day. Spreads from above downwards. Look at the dorsum of the feet.

Within hours.

Apper on the 3rd and the 4th day. On the back of the head, neck, upper and lower extremities, nose and mouth triangle area.

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Size Up to 2mm Medium and big (2-3rd day merged)

Small, rarely medium sized

From small spots to large ecchymosis

Small sized has macular, hemorrhagic, papular elments

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Occurring order

Simultaneously throughout the entire body

In stages, starting from the face within 3-4 days

Simultaneously within 1 day

Gradually, with fast dynamics

1-4th day, scarlatine like.

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Localization Face (red cheeks, circumorial pallor, crimson lips). Intense in skin folds (axillae, cubital, inguinal, popliteal). Pastia’s sign. Also on the neck, breast, abdomen, buttocks.

Depending on the occurring day (1st – face, 2nd – face and trunk, 3rd – face, trunk and extremeties).

Throughout the body especially on the axillar skin folds, back, buttocks and face.

Buttocks, lower extremities, rarely face and hands.

On the sides of the trunk, skin fold areas, joints, lower abdomen, waist.

Symptoms Scarlet Fever Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Rash intensity

Intense Intense or very intense

Pale-pink Very intense with bluish tint

Intense

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Skin tone Hyperemia None None None Hyperemia in palms and soles

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

End stage leaves no marks, peeling skin, macrolaminar desquamation.

Transitions into pigmentaion starting from the face.

Disappears without within 3-5 days.

Necrosis of skin.

Remission is possible unlike the scarlet fever.

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Catarrhal colds

None Distinct from 5 to 6 days.

Weak or inconsequential, disappears after 1-2 days.

None None

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Changes in the mucous membrane of the oral cavity

Enanthema on a soft palate

Hyperemia, enanthema on a soft palate, Belsky — Filatov — Koplik spots

Clean, sometimes singular enanthem spots

Clean, hyperemia of oropharynx

Hyperemia of palatal archs, soft palate, uvula, back walls of pharynx. Disseminated hemorrhages on mucous of soft palate.

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Inoxication Mediate Considerable, in the period of rash breakout is maximal.

Minimal Acute Considerable/maximal

Symptoms Scarlet Fever

Measles Rubella Meningococcemia

Y. Pseudotuberculosis

Other organ systems

Heart, joints and kidneys

Respiratory system, GIT, CNS

Very rarely CNS, joints

CNS, adrenal glands, heart, lungs, joints, eyes

CNS, heart, lungs, kidneys