Bytheway...GPsmustbevigilantaboutscarletfever

AROUND this time of year, we see an upsurge in scarlet fever — in fact, this year, numbers have reached a 30-year high.

The worry is that if it’s not diagnosed promptly and treated with antibiotics, scarlet fever can lead to complications, which include pneumonia and acute rheumatic fever. Although it’s not common, rheumatic fever can result in permanent, even fatal, damage to the valves in the heart.

Scarlet fever starts with a sore throat — a throat infection due to bacteria called group A streptococci. This kind of infection usually resolves after a few days.

With scarlet fever, there is headache, a fever, and after a day or two, a widespread red rash — the result of a toxin produced by the bacteria.

The rash starts in the groin and armpits — the area around the mouth may be pale, but the cheeks red, and the tongue takes on a strawberry appearance. The rash eventually spreads over the trunk and arms. All of this should be enough to diagnose it for doctors who are used to seeing it.

A throat swab should be taken for confirmatory culture and, while waiting for the result, antibiotics started at once.

Clearly, it’s important to take action to prevent complications. This is what worries me about the rise in scarlet fever cases.

My fear is that pressure on GPs to avoid unnecessary antibiotic prescribing is a factor, as is the pressure to see patients quickly and to save money by refraining from the added costs of throat swab culture.

If the child i s not undressed to be examined — which not only takes valuable time, but is impossible if it’s one of those telephone consultations being encouraged of GPs — then the early signs of the rash may be missed.

If the cheeks are red it is all too easy to conclude that the mild illness is due to ‘slapped cheek disease’, the common name for erythema infectiosum, a viral infection (due to parvovirus B19) which is common in children aged between five and ten. This, too, causes a bright red rash on the cheeks, and as it’s a virus, antibiotics are of no use.

Missing the diagnosis could lead to rheumatic fever and lifelong infirmity in a few unlucky individuals, not good news.

It’s another reason why pressure on GPs, cutting costs to the bone, and trying to rely on telephone diagnosis, is a counterproductive strategy.

Ill patients should be seen in person, properly examined, and subject to the correct investigations when indicated.