Staphylococcus scarlet fever B06.8

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Duke's Disease; Dukes-Filatov disease; Forth Disease; fourth disease; Fourth disease; Nonmenstrual staphylococcal toxic shock syndrome; Non-menstrual staphylogenic toxin shock syndrome; Parascarlatina; rubella scarlatiniformia; SSF; Staphylococcal scarlet fever; Staphylogenic scarlet fever

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Filatov, 1883; Dukes, 1900

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Rare, exanthematic infectious disease, especially in children, which is caused by the staphylococcal toxins SEB, SEA, SEG, SEI, TSST-1

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Staph. aureus, usually phage type 71.

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Infection with Staph. aureus, usually phage type 71, whose enterotoxins (SEB, SEA, SEG, SEI, TSST-1) cause the typical exfoliative skin lesions. The disease has been described in connection with otitis media or purulent pharyngitis (Mun SJ et al. 2019; Andrey DO et al. 2015; Lu YC et al. 2011). Furthermore, staphylogenic infections after insect bites, after intra-articular injections or bursitis can be causative.

Note: Staphylococcal enterotoxins are proteins with different biochemical effects. In addition to the 5 classical, main serological enterotoxins, more than 20 SE types are known. These are relatively stable to heat and similar in their molecular structure (see exfoliatins below).

In Staphylococcus scarlet fever in older children the exfoliative skin changes of the "staphylogenic lyell" remain in the stage of exanthema. This may be due to partial immunity to protective anti-epidermolysin antibodies.

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Affected are mainly children with an age peak around the age of 3 years. Only rarely are adults affected (Mun SJ et al. 2019)

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Especially intertrigines and the neck region are affected.

Clinical features
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Incubation period: 9-20 days. Uncharacteristic prodromal stage. Rubeoliform or small spotted scarlatiniform exanthema. Bran-like scaling on day 4 or 5. Swelling of the cervical and nuchal lymph nodes. Pharyngitis.

Differential diagnosis
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Staphylogenic scarlet fever (SSF), also known as non-menstrual staphylogenic toxin shock syndrome, differs from staphylogenic toxin shock syndrome (STSS) in that it is caused by a variety of very different factors. TSST-1 is the triggering erythrogenic toxin in only 50% of cases.

Furthermore, it must be delimited:

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Symptomatic therapy, e.g. with Lotio alba and additional skin care measures (e.g. Excipial U Lipolotio), is indicated. Usually without complications.

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The disease is considered a (non-menstrual) minus variant of STSS (Godoy Gijón E et al. 2010).

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  1. Andrey DO et al (2015) Unusual staphylococcal toxic shock syndrome presenting as a scarlet-like fever. New Microbes New Infect 8:10-13.
  2. Feldman CA (1962) Staphylococcal scarlet fever. N Engl J Med 267:877-878.
  3. Godoy Gijón E et al. (2010) Scarlet fever variant of staphylococcal scalded skin syndrome.An Pediatr (Barc) 72:434-435.
  4. Filatov NF (1883) Lectures on acute infectious diseases in childhood. Lektsii ob ostrykh infektsionnykh bolezniiakh detei. Moscow, S. 113
  5. Dukes C (1900) On the confusion of two different diseases under the name of rubella (rose-rash). Lancet 2: 89-94
  6. Lu YC et al (2011) Scarlet fever caused by community-associated methicillin-resistant Staphylococcus aureus. Indian Pediatrics 48:563-565.
  7. Mun SJ et al (2019) Staphylococcal scarlet fever associated with staphylococcal enterotoxin M in an elderly patient.Int J Infect Dis 85:7-9.
  8. Schulz H (1989) Practically relevant pediatric skin diseases. Close derm: 86-95
  9. White ME (2001) The fourth disease, 1900-2000. Lancet 357: 299-301


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020