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Scarlet fever — RACGP Fellowship MCQ

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HardInfectious diseaseScarlet feverRACGP Fellowship

A 6‑year‑old child presents with fever, sore throat and a fine blanching erythematous rash with a sandpaper texture. On examination, there are exudative tonsils and tender anterior cervical lymph nodes. There is no cough. A sibling was recently diagnosed with group A streptococcal pharyngitis. What is the most appropriate management?

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Correct answer: E — Apply local risk‑based guidance and treat with antibiotics if group A streptococcal infection is likely or confirmed

This is a classic presentation of scarlet fever (GAS pharyngitis with rash), and recent household exposure further increases likelihood. Australian Therapeutic Guidelines state that a scarlet‑fever type rash warrants empirical antibiotic therapy, especially in high‑risk or ARF‑endemic settings. Option E reflects this test‑or‑treat strategy. Option B is incorrect—the rash is not herpetic. Option C contradicts ARF prevention strategy. Option A inappropriately delays management and substitutes EBV testing. Option D (corticosteroids alone) fails to address the bacterial infection. Therefore E is the only appropriate management.

Reference: Therapeutic Guidelines—Sore throat algorithm, Nov 2021; RACGP Primary prevention of acute rheumatic fever, 2021