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Scarlet Fever

Scarlet Fever (Infectious disease) — Comprehensive Disease Characteristics Report

2026-05-06
Falcon MONDO:0005952 Model: Edison Scientific Literature 45 citations

Scarlet Fever (Infectious disease) — Comprehensive Disease Characteristics Report

Target Disease

  • Disease name: Scarlet fever
  • Category: Infectious (bacterial toxin–mediated exanthematous illness secondary to Streptococcus pyogenes [Group A Streptococcus, GAS])
  • MONDO ID: Not retrieved from the available sources in this run (evidence gap; should be filled from MONDO/OLS).

Executive summary (current understanding)

Scarlet fever is a GAS disease classically characterized by fever, pharyngitis/tonsillopharyngitis, a sandpaper-like erythematous exanthem, and mucosal findings such as “strawberry tongue.” (bergsten2024theintricatepathogenicity pages 2-3, leung2025groupaβhemolytic pages 1-2) The modern resurgence of GAS illnesses after COVID-19 nonpharmaceutical interventions has been linked to changes in circulating GAS lineages and toxin profiles, including expansion of the toxigenic emm1 M1UK lineage with increased SpeA superantigen expression. (rumke2024nationwideupsurgein pages 1-2, rumke2024nationwideupsurgein pages 2-4, bergsten2024theintricatepathogenicity pages 3-4)

1. Disease Information

1.1 Concise overview

Scarlet fever is a clinical syndrome caused by GAS strains producing streptococcal pyrogenic exotoxins/superantigens, presenting with fever and pharyngitis and a diffuse erythematous rash with rough “sandpaper” texture, often accompanied by strawberry tongue and later desquamation. (bergsten2024theintricatepathogenicity pages 2-3, inamadar2018thestrawberrytongue pages 1-2, wu2024epidemiologicalchangesof pages 1-2)

1.2 Key identifiers (ontology/terminology)

  • ICD-10: A38 (standard coding; not explicitly quoted in the retrieved texts—needs confirmation from ICD-10 dataset).
  • ICD-11 / MeSH / SNOMED CT / MONDO: Not retrieved in the accessible full texts here; recommended to populate directly from authoritative terminologies.

1.3 Common synonyms / alternative names

  • “Scarlatina” (common synonym; not explicitly shown in the retrieved evidence set)
  • “Streptococcal scarlet fever” (clinical synonym)

1.4 Evidence provenance

Evidence used here is largely from aggregated disease-level resources (surveillance studies and reviews) plus case reports/series for phenotype details (e.g., oral findings and timing of desquamation). (wu2024epidemiologicalchangesof pages 1-2, slebioda2020scarletfever– pages 3-5, inamadar2018thestrawberrytongue pages 1-2)

2. Etiology

2.1 Disease causal factors

2.2 Risk factors (host/environment)

  • Age: Predominantly children (e.g., under 10 in Chongqing surveillance; 3–7 years highest burden). (wu2024epidemiologicalchangesof pages 1-2)
  • Crowding/contact networks: Transmission facilitated in kindergartens/schools and households; household transmission ~35% for GAS pharyngitis. (leung2025groupaβhemolytic pages 1-2)
  • Seasonality: Peaks reported in winter/early spring for GAS pharyngitis and bimodal seasonal peaks for scarlet fever in Chongqing (Apr–Jun; Nov–Dec). (wu2024epidemiologicalchangesof pages 1-2, leung2025groupaβhemolytic pages 1-2)

2.3 Protective factors

Not well characterized in the retrieved sources. Conceptually, immunity accumulates with age; a comprehensive GAS review notes immunity development over time and long-lived antibodies, but protective factors specific to scarlet fever (e.g., correlates of protection) are not quantified here. (bergsten2024theintricatepathogenicity pages 8-10)

2.4 Gene–environment / host–pathogen interaction

A GAS pathogenicity review highlights HLA–superantigen (SpeA) interactions, noting associations of HLA-DQA1/HLA-DQ with increased infection risk and nasal colonization. (bergsten2024theintricatepathogenicity pages 3-4)

3. Phenotypes

3.1 Core clinical phenotype set (with characteristics)

Typical timing - Incubation: 2–5 days for GAS pharyngitis. (leung2025groupaβhemolytic pages 1-2) - Rash timing: Often follows pharyngeal symptoms within ~1–2 days (case-based/clinical descriptions). (m.2026araremanifestation pages 1-2) - Desquamation: May occur during convalescence, including palm/sole peeling within ~2 weeks in classic descriptions and case reports. (m.2026araremanifestation pages 1-2, slebioda2020scarletfever– pages 3-5)

Common manifestations - Fever, headache, sore throat, lymphadenopathy, sandpaper-like erythematous rash, and post-rash peeling/desquamation are listed as characteristic clinical features in a large surveillance study. (wu2024epidemiologicalchangesof pages 1-2) - “Strawberry tongue”: a “white strawberry tongue” early with loss of coating in 1–2 days, exposing hypertrophic papillae (red strawberry tongue). (leung2025groupaβhemolytic pages 1-2, inamadar2018thestrawberrytongue pages 1-2) - Pastia lines and circumoral pallor (Filatov mask) are included in clinical descriptions of scarlet fever exanthem variants. (m.2026araremanifestation pages 2-4)

Quality of life / functional impact A contemporary review of GAS pharyngitis reports short-term functional burden: children missed a mean 1.9 days of daycare/school and 42% of parents missed a mean 1.8 workdays. (leung2025groupaβhemolytic pages 6-7)

3.2 Suggested HPO terms (examples)

(These are ontology suggestions; the IDs should be verified against the HPO database.) - Fever — HP:0001945 - Pharyngitis / sore throat — HP:0025421 (pharyngitis) / HP:0033050 (sore throat; verify) - Exanthem / rash — HP:0000988 - Desquamation — HP:0000977 - Strawberry tongue — term exists in HPO (verify exact ID) - Cervical lymphadenopathy — HP:0000450

4. Genetic / Molecular Information

4.1 Causal genes (human)

Not applicable in the Mendelian sense: scarlet fever is not a monogenic inherited disorder.

4.2 Host genetic susceptibility (non-Mendelian)

Evidence indicates host HLA class II variation can modulate susceptibility via SpeA interactions (HLA-DQA1/HLA-DQ). (bergsten2024theintricatepathogenicity pages 3-4)

4.3 Pathogen molecular determinants (primary molecular “genetics” for this disease)

4.4 Epigenetics / chromosomal abnormalities

Not applicable for the human host in typical clinical usage; pathogen regulatory and mobile-element effects exist (prophage-encoded toxins) but were not comprehensively extracted here beyond toxin carriage/expression. (rumke2024nationwideupsurgein pages 2-4, bergsten2024theintricatepathogenicity pages 3-4)

5. Environmental Information

6. Mechanism / Pathophysiology

6.1 Causal chain (upstream → downstream)

1) Colonization/infection of upper respiratory tract by GAS, with potential asymptomatic carriage in children (~8% school-age carriage cited in a review). (bergsten2024theintricatepathogenicity pages 2-3) 2) Expression and/or increased expression of superantigens/toxins (SpeA, SSA, SpeC), influenced by lineage (e.g., M1UK) and prophage acquisition. (rumke2024nationwideupsurgein pages 2-4, bergsten2024theintricatepathogenicity pages 3-4) 3) Immune activation: superantigen-mediated T-cell hyperactivation through TCR–HLA interactions; clinical immune signatures in acute illness include elevated inflammatory cytokines (IFN-γ, IL-6) alongside regulatory IL-10, with reduced IL-17A reported in one pediatric cohort. (bergsten2024theintricatepathogenicity pages 3-4, keuleyan2025characterizationofstreptococcus pages 1-2) 4) Clinical phenotype: systemic symptoms (fever) and mucocutaneous inflammation resulting in rash and strawberry tongue; later epidermal desquamation/peeling. (wu2024epidemiologicalchangesof pages 1-2, inamadar2018thestrawberrytongue pages 1-2) 5) Downstream immune sequelae risk: GAS infection can be followed by acute rheumatic fever (ARF) and post-streptococcal glomerulonephritis (PSGN) in susceptible settings/populations. (bergsten2024theintricatepathogenicity pages 2-3)

6.2 Suggested GO biological process terms (examples)

(Verify exact GO IDs against GO.) - T cell activation - Cytokine-mediated signaling pathway - Inflammatory response - Response to bacterium

6.3 Suggested Cell Ontology (CL) terms (examples)

  • CD4-positive T cell
  • Neutrophil
  • Dendritic cell / antigen-presenting cell

7. Anatomical Structures Affected

7.1 Organ/system level

7.2 Suggested UBERON terms (examples)

  • Oropharynx; palatine tonsil; tongue; skin; kidney glomerulus; heart valve (verify IDs in Uberon).

8. Temporal Development

  • Onset pattern: Acute (incubation ~2–5 days; abrupt fever/sore throat described in GAS pharyngitis). (leung2025groupaβhemolytic pages 1-2)
  • Course: Generally self-limited with appropriate treatment; rash and mucocutaneous findings may persist longer than systemic symptoms, with peeling over ~2 weeks in classic descriptions and cases. (m.2026araremanifestation pages 1-2, slebioda2020scarletfever– pages 3-5)

9. Inheritance and Population

9.1 Epidemiology (recent data prioritized)

Chongqing, China (19-year surveillance; publication Sep 2024) - 2005–2023: 9,593 cases; annual average incidence 1.6694 per 100,000; children 3–7 highest burden; kindergarteners 54.32% of cases; male:female incidence ratio 1.51. (wu2024epidemiologicalchangesof pages 1-2) - Predicted 2024–2025 burden: 675 and 705 cases, respectively, using SARIMA. (wu2024epidemiologicalchangesof pages 1-2) - Visual evidence of long-term incidence and 2024–2025 predictions is available in extracted figures. (wu2024epidemiologicalchangesof media b02e46ec, wu2024epidemiologicalchangesof media e239d009)

UK resurgence snapshot (review citing UK surveillance; publication Jun 2023) - Reported “27,486 confirmed scarlet fever cases and 94 deaths from September 2022 to December 2022” (as cited in the review). (matsubara2023recrudescenceofscarlet pages 1-2)

Global burden estimates (review; publication Nov 2024) - Review-level estimates list scarlet fever incidence as 186 per 100,000 children and 33 per 100,000 across all ages. (bergsten2024theintricatepathogenicity pages 2-3)

9.2 Demographics

10. Diagnostics

10.1 Clinical diagnosis

Scarlet fever is often diagnosed clinically by the combination of pharyngitis/fever and characteristic rash plus oral findings (strawberry tongue), with confirmatory microbiologic testing where appropriate. (leung2025groupaβhemolytic pages 1-2, matsubara2023recrudescenceofscarlet pages 2-4)

10.2 Laboratory confirmation and current implementations

Rapid antigen detection test (RADT), NAAT, and culture - Belgium (Nov 2022–Feb 2023; n=82 swabs): RADT sensitivity 80.76% and specificity 100%; NAAT sensitivity 100% and specificity 96.42% vs culture. (panahandeh2024moleculardiagnosticsfor pages 1-2, panahandeh2024moleculardiagnosticsfor pages 2-4)

PCR implementation / operational performance - New Zealand (from Sep 2023; n=1,093 swabs): culture detected 24.0% vs PCR 29.2%; median turnaround time decreased from 44 to 16 hours after introducing PCR. (lucas2024alaboratorydevelopedextraction pages 1-2)

10.3 Differential diagnosis

Differentials discussed in clinical case literature include viral exanthems, measles, rubella, Kawasaki disease, infectious mononucleosis, hand-foot-and-mouth disease, and drug eruptions; strawberry tongue is not specific and appears in other toxin-mediated or inflammatory conditions. (slebioda2020scarletfever– pages 3-5, inamadar2018thestrawberrytongue pages 1-2)

11. Outcome / Prognosis

  • With appropriate treatment, prognosis for scarlet fever itself is generally excellent; however, GAS infections can lead to post-infectious immune sequelae (ARF, PSGN) and severe invasive disease in other clinical contexts. (bergsten2024theintricatepathogenicity pages 2-3, leung2025groupaβhemolytic pages 6-7)
  • Severe GAS disease (iGAS) has high mortality; a review notes iGAS burden and fatality considerations, and outbreak dynamics may require public health interventions. (esposito2025recentchangesin pages 1-2)

12. Treatment

12.1 Pharmacotherapy (first-line and alternatives)

Management largely follows GAS pharyngitis treatment principles to eradicate GAS, reduce transmission, and prevent complications. - First-line: Oral penicillin V for 10 days; amoxicillin commonly used in children (e.g., 50 mg/kg/day, max 1200 mg/day) for 10 days. (leung2025groupaβhemolytic pages 6-7) - Contagiousness after therapy: Patients are “usually not contagious 24 hours after initiating appropriate antimicrobial therapy.” (leung2025groupaβhemolytic pages 1-2) - Alternatives (penicillin allergy): Oral cephalosporins for non-anaphylactic allergy; clindamycin/azithromycin/clarithromycin for immediate-type hypersensitivity, with regimen details provided in the review. (leung2025groupaβhemolytic pages 6-7)

12.2 MAXO term suggestions (examples)

(Verify exact MAXO IDs.) - Antibiotic therapy - Penicillin administration - Throat swab diagnostic testing - Patient isolation / infection control

13. Prevention

14. Other Species / Natural Disease

Not addressed in retrieved sources; GAS is described as primarily human-adapted/human-restricted in major reviews, implying limited natural animal disease relevance for scarlet fever per se. (bergsten2024theintricatepathogenicity pages 2-3)

15. Model Organisms

Not systematically extracted in this run (evidence gap). GAS pathogenesis research commonly uses in vitro and animal models, but model details specific to scarlet fever manifestations were not captured in the retrieved evidence.

Recent developments (2023–2024 prioritized) and expert analysis

  • Post-pandemic resurgence & lineage effects: Molecular surveillance in the Netherlands shows the 2022–2023 iGAS upsurge coincided with a sharp rise in emm1.0 invasive isolates and dominance of M1UK (72% → 96% among invasive emm1 from Q1 2022 to Q1 2023), supporting expert interpretations that lineage fitness/virulence changes contributed to post-COVID increases. (rumke2024nationwideupsurgein pages 1-2)
  • Mechanistic expert synthesis: A 2024 GAS virulence review links scarlet fever resurgence to toxin/superantigen biology and emphasizes airborne transmission potential in schools and outbreaks with increased asymptomatic carriage. (bergsten2024theintricatepathogenicity pages 2-3)
  • Diagnostics shift to molecular: 2024 evaluations show NAAT/PCR can increase detection and shorten turnaround time vs culture/RADT, supporting real-world implementation and antimicrobial stewardship. (panahandeh2024moleculardiagnosticsfor pages 2-4, lucas2024alaboratorydevelopedextraction pages 1-2)

Quantitative findings summary table

Table (click to expand)
Domain (Epidemiology/Resurgence/Transmission/Diagnostics/Treatment) Setting/Population Time period Key quantitative results (incidence, counts, %) Interpretation/notes Source (first author year, journal) URL Citation context ID
Epidemiology Chongqing, China; reported scarlet fever cases 2005–2023 9,593 cases; annual average incidence 1.6694 per 100,000 Long-term surveillance shows persistent pediatric burden Wu 2024, BMC Public Health https://doi.org/10.1186/s12889-024-20116-5 (wu2024epidemiologicalchangesof pages 1-2)
Epidemiology Chongqing, China; children 3–7 years 2005–2023 Highest average incidence at age 6: 5.0002 per 100,000; kindergarten children 54.32% of cases; students 34.09%; male incidence 1.51× female Young school/daycare-aged boys were the highest-risk group Wu 2024, BMC Public Health https://doi.org/10.1186/s12889-024-20116-5 (wu2024epidemiologicalchangesof pages 1-2)
Epidemiology Chongqing, China 2005–2023 Bimodal seasonal peaks: Apr–Jun and Nov–Dec; incidence increased by 106.54% in 2015–2019 and 39.33% in 2020–2022 vs 2005–2014 Supports seasonality and post-2011/2015 resurgence pattern Wu 2024, BMC Public Health https://doi.org/10.1186/s12889-024-20116-5 (wu2024epidemiologicalchangesof pages 1-2)
Epidemiology Chongqing, China 2020–2025 During zero-COVID period, incidence decreased by 68.61% (2020), 25.66% (2021), and 10.59% (2022) vs predicted; 2023 incidence 1.5168 per 100,000; predicted 675 cases in 2024 and 705 in 2025 NPIs suppressed transmission; burden expected to rebound Wu 2024, BMC Public Health https://doi.org/10.1186/s12889-024-20116-5 (wu2024epidemiologicalchangesof pages 1-2, wu2024epidemiologicalchangesof media b02e46ec, wu2024epidemiologicalchangesof media e239d009)
Epidemiology Global/summary burden estimates Contemporary review (published 2024) Scarlet fever incidence estimated at 186 per 100,000 children and 33 per 100,000 all ages Review-level estimate; useful for broad burden comparison Bergsten 2024, Virulence https://doi.org/10.1080/21505594.2024.2412745 (bergsten2024theintricatepathogenicity pages 2-3)
Resurgence Shanghai, China; scarlet fever surveillance 2011–2024 25,539 cases; incidence fell from pre-COVID mean 17.1/100,000 (95% CI 9.7–24.3) to post-COVID 4.8/100,000 (95% CI 2.0–10.1); children 4–9 years = 85.6% of cases No major post-COVID rebound in Shanghai, but substantial ongoing burden in children Cai 2025, Lancet Regional Health – Western Pacific https://doi.org/10.1016/j.lanwpc.2025.101576 (cai2025ongoingepidemicof pages 1-2)
Resurgence Shanghai, China; molecular epidemiology 2011–2024 16 emm types; emm12 66.4%, emm1 29.8%; emm1 ST1274 increased from 10.5% pre-COVID to 73.7% post-COVID; 4 novel M1UK isolates identified Strain replacement and emergence of M1UK may alter future epidemiology Cai 2025, Lancet Regional Health – Western Pacific https://doi.org/10.1016/j.lanwpc.2025.101576 (cai2025ongoingepidemicof pages 1-2)
Resurgence Netherlands; invasive S. pyogenes isolates Q1 2022 to Q1 2023 emm1.0 among invasive isolates rose from 18% (18/100) to 58% (388/670), P<0.0001; M1UK among invasive emm1 rose from 72% to 96% Strong evidence that recent iGAS surge was driven by expansion of toxigenic M1UK rather than increased carriage Rümke 2024, Journal of Clinical Microbiology https://doi.org/10.1128/jcm.00766-24 (rumke2024nationwideupsurgein pages 1-2, rumke2024nationwideupsurgein pages 2-4)
Resurgence Netherlands; genomic surveillance 2009–2023 2,698 invasive isolates, 351 carriage isolates, WGS of 497 emm1 isolates; DNase Spd1 and SpeC acquired in 9% (46/497) of emm1 isolates Large-scale molecular surveillance supports increased virulence/fitness of emergent clades Rümke 2024, Journal of Clinical Microbiology https://doi.org/10.1128/jcm.00766-24 (rumke2024nationwideupsurgein pages 1-2)
Resurgence Australia; tertiary hospital GAS isolate collection 2021–2022 17 non-emm1 clinical isolates; 9 emm types; emm22, emm12, emm3 each 18% (3/17); 82% (14/17) carried at least one scarlet-fever–associated superantigen gene Superantigen carriage was common and not confined to one emm type Shaw 2024, Pathogens https://doi.org/10.3390/pathogens13110956 (shaw2024clinicalsnapshotof pages 1-2)
Resurgence UK surveillance cited in review Sep–Dec 2022 27,486 confirmed scarlet fever cases and 94 deaths; compared with 3,287 infections in the same period of 2017–2018 Illustrates magnitude of 2022–2023 resurgence in a high-income setting Matsubara 2023, International Dental Journal https://doi.org/10.1016/j.identj.2023.03.009 (matsubara2023recrudescenceofscarlet pages 1-2)
Transmission Household spread of GAS pharyngitis/scarlet fever-related infection General clinical epidemiology Approximate household transmission rate 35%; incubation period 2–5 days; usually not contagious 24 h after appropriate antimicrobial therapy Key operational figures for case management and school exclusion advice Leung 2025, Current Pediatric Reviews https://doi.org/10.2174/1573396320666230726145436 (leung2025groupaβhemolytic pages 1-2)
Transmission Pharyngeal carriage; adults and school-age children Contemporary review (published 2024) Asymptomatic carriage ~3% of adults and 8% of school-age children; school outbreaks may involve up to 50% asymptomatic carriage of outbreak strain Carriage reservoir helps explain classroom spread and difficulty of control Bergsten 2024, Virulence https://doi.org/10.1080/21505594.2024.2412745 (bergsten2024theintricatepathogenicity pages 2-3)
Diagnostics Belgium; 82 throat swabs, culture reference Nov 2022–Feb 2023 RADT sensitivity 80.76%, specificity 100%; NAAT sensitivity 100%, specificity 96.42%; 28/82 (34.14%) positive for pathogens, 92.85% of positives were S. pyogenes NAAT outperformed RADT on sensitivity while maintaining high specificity Panahandeh 2024, Journal of Clinical Medicine https://doi.org/10.3390/jcm13216627 (panahandeh2024moleculardiagnosticsfor pages 1-2, panahandeh2024moleculardiagnosticsfor pages 2-4, panahandeh2024moleculardiagnosticsfor pages 5-7, panahandeh2024moleculardiagnosticsfor pages 4-5)
Diagnostics Belgium; contingency counts Nov 2022–Feb 2023 RADT: 21 true positives, 5 false negatives, 0 false positives, 56 true negatives; NAAT: 26 true positives, 0 false negatives, 2 false positives, 54 true negatives Useful for direct comparison of missed cases by test modality Panahandeh 2024, Journal of Clinical Medicine https://doi.org/10.3390/jcm13216627 (panahandeh2024moleculardiagnosticsfor pages 2-4)
Diagnostics New Zealand; prospective throat swab PCR validation From 4 Sep 2023; publication 2024 1,093 throat swabs; culture positive 262/1,093 (24.0%) vs PCR 319/1,093 (29.2%); overall agreement 94.2%, positive agreement 98.9%, negative agreement 92.8%; median turnaround time improved from 44 h to 16 h PCR detected more GAS and substantially shortened reporting time Lucas 2024, New Zealand Medical Journal https://doi.org/10.26635/6965.6676 (lucas2024alaboratorydevelopedextraction pages 1-2)
Diagnostics The Gambia; children with pharyngitis Jun 9, 2021–Sep 26, 2022 376 participants; culture positive 37/376 (9.8%); LFT positive 119/376 (31.6%); PCR positive 122/376 (32.4%); ID NOW positive 122/366 (33.3%) Highlights discordance between molecular tests and culture in a high-carriage setting Armitage 2025, thesis/report N/A (armitage2025epidemiologyofstreptococcus pages 76-78, armitage2025epidemiologyofstreptococcus pages 74-76)
Diagnostics The Gambia; diagnostic accuracy vs culture Jun 2021–Sep 2022 LFT sensitivity 83.8%, specificity 74.0%; PCR sensitivity 94.6%, specificity 74.3%; ID NOW sensitivity 94.6%, specificity 73.6% NAAT/PCR were more sensitive than lateral-flow antigen testing in this cohort Armitage 2025, thesis/report N/A (armitage2025epidemiologyofstreptococcus pages 78-81, armitage2025epidemiologyofstreptococcus pages 76-78)
Treatment GAS pharyngitis/scarlet-fever–relevant management Contemporary review (published 2025) Antibiotics started within 48 h shorten recovery by 12–24 h; penicillin V 10 days standard; amoxicillin 50 mg/kg/day (max 1200 mg/day); patients generally noncontagious after 24 h of therapy Supports current first-line treatment and return-to-school timing Leung 2025, Current Pediatric Reviews https://doi.org/10.2174/1573396320666230726145436 (leung2025groupaβhemolytic pages 6-7, leung2025groupaβhemolytic pages 1-2)
Treatment Comparative antibiotic outcomes Review evidence Cephalosporins reduced relapse vs penicillin: children OR 0.55 (95% CI 0.30–0.99), adults OR 0.42 (95% CI 0.20–0.88) Suggests alternative agents may modestly improve relapse outcomes, though penicillin remains standard first-line therapy Leung 2025, Current Pediatric Reviews https://doi.org/10.2174/1573396320666230726145436 (leung2025groupaβhemolytic pages 7-7)
Treatment Childhood carriage/eradication context Review evidence GAS carriage estimated at 5–13% of children; clindamycin for carriage eradication when indicated: 20–30 mg/kg/day, max 900 mg/day, divided TID for 10 days Routine treatment of carriers is not generally recommended Leung 2025, Current Pediatric Reviews https://doi.org/10.2174/1573396320666230726145436 (leung2025groupaβhemolytic pages 7-7)
Epidemiology/Impact Daycare/school and parent work loss from GAS pharyngitis Review evidence Children missed mean 1.9 days of daycare/school; 42% of parents missed mean 1.8 workdays Indicates nontrivial short-term quality-of-life and economic burden Leung 2025, Current Pediatric Reviews https://doi.org/10.2174/1573396320666230726145436 (leung2025groupaβhemolytic pages 6-7)

Table: This table summarizes the main quantitative findings extracted from the gathered literature on scarlet fever and related group A streptococcal disease. It highlights recent epidemiology, resurgence patterns, transmission estimates, diagnostic performance, and treatment-related figures useful for a disease knowledge base.

Visual epidemiology evidence

  • Extracted figures showing Chongqing annual incidence (2005–2023) and monthly predictions for 2024–2025 are available from the BMC Public Health surveillance report. (wu2024epidemiologicalchangesof media b02e46ec, wu2024epidemiologicalchangesof media e239d009)

Notes on evidence limitations and missing items

1) PMIDs: Many retrieved sources in this run did not include PMIDs in the extracted metadata; PMIDs should be added during curation by cross-referencing PubMed using the DOI/metadata. 2) Ontology identifiers (MONDO/MeSH/SNOMED/ICD-11): Not retrieved from dedicated ontology resources here; these should be populated from OLS/MONDO/MeSH browser. 3) Protective factors: Not well quantified in the retrieved literature snippets. 4) Model organisms: Not extracted; requires targeted searching in GAS pathogenesis literature.

References

  1. (bergsten2024theintricatepathogenicity pages 2-3): Helena Bergsten and Victor Nizet. The intricate pathogenicity of group a streptococcus : a comprehensive update. Virulence, Nov 2024. URL: https://doi.org/10.1080/21505594.2024.2412745, doi:10.1080/21505594.2024.2412745. This article has 22 citations and is from a peer-reviewed journal.

  2. (leung2025groupaβhemolytic pages 1-2): Alexander K.C. Leung, Joseph M. Lam, Benjamin Barankin, Kin F. Leong, and Kam L. Hon. Group a β-hemolytic streptococcal pharyngitis: an updated review. Current Pediatric Reviews, 21:2-17, Jan 2025. URL: https://doi.org/10.2174/1573396320666230726145436, doi:10.2174/1573396320666230726145436. This article has 14 citations and is from a peer-reviewed journal.

  3. (rumke2024nationwideupsurgein pages 1-2): Lidewij W. Rümke, Matthew A. Davies, Stefan M. T. Vestjens, Boas C. L. van der Putten, Wendy C. M. Bril-Keijzers, Marlies A. van Houten, Nynke Y. Rots, Alienke J. Wijmenga-Monsuur, Arie van der Ende, Brechje de Gier, Bart J. M. Vlaminckx, and Nina M. van Sorge. Nationwide upsurge in invasive disease in the context of longitudinal surveillance of carriage and invasive streptococcus pyogenes 2009–2023, the netherlands: a molecular epidemiological study. Journal of Clinical Microbiology, Oct 2024. URL: https://doi.org/10.1128/jcm.00766-24, doi:10.1128/jcm.00766-24. This article has 38 citations and is from a peer-reviewed journal.

  4. (rumke2024nationwideupsurgein pages 2-4): Lidewij W. Rümke, Matthew A. Davies, Stefan M. T. Vestjens, Boas C. L. van der Putten, Wendy C. M. Bril-Keijzers, Marlies A. van Houten, Nynke Y. Rots, Alienke J. Wijmenga-Monsuur, Arie van der Ende, Brechje de Gier, Bart J. M. Vlaminckx, and Nina M. van Sorge. Nationwide upsurge in invasive disease in the context of longitudinal surveillance of carriage and invasive streptococcus pyogenes 2009–2023, the netherlands: a molecular epidemiological study. Journal of Clinical Microbiology, Oct 2024. URL: https://doi.org/10.1128/jcm.00766-24, doi:10.1128/jcm.00766-24. This article has 38 citations and is from a peer-reviewed journal.

  5. (bergsten2024theintricatepathogenicity pages 3-4): Helena Bergsten and Victor Nizet. The intricate pathogenicity of group a streptococcus : a comprehensive update. Virulence, Nov 2024. URL: https://doi.org/10.1080/21505594.2024.2412745, doi:10.1080/21505594.2024.2412745. This article has 22 citations and is from a peer-reviewed journal.

  6. (inamadar2018thestrawberrytongue pages 1-2): ArunC Inamadar, KeshavmurthyA Adya, and Aparna Palit. The strawberry tongue: what, how and where? Indian Journal of Dermatology, Venereology and Leprology, 84:500-505, Jul 2018. URL: https://doi.org/10.4103/ijdvl.ijdvl_57_17, doi:10.4103/ijdvl.ijdvl_57_17. This article has 28 citations.

  7. (wu2024epidemiologicalchangesof pages 1-2): Rui Wu, Yu Xiong, Ju Wang, Baisong Li, Lin Yang, Han Zhao, Jule Yang, Tao Yin, Jun Sun, Li Qi, Jiang Long, Qin Li, Xiaoni Zhong, Wenge Tang, Yaokai Chen, and Kun Su. Epidemiological changes of scarlet fever before, during and after the covid-19 pandemic in chongqing, china: a 19-year surveillance and prediction study. BMC Public Health, Sep 2024. URL: https://doi.org/10.1186/s12889-024-20116-5, doi:10.1186/s12889-024-20116-5. This article has 9 citations and is from a peer-reviewed journal.

  8. (slebioda2020scarletfever– pages 3-5): Zuzanna Ślebioda, Agnieszka Mania-Końsko, and Barbara Dorocka-Bobkowska. Scarlet fever – a diagnostic challenge for dentists and physicians: a report of 2 cases with diverse symptoms. Dental and Medical Problems, 57:455-459, Dec 2020. URL: https://doi.org/10.17219/dmp/125574, doi:10.17219/dmp/125574. This article has 6 citations and is from a peer-reviewed journal.

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