1,575,000 (US); 31,500,000 (Global)
Associated diseases: pharyngitis (cough, laryngitis & rhinitis not characteristic), tonsillitis, skin infection, septicemia, scarlet fever, pneumonia, rheumatic fever, glomerulonephritis, and necrotizing fasciitis; [Merck Manual, p. 1605-6]
In scarlet fever, the rash is caused by exotoxin produced by some strains. The rash is red, fine, and appears on the trunk 2-3 days after onset of the sore throat. There are scattered petechiae, and the rash feels like sandpaper and blanches with pressure. The rash is typically central in location (neck, chest, folds in the axilla, elbows, groin and inner thighs), sparing the face. Flushing of cheeks is common. Strawberry tongue occurs (white on day 1-2 and red on day 4-5). As the rash clears in a few days, desquamation, especially on the tips of fingers and toes (palms & soles), may be seen. Small vesicles of the hands, feet, and abdomen are sometimes seen in severe cases. Leukocytosis and eosinophilia may be present. Some patients have abdominal pain. Pastia's lines are red streaks in skin folds of the trunk and antecubital fossa. High fever, vomiting, seizures, and delirium are seen in severe cases. Streptococci also cause skin infections (erysipelas, impetigo, and necrotizing fasciitis), conjunctivitis/keratitis, pneumonia, meningitis, endocarditis, sepsis, and toxic shock syndrome. Group A beta-hemolytic Streptococci are the most common cause of cellulitis and lymphangitis. Sequelae include glomerulonephritis (skin and throat infections) and rheumatic fever (throat infections only). Proteinuria, hematuria and red cell casts are signs of poststreptococcal glomerulonephritis. Rare in the West in recent decades, rheumatic fever continues to be a significant health problem in the developing world. It typically presents about two weeks after streptococcal pharyngitis with painful migratory polyarthritis. If not treated with antibiotics, rheumatic fever tends to recur, causing permanent damage to heart valves. [CCDM, p. 581-9 5; Merck Manual, p. 1605-8, 1150-53, 2321, 2328; PPID, p. 2446-60; Guerrant, p. 203, 206, 1004] See "Pharyngitis," "Impetigo," "Streptococcal toxic-shock syndrome," "Necrotizing fasciitis," and "Acute rheumatic fever."
REFERENCES FOR CASES/YEAR
1. (US) 7 million cases of pharyngitis treated by pediatricians every year--only 15% to 30% are Group A Strept. [Cecil, 24th Ed, p. 1824] 7 million X 22.5% = 1,575,000;
2. (Global) Estimated 500,000 deaths per year, mainly from acute rheumatic fever and rheumatic heart disease; [Harrison ID, p. 421] Estimate global cases as 20 X US cases/yr;