Outbreaks of group a beta-hemolytic streptococcal pharyngitis in children: Correlation of serotype t4 with scarlet fever

We evaluated the clinical features of 121 children who had group A beta-hemolytic streptococcal (GABHS) pharyngitis during 2 outbreaks in the Chikuhou district, Fukuoka, Japan, with respect to T types. During the first outbreak (November 1989-February 1990), T12 (50%) and T22 (27%) were the dominant T types isolated. During the second outbreak (January-April 1991), 64% of the typable strains were T4. Pus on the tonsils was less common and strawberry tongue more common in patients with eruptions than in those without. Skin eruptions were much more common in the patients infected with T4 than with other T types (p < 0.001). Despite a 10-day regimen of amoxicillin, 12/69 patients (17.4%) had evidence of GABHS on repeat cultures. The results suggest that T4 may be associated with a high incidence of scarlet fever. Serotyping should be performed to identify disease carriers and patterns of GABHS infection.