Dukes' disease
[3] Although Dukes identified it as a separate entity, it is thought not to be different from scarlet fever caused by exotoxin-producing Streptococcus pyogenes after Keith Powell proposed equating it with the condition currently known as staphylococcal scalded skin syndrome in 1979.
[13] However, in the presentation of the Scarlet Fever, it notably manifests as pharyngitis, rash, Filatov mask, Pastia sign, and strawberry tongue.
[13] Though the diagnosis for Dukes' disease is unclear, it may be similar to that of Scarlet Fever, which includes throat and tonsil swab culture or a rapid antigen detection test for group A beta-hemolytic streptococcus (GABHS).
[13] The Dukes' disease is also sometimes compared to the staphylococcal scalded skin syndrome (SSSS), in which symptoms of sunburn-like rashes will appear with the possibility of sprouting blisters.
[14] The characteristics of SSSS in Dukes' disease shows up as peeling caused by an infection, and often will look like it has been burned by hot liquid.
[15] Contrarily, Scarlet Fever shows up with extreme similarities in the peeling of the skin, however, with more signs of rough, patchy, sandpaper-like texture that stems from the groin and folds in the arms and the back of the legs.
For instance, toxic shock syndrome (TSS) is linked to the properties of the superantigens that S. aureus toxins produce which causes the cytokines to spike in production.
[18] However, after only 2 years of penicillin being used for treatment, there was already the development of an S. aureus strain that was methicillin-resistant due to the mecA gene, which resulted in MRSA.
Typically, in a methicillin-sensitive S. aureus, the β-lactam antibiotics can bind to the PBP on the bacterial cell wall, which destabilizes the production of the peptidoglycan layer of the bacteria.
[21] The Centor score is assessed from 0 to 4, where one point is added based on the criteria of a fever ≥ 38 °C, absence of cough, swollen anterior cervical lymph nodes, tonsillar exudate, or swelling.
Reduced immune systems and imperfect renal clearance increase the chance of Dukes' disease in newborns.
It shows irrespective of age and sex, immunocompromised people and patients having renal failure are at risk of Dukes' disease.
[8] As a chief surgeon at a large public school in England, Dukes was able to closely monitor and observe the symptoms of the ill boys.
[29] Many years later in 1991, an epidemiological evaluation conducted by David M. Moreno and Alan R. Katz corroborated both Washburn's and Millard's conclusions that there is no evidence that fourth disease existed and that the cases described by Dukes as being fourth disease were actually cases of either rubella or scarlet fever that were misdiagnosed by Dukes.
[8] On December 8, 2022, there were reports of at least five countries in the European Union who informed the World Health Organization (WHO) about a rise in an invasive GAS (group A streptococcus) case.
[30] Some noting an increase in scarlet fever instances while others reported a rise in other unknown GAS-related fatalities, primarily affecting children who were under 10 years old.
[30] Between January 1 and March 24 of 2024, the UK Health Security Agency (UKHSA) reported at least 12,000 cases of what it may have been associated with scarlet fever and signs of Dukes' in England.
[31] Dr. Theresa Lamagni from UKHSA highlighted that while scarlet fever is a common childhood illness, it can affect individuals of any age.
The symptoms reported were extremely similar to that of Dukes', including fever, a sandpapery rash, sore throat, and swollen tonsils.
Currently, the only effective treatment in targeting the numbered diseases is the use of antibiotics, as it can reduce complications and prevent the spread of the infection.
In addition, to prevent the spread, regular hand washing, good ventilation at home, and avoiding close contact with others while symptomatic are strongly recommended.
In the U.S. alone, the Centers for Disease Control and Prevention (CDC) has reported early and elevated levels of those said infections from 2023 and beyond, particularly among children, coinciding with increased cases in respiratory viruses.
Although severe GAS infections decreased during the COVID-19 pandemic, they have since risen, possibly due to reduced immunity and reluctance to see treatment.
However, despite the resurgence, antibiotics remain effective against treating GAS cases associated with Scarlet Fever and Dukes', and there is no evidence of increased resistance of new genetic variants.
Early recognition and treatment are crucial to preventing complications and ensuring recovery all the while avoiding any bacterial mutation and unwanted evolutions.
