Disease Topics:Scarlet fever

Scarlet fever is a bacterial illness that develops in some people who have strep throat. Also known as scarlatina, scarlet fever features a bright red rash that covers most of the body. Scarlet fever is almost always accompanied by a sore throat and a high fever.

Scarlet fever is most common in children 5 to 15 years of age. Although scarlet fever was once considered a serious childhood illness, antibiotic treatments have made it less threatening. Still, if left untreated, scarlet fever can result in more-serious conditions that affect the heart, kidneys and other parts of the body.The rash and the redness in the face and tongue usually last about a week. After these signs and symptoms have subsided, the skin affected by the rash often peels. Other signs and symptoms associated with scarlet fever include:

  • Fever of 101 F (38.3 C) or higher, often with chills
  • Very sore and red throat, sometimes with white or yellowish patches
  • Difficulty swallowing
  • Enlarged glands in the neck (lymph nodes) that are tender to the touch
  • Nausea or vomiting
  • Headache
  • Scarlet fever is caused by the same type of bacteria that cause strep throat. In scarlet fever, the bacteria release a toxin that produces the rash and red tongue.

    The infection spreads from person to person via droplets expelled when an infected person coughs or sneezes. The incubation period — the time between exposure and illness — is usually two to four days.

  • Scarlet fever can occur as a result of a group A Streptococcus (group A strep) infection.[1]The signs and symptoms include a sore throatfever, headaches, swollen lymph nodes, and a characteristic rash. The rash is red and feels like sandpaper and the tongue may be red and bumpy. It most commonly affects children between five and fifteen years of age.[1]

    Scarlet fever affects a small number of people who have either strep throat or streptococcal skin infections. The bacteria are usually spread by people coughing or sneezing. It can also be spread when a person touches an object that has the bacteria on it and then touches their mouth or nose.[1] The characteristic rash is due to the erythrogenic toxin, a substance produced by some types of the bacterium.[1][3] The diagnosis is typically confirmed by culturingthe throat.[1]

    There is no vaccine. Prevention is by frequent handwashing, not sharing personal items, and staying away from other people when sick. The disease is treatable with antibiotics which prevents most complications.[1] Outcomes with scarlet fever are typically good.[4] Long-term complications as a result of scarlet fever include: kidney diseaserheumatic heart disease, and arthritis.

    Signs and symptoms

    Strawberry tongue is a characteristic of scarlet fever.
    The rash of scarlet fever
    Red cheeks and pale area around the mouth in scarlet fever
    Characteristic red cheeks and rash of scarlet fever

    Scarlet fever is characterized by:

    • Sore throat
    • Fever
    • Bright red tongue with a "strawberry" appearance
    • Forchheimer spots (fleeting small, red spots on the soft palate)
    • Paranoia
    • Hallucinations
    • A characteristic rash, which:
      • is fine, red, and rough-textured,
      • blanches upon pressure,
      • appears 12–72 hours after the fever starts,
      • generally begins on the chest and armpits and behind the ears but may also appear in the groin,
      • on the face, often shows as red cheeks with a characteristic pale area around the mouth (circumoral pallor),
      • is worse in the skin folds (so-called Pastia's lines, where the rash runs together in the armpits and groin, appears and can persist after the rash is gone),
      • may spread to cover the uvula, and
      • begins to fade three to four days after onset, upon which desquamation (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later." Peeling also occurs in the axilla, the groin, and the tips of fingers and toes


    The rash is the most striking sign of scarlet fever. It usually appears first on the neck and face (often leaving a clear, unaffected area around the mouth). It looks like a bad sunburn with tiny bumps, and it may itch. It then spreads to the chest and back and finally to the rest of the body. In the body creases, especially around the underarms and elbows, the rash forms the classic red streaks known as Pastia's lines. On very dark skin, the streaks may appear darker than the rest of the skin. Areas of rash usually turn white (or paler brown, with dark complexioned skin) when pressed on. By the sixth day of the infection, the rash usually fades, but the affected skin may begin to peel.

    Other features

    Usually, other symptoms help to confirm a diagnosis of scarlet fever, including a reddened and sore throat, a fever at or above 38 °C (100.4 °F), and swollen glands in the neck. Scarlet fever can also occur with a low fever. The tonsils and back of the throat may have a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. Also, an infected person may have chills, body aches, nausea, vomiting, and loss of appetite.

    In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the person may not develop soreness of the throat.


    When scarlet fever occurs because of a throat infection, the fever typically subsides within 3 to 5 days, and the sore throat passes soon afterward. The scarlet-fever rash usually fades on the sixth day after sore-throat symptoms started, and begins to peel (as described above). The infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

  • Image result for scarlet feverImage result for scarlet feverImage result for scarlet feverImage result for scarlet fever

The signs and symptoms that give scarlet fever its name include:

  • Red rash. The rash looks like a sunburn and feels like sandpaper. It typically begins on the face or neck and spreads to the trunk, arms and legs. If pressure is applied to the reddened skin, it will turn pale.
  • Red lines. The folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the surrounding rash.
  • Flushed face. The face may appear flushed with a pale ring around the mouth.
  • Strawberry ton

    Talk to your doctor if your child has a sore throat with:

    • A fever of 102 F (38.9 C) or higher
    • Swollen or tender glands in the neck
    • A red rash
     The tongue generally looks red and bumpy, and it's often covered with a white coating early in the disease.

Complications of scarlet fever

With the right treatment, further problems are unlikely. However, there's a small risk of the infection spreading to other parts of the body and causing more serious infections, such as an ear infectionsinusitis, orpneumonia.

Preventing scarlet fever from spreading

There’s currently no vaccine for scarlet fever.

If your child has scarlet fever, keep them away from nursery or school for at least 24 hours after starting treatment with antibiotics. Adults with the illness should also stay off work for at least 24 hours after starting treatment.

GPs, schools and nurseries should be aware of the current high levels of scarlet fever and inform local health protection teams if they become aware of cases, particularly if more than one child is affected.

Children and adults should cover their mouth and nose with a tissue when they cough or sneeze and wash their hands with soap and water after using or disposing of tissues.

Avoid sharing contaminated utensils, cups and glasses, clothes, baths, bed linen or towels.


The treatment and course of scarlet fever are no different from those of any strep throat.

Antibiotic resistance

drug-resistant strain of scarlet fever, resistant to macrolide antibiotics such as erythromycin, but retaining drug-sensitivity to beta-lactam antibiotics such as penicillin, emerged in Hong Kong in 2011, accounting for at least two deaths in that city—the first such in over a decade.[14] About 60% of circulating strains of the group A Streptococcus that cause scarlet fever in Hong Kong are resistant to macrolideantibiotics, says Professor Kwok-yung Yuen, head of Hong Kong University's microbiology department. Previously, observed resistancerates had been 10–30%; the increase is likely the result of overuse of macrolide antibiotics in recent years.


No vaccines are currently available to protect against S. pyogenes infection; the vaccine developed by George and Gladys Dick in 1924 was discontinued due to poor efficacy and the introduction of antibiotics. Difficulties in vaccine development include the considerable strain variety of S. pyogenes present in the environment and the amount of time and number of people needed for appropriate trials for safety and efficacy of any potential vaccine.[15]


The complications of scarlet fever include septic complications due to spread of streptococci in blood, and immune-mediated complications due to an aberrant immune response. Septic complications—today rare—include ear and sinus infection, streptococcal pneumonia,empyema thoracis, meningitis, and full-blown sepsis, upon which the condition may be called malignant scarlet fever.

Immune complications include acute glomerulonephritisrheumatic fever, and erythema nodosum. The secondary scarlatinous disease, or secondary malignant syndrome of scarlet fever, includes renewed fever, renewed angina, septic ear, nose, and throat complications, and kidney infection or rheumatic fever, and is seen around the 18th day of untreated scarlet fever.

An association between scarlet fever and hepatitis has been recognized for several decades.

Wiki pedia/NHS/Mayo clinic