Scarlet Fever

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Definition

Scarlet fever is an infection that is caused by a bacteria called streptococcus. The disease is characterized by a sore throat, fever, and a sandpaper-like rash on reddened skin. It is primarily a childhood disease. If scarlet fever is untreated, serious complications such as rheumatic fever (a heart disease) or kidney inflammation (glomerulonephritis) can develop.

Description

Scarlet fever, also known as scarlatina, gets its name from the fact that the patient's skin, especially on the cheeks, is flushed. A sore throat and raised rash over much of the body are accompanied by fever and sluggishness (lethargy). The fever usually subsides within a few days and recovery is complete by two weeks. After the fever is gone, the skin on the face and body flakes; the skin on the palms of the hands and soles of the feet peels more dramatically.

This disease primarily affects children ages two to ten. It is highly contagious and is spread by sneezing, coughing, or direct contact. The incubation period is three to five days, with symptoms usually beginning on the second day of the disease, and lasting from four to ten days.

Early in the 20th century, severe scarlet fever epidemics were common. Today, the disease is rare. Although this decline is due in part to the availability of antibiotics, that is not the entire reason since the decline began before the widespread use of antibiotics. One theory is that the strain of bacteria that causes scarlet fever has become weaker with time.

— Sally J. Jacobs, EdD

An acute contagious disease caused by a hemolytic streptococcus, occurring predominantly among children and characterized by a scarlet skin eruption and high fever. Also called scarlatina.

An acute contagious disease that results from infection with Streptococcus pyogenes (group A streptococci). It most often accompanies pharyngeal (throat) infections with this organism but is occasionally associated with wound infection or septicemia. Scarlet fever is characterized by the appearance, about 2 days after development of pharyngitis, of a red rash that blanches under pressure and has a sandpaper texture. Usually the rash appears first on the trunk and neck and spreads to the extremities. The rash fades after a week, with desquamation, or peeling, generally occurring during convalescence. The disease is usually self-limiting, although severe forms are occasionally seen with high fever and systemic toxicity. Appropriate antibiotic therapy is recommended to prevent the onset in susceptible individuals of rheumatic fever and rheumatic heart disease. See also Medical bacteriology; Rheumatic fever; Streptococcus.

An acute contagious disease of childhood caused by an erythrotoxin-producing strain of group A hemolytic Streptococcus. The infection is characterized by sore throat, fever, strawberry tongue, enlarged lymph nodes in the neck, prostration, and a diffuse bright red rash.

Definition

Scarlet fever is an infection caused by a streptococcus bacterium. It can be transmitted through the air or by physical contact and primarily affects children between four and eight years of age. In temperate climates, scarlet fever is most common during the late fall, winter, and early spring.

Scarlet fever is characterized by a sore throat, a fever of 103–104°F (39.4–40°C), and a sandpaper-like rash on reddened skin. If scarlet fever is untreated, such serious complications can develop; as rheumatic fever (a heart disease) or kidney inflammation (glomerulonephritis).

Description

Scarlet fever, or scarlatina, gets its name from the characteristic flush of the patient's skin, especially on the cheeks. Fever and sluggishness accompany a sore throat and raised rash that progressively covers much of the body. Symptoms usually begin within two to five days after a person is exposed. The fever usually subsides within a few days, and recovery is complete by two weeks. After the fever is gone, the skin on the face and body forms flakes, with the skin on the palms of the hands and soles of the feet peeling more dramatically.

Scarlet fever is highly contagious when the patient is in the early stages and is not being treated with antibiotics. It is spread by sneezing, coughing, or direct contact with an infected person. Early in the twentieth century, severe scarlet fever epidemics were common. As of the early 2000s, the disease is rare, partially because of the availability of antibiotics. However, antibiotics are not the entire reason, since the decline began before their widespread use. One theory is that the strain of bacteria that causes scarlet fever has become weaker over time.

Causes & Symptoms

Scarlet fever is caused by Group A streptococcal bacteria (Streptococcus pyogenes). In addition to causing scarlet fever, Group A streptococci bacteria cause many different illnesses, such as strep throat, wound or skin infections, pneumonia, serious kidney infections, and toxic shock syndrome. The strain of streptococcus that causes scarlet fever is slightly different from the strain that causes most strep throats. The scarlet fever strain produces an erythrogenic toxin, which is what causes the skin to turn red.

The main symptoms and signs of scarlet fever are fever, sluggishness, sore throat, and a bumpy rash that blanches (turns white) when it's pressed. The rash appears first on the upper chest and spreads to the neck, abdomen, legs, arms, and in folds of skin such as under the arm or in the groin. The skin around the mouth tends to be pale while the cheeks are flushed. In children, the disease causes a "strawberry tongue," in which inflamed bumps on the tongue rise above a bright red coating. Strawberry tongue is rarely seen in adults. Finally, dark red lines (called Pastia's lines) may appear in the creases of skin folds.

Diagnosis

A medical practitioner must diagnose and treat scarlet fever. The doctor notes the symptoms and eliminates the possibility of other diseases. Measles is a viral infection that is also associated with a fever and rash. However, scarlet fever can be distinguished from measles by the quality of the rash, the presence of a sore throat in scarlet fever, and the absence of the severe eye inflammation and runny nose that usually accompany measles.

Because scarlet fever may begin with a sore throat, the doctor will first determine if the problem is bacterial or viral in nature by checking for specific symptoms. For example, inflammation of the lymph nodes in the neck is typical in strep infections but not viral infections. On the other hand, cough, laryngitis, and stuffy nose tend to be associated with viral infections rather than strep infections.

Laboratory tests are necessary to make a definitive diagnosis of a strep infection and to distinguish a strep throat from a viral sore throat. One test that can be performed is a blood cell count. Bacterial infections are associated with an elevated white blood cell count. In viral infections, the white blood cell count is generally below normal. A throat culture can distinguish between a strep infection and a viral infection. A throat swab from the infected person is brushed over a nutrient gel containing red blood cells (a sheep blood agar plate) and incubated overnight. If streptococcal bacteria are present in the sample, they will break down the red blood cells and leave a clear zone in the gel surrounding the bacteria.

The doctor will also distinguish between a strep throat and scarlet fever. In a strep infection, the throat is sore and appears beefy and red. White spots appear on the tonsils. Lymph nodes under the jaw line may swell and become tender. These symptoms may or may not be present with scarlet fever. The main feature that distinguishes scarlet fever from a strep throat is the presence of the sandpapery red rash.

Treatment

Because of the nature of the infection and the danger of serious complications, scarlet fever cannot be treated solely with alternative therapies. A course of antibiotics and treatment by a physician is imperative. However, alternative therapies may be used to relieve the symptoms of fever and sore throat.

Fever

For fever, especially in children, there are some alternative treatments. Naturopathy recommends sponging with tepid water if the fever rises over 102°F (38.9°C). Rest and plenty of water are advised.

Homeopathy treats the specific type of fever, so it will be necessary to consult with a homeopath to determine the correct remedy for the patient. Some common homeopathic remedies for fever are:

• Aconite 6c at the onset of fever that is accompanied by thirst, chills, dry burning skin, and restlessness.
• Belladonna 6c for high fever with dry burning skin, red face, dilated pupils, and swollen glands.
• Arsenicum album 6c for patients who are restless and agitated, alternately hot and cold, thirsty, and patients whose fever is worse after midnight.
• Byronia 6c for the patient who is shivery and sweating, very thirsty at long intervals, and having headaches and pain.
• Ferrum phosphoricum (iron phosphate) 6c for a mild fever of slow onset accompanied by frequent bouts of sweating, shivering, and headaches.

Western herbalism may be used to treat fever, but treatment requires a qualified medical herbalist. The herbalist may recommend a bath with tepid infusions of limeflower, elderflower, yarrow, or German chamomile. Herbs such as catnip, hyssop, lemon balm, and vervain can lower the temperature and increase perspiration. German chamomile, lavender, and limeflower promote relaxation, and echinacea and garlic fight infection.

Chinese herbs in combinations can treat specific patterns of fever. They can also be used to balance the energies, specifically the yin (cool and moist) energies after the illness subsides.

Sore Throat

Some recommended treatments for sore throat are:

• Aromatherapy, in which the patient gargles with water and very small amounts of geranium or tea tree essential oils. A massage using diluted eucalyptus oil may also be helpful.
• Naturopathy may suggest fasting to eliminate toxins and the use of garlic to fight infection. Naturopaths will also recommend fruit juices high in vitamin C, especially citrus fruit juices, to soothe irritation.
• Hydrotherapy, in which water is utilized to restore health, uses humidifiers to prevent the irritation of a sore throat by dry air. A practitioner may also recommend using a cold abdominal pack and throat compress to stimulate both circulation and the immune system.
• Western herbalists will recommend gargling with an infusion of antiseptic herbs such as calendula or sage, and may use echinacea to fight infection.

Allopathic Treatment

Although the symptoms of scarlet fever often clear within a few days, the patient should receive antibiotic treatment to reduce the severity of symptoms, prevent complications, and avoid spreading the infection to others. Antibiotics may be taken either orally or by injection. After a patient has been on antibiotics for 24 hours, he or she is no longer contagious. The rash itself is not contagious. Antibiotic treatment will shorten the course of the illness in small children but may not do so in adolescents or adults. Nevertheless, a full course of treatment with antibiotics is important for preventing complications.

Since penicillin injections are painful, oral penicillin may be preferable. If the patient is unable to tolerate penicillin, alternative antibiotics such as erythromycin or clindamycin may be substituted. The patient must take the entire course of medication—usually 10 days—for the therapy to be effective and to ensure that the bacteria have been killed. Because symptoms subside quickly, there is a temptation to stop therapy prematurely. However, not completing the medication increases the risk of developing rheumatic fever and kidney inflammation. If the patient is considered too unreliable to take all of the pills or is unable to take oral medication, daily injections of procaine penicillin can be given in the hip or thigh muscle.

After the contagious period has passed, the patient does not need to be isolated. Bed rest is not necessary. Aspirin or Tylenol (acetaminophen) may be given for fever or pain relief.

Expected Results

If the patient is treated promptly with antibiotics, full recovery can be expected. Patients who have had scarlet fever develop immunity to the disease and cannot be infected again. However, about 10% of children don't respond to an initial antibiotic treatment, so it may be necessary for a second throat culture and the use of a different antibiotic.

Prevention

Although scarlet fever is only contagious before treatment with antibiotics is begun, it is wise to avoid exposure to children at any stage of the disease. Doing so will help prevent the spread of scarlet fever.

Resources

Books

Berkow, Robert M.D., ed. The Merck Manual of Diagnosis and Therapy. 16th ed. Rahway, NJ: Merck, 1992.

Driscoll, John. "Scarlet Fever." In The Columbia University College of Physicians and Surgeons Complete Home Medical Guide. 3rd rev. ed. New York: Crown Publishers, 1995.

Woodham, Anne, and David Peters, M.D. Encyclopedia of Healing Therapies. New York: DK Pub., 1997.

Wyngaarden, James B., Lloyd H. Smith, and J. Claude Bennett, eds. Cecil Textbook of Medicine. 19th ed. New York: W.B. Saunders Company, 1992.

Periodicals

Gregory, Tanya. "Scarlet Fever and Its Relatives." Patient Care (June 15, 1998): 109.

Schmitt, B. D. "Scarlet Fever" Clinical Reference Systems (July 1, 1999): 1293.

[Article by: Amy Cooper]

Definition

Scarlet fever is a rash that complicates a bacterial throat infection called strep throat.

Description

Scarlet fever, also known as scarlatina, gets its name from the fact that the patient's skin, especially on the cheeks, is flushed. The disease primarily affects children. A sore throat and a raised, sandpaper-like rash over much of the body are accompanied by fever and sluggishness (lethargy). The fever usually subsides within a few days, and recovery is complete by two weeks. After the fever is gone, the skin on the face and body flakes; the skin on the palms of the hands and soles of the feet peels more dramatically. Treatment for scarlet fever is intended to offset the possibility of serious complications such as rheumatic fever (a heart disease) or kidney inflammation (glomerulonephritis) can develop.

Scarlet fever is highly contagious and is spread by sneezing, coughing, or direct contact. The incubation period is three to five days, with symptoms usually beginning on the second day of the disease and lasting from four to ten days.

Early in the twentieth century, severe scarlet fever epidemics were common. In the early 2000s, the disease is rare. Antibiotics have helped, and it is possible that the strain of bacteria that causes scarlet fever has become weaker with time.

Demographics

Scarlet fever primarily affects children between the ages of five and 15 years. Approximately 10 percent of all children who have strep throat develop the characteristic scarlet fever rash.

Causes and Symptoms

Scarlet fever is caused by group A streptococcal bacteria (S. pyogenes), highly toxic microbes that can also cause strep throat, wound or skin infections, pneumonia, and serious kidney infections. The group A streptococci are hemolytic bacteria, which means that they have the ability to break red blood cells. The strain of streptococcus that causes scarlet fever, unlike the one that causes most strep throats, produces an erythrogenic toxin, which causes the skin to flush.

The main symptoms and signs of scarlet fever are fever, lethargy, sore throat, and a bumpy rash that blanches under pressure. The rash appears first on the upper chest and spreads to the neck, abdomen, legs, arms, and in folds of skin such as under the arm or groin. In scarlet fever, the skin around the mouth tends to be pale, while the cheeks are flushed. The patient usually has a "strawberry tongue," in which inflamed bumps on the tongue rise above a bright red coating. Finally, dark red lines (called Pastia's lines) may appear in the creases of skin folds.

Diagnosis

Cases of scarlet fever are usually diagnosed and treated by pediatricians or family medicine practitioners. The chief diagnostic signs of scarlet fever are the characteristic rash, which spares the palms and soles of the feet, and the presence of a strawberry tongue in children. Strawberry tongue is rarely seen in adults.

The doctor will take note of the signs and symptoms to eliminate the possibility of other diseases. For example, scarlet fever can be distinguished from measles, a viral infection that is also associated with a fever and rash, by the quality of the rash, the presence of a sore throat in scarlet fever, and the absence of the severe eye inflammation and severe runny nose that usually accompany measles.

Treatment

Although scarlet fever often clears up spontaneously within a few days, antibiotic treatment with either oral or injectable penicillin is usually recommended to reduce the severity of symptoms, prevent complications, and prevent spread to others. Antibiotic treatment shortens the course of the illness in small children but may not do so in adolescents or adults. Nevertheless, treatment with antibiotics is important to prevent complications.

One benzathine penicillin injection is required for treatment. But since penicillin injections are painful, oral penicillin may be preferable. If the patient is unable to tolerate penicillin, alternative antibiotics such as erythromycin or clindamycin may be used. However, the entire course of antibiotics, usually ten days, needs to be followed for the therapy to be effective. Because symptoms subside quickly, there is a temptation to stop therapy prematurely. It is important to take all of the pills in order to kill the bacteria. Not completing the course of therapy increases the risk of developing rheumatic fever and kidney inflammation.

Bed rest is not necessary, nor is isolation of the patient. Acetaminophen may be given for fever or relief of pain.

Prognosis

If treated promptly with antibiotics, full recovery is expected. Once a patient has had scarlet fever, the person develops immunity and cannot develop it again.

Prevention

Avoiding exposure to children who have the disease helps prevent the spread of scarlet fever.

Parental Concerns

The most important thing to do for children with scarlet fever is to carefully and completely follow the healthcare provider's instructions for administering a course of antibiotics.

See also Strep throat.

Resources

Web Sites

Balentine, Jerry. "Scarlet Fever." eMedicine, November 2, 2004. Available online at www.emedicine.com/emerg/topic518.htm (accessed December 30, 2004).

Goldenring, John. "Scarlet Fever." MedlinePlus, November 11, 2003. Available online at www.nlm.nih.gov/medlineplus/ency/article/000974.htm (accessed December 30, 2004).

Organizations

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098. Web site: www.aap.org.

[Article by: Sally J. Jacobs, EdD Rosalyn Carson-DeWitt, MD]

For more information on scarlet fever, visit Britannica.com.

An acute and contagious disease caused by a kind of streptococcus. Characterized by fever, sore throat, and a bright red rash, scarlet fever can be treated with penicillin.

Scarlet fever
Classification & external resources

ICD-10	A38.
ICD-9	034
DiseasesDB	29032
MedlinePlus	000974
eMedicine	derm/383  emerg/402, emerg/518

Scarlet fever is an exotoxin-mediated disease that occurs most often in association with a sore throat and rarely with impetigo or other streptococcal infections. It is characterized by sore throat, fever, a 'strawberry' tongue, and a fine sandpaper rash over the upper body that may spread to cover almost the entire body. Scarlet fever is not rheumatic fever, but may progress into that condition as the infection develops (rheumatic fever is an autoimmune disease that can occur after infection with Group A strep).

Cause

Streptococcus pyogenes (group A strep) is responsible for scarlet fever. It can also cause simple angina, erysipelas and serious toxin-mediated syndromes like necrotizing fasciitis and the so-called streptococal toxic shock-like syndrome. The virulence of group A strep seems to be increasing lately. The exanthem of scarlatina is thought to be due to erythrogenic toxin production by specific streptococcal strains in a nonimmune patient. Along with erythrogenic toxins, the Group A strep produces several toxins and enzymes. Two of the most important are the streptolysins O and S. Streptolysin O, an hemolytic, thermolabile and immunogenic toxin, is the base of an assay for scarlatina and erysipelas - the anti-streptolysin O titer.

History

This disease was also once known as Scarlatina (from the Italian scarlattina). Many novels depicting life before the nineteenth century (see Scarlet fever in literature below) describe scarlet fever as an acute disease being followed by many months spent in convalescence. The convalescence was probably due to complications with rheumatic fever. Prior to an understanding of how streptococcus was spread, it was also not uncommon to destroy or burn the personal effects of a person afflicted with scarlet fever to prevent transmission to other people.

Signs and symptoms

The "slapped cheeks" and "white mustache" of scarlet fever.

The scarlet fever rash.

Tongue with a strawberry appearance.

Early symptoms indicating the onset of scarlet fever can include: ^{[1] [2]}

• Fever of 38 to 40 degrees C.(101-104 degrees F.)
• Fatigue
• Sore throat
• Headache
• Nausea or Vomiting
• Abdominal pain
• Flushed face with perioral pallor (circumoral pallor)
• Tachycardia (rapid pulse)
• Lymphadenopathy (enlarged lymph nodes)
• Punctate red macules on the hard and soft palate and uvula (ie, Forchheimer spots).
• Bright red tongue with a "strawberry" appearance

• Characteristic rash, which:

• is fine, red, and rough-textured; it blanches upon pressure
• appears 12–48 hours after the fever
• generally starts on the chest, axilla (armpits), and behind the ears
• is worse in the skin folds
• Pastia lines (where the rash becomes confluent in the arm pits and groins) appear and persist after the rash is gone

• The rash begins to fade three to four days after onset and 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 and can last up to a month."^[2] Peeling also occurs in axilla, groin, and tips of the fingers and toes.^[1]

Diagnosis of scarlet fever is clinical. The blood tests shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high ESR and CRP , and elevation of antistreptolysin O titer. Blood culture is rarely positive, but the streptococci can usually be demonstrated in throat culture. The complications of scarlet fever include septic complications due to spread of streptococcus in blood and immune-mediated complications due to an aberrant immune response. Septic complications, today rare, include otitis, sinusitis, streptococcal pneumonia, empyema thoracis, meningitis and full-blown septicaemia ( malignant scarlet fever). Immune complications include acute glomerulonephritis, rheumatic fever and erythema nodosum. The secondary scarlatinous disease (or secondary malignant syndrome of scarlet fever) included renewed fever, renewed angina, septic ORL complications and nephritis or rheumatic fever and is seen around the 18th day of untreated scarlet fever.

Treatment

Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any strep throat. In case of penicillin allergy, clindamycin or erythromycin can be used with success.

Antibiotic treatment is usually given. It has however never been shown to reduce the chance that rheumatic fever develops.

Scarlet fever in literature

• Little Women by Louisa May Alcott (1868) - Beth contracts scarlet fever, seems to recover, but progresses to rheumatic fever and ultimately succumbs to congestive heart failure.
• The Velveteen Rabbit by Margery Williams (1922) - The main protagonist, a small boy, contracts scarlet fever and his toys are all burned. Indeed, the velveteen rabbit itself, the boy's favorite toy, was going to be burned by a nurse, but at the book's climax, the toy rabbit comes alive and joins the "real" rabbits outside in the garden.
• By the Shores of Silver Lake by Laura Ingalls Wilder (1939) - Before the start of the book, Laura's older sister Mary has been left blind by a bout with scarlet fever.
• Frankenstein; or, The Modern Prometheus by Mary Wollstonecraft Shelley (1818) - Victor Frankenstein's adoptive sister Elizabeth contracts scarlet fever and recovers. But Victor's mother, who contracts the scarlet fever from Elizabeth, dies.
• The Witch of Blackbird Pond (1958) by Elizabeth George Spears. A young girl from Barbados is accused of giving scarlet fever to her cousins by using witchcraft. She is accused of witchcraft because she is friends with a Quaker, which are always accused as witches in Puritan colonies.
• Fever Dream by Ray Bradbury - the young protagonist is diagnosed with scarlet fever, though it appears to mutate into something much more sinister.
• Private Peaceful by Michael Morpurgo - Molly gets it and survives.
• The first episode of Ozzy & Drix featured a villain named Scarlet Fever, who died after getting sucked into the spleen and shredded.

References

1. ^ ^{a b} Balentine J and Kessler D (March 7, 2006). "Scarlet Fever". eMedicine. emerg/518. 
2. ^ ^{a b} Dyne P and McCartan K (October 19, 2005). "Pediatrics, Scarlet Fever". eMedicine. emerg/402. 

Exanthema
Measles (1st disease) - Scarlet fever (2nd disease) - Rubella (3rd disease) Duke's disease (4th disease) - Slap cheek (5th disease) - Roseola (6th disease)

Bacterial diseases (primarily A00-A79, 001-041,080-109)
G+/Firmicutes	Clostridium (Pseudomembranous colitis, Botulism, Tetanus, Gas gangrene) - Streptococcus A and B (Scarlet fever, Erysipelas) - Staphylococcus (Toxic shock syndrome) - Bacilli (Anthrax, Listeriosis)
G+/Actinobacteria	Mycobacterium: Tuberculosis (Ghon focus, Ghon's complex, Tuberculous meningitis, Pott's disease, Scrofula, Bazin disease, Lupus vulgaris, Miliary tuberculosis) - Leprosy - Lady Windermere syndrome - Buruli ulcer - Actinomycetales: Actinomycosis - Nocardiosis - Diphtheria - Erythrasma
G-/Spirochetal	Syphilis (Bejel) - Yaws - Pinta - Relapsing fever - Noma - Trench mouth - Lyme disease - Rat-bite fever (Sodoku) - Leptospirosis
G-/Chlamydiae	Chlamydia - Lymphogranuloma venereum - Psittacosis - Trachoma
G-/α Proteobacteria	Rickettsioses (Typhus, Scrub typhus, Rocky Mountain spotted fever, Boutonneuse fever, Q fever, Trench fever, Rickettsialpox) - Brucellosis - Cat scratch fever - Bartonellosis (Bacillary angiomatosis)
G-/β&γ Proteobacteria	Salmonella (Typhoid fever, Paratyphoid fever, Salmonellosis) - other intestinal (Cholera, Shigellosis) - Zoonotic (Bubonic plague, Tularemia, Glanders, Melioidosis, Pasteurellosis) - Other: Pertussis - Meningococcus (Meningococcemia, Waterhouse-Friderichsen syndrome) - Legionellosis - Brazilian purpuric fever - Chancroid - Donovanosis - Gonorrhea

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