scarlet fever

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

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.

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]

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.

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.

• Diseases and Infestations - scarlet fever: highly contagious childhood disease caused by streptococcus bacteria, characterized by sore throat and widespread rash; scarlatina

This article is about disease. For Cee-Lo Green's backing band, see Scarlet Fever (band). For the song by Kenny Rogers, see Scarlet Fever (song).

Scarlet fever
Classification and external resources
ICD-10	A38
ICD-9	034.1
DiseasesDB	29032
MedlinePlus	000974
eMedicine	derm/383 emerg/402, emerg/518
MeSH	D012541

This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (December 2009)

Scarlet fever is a disease caused by erythrogenic toxin (a bacterial exotoxin) released by Streptococcus pyogenes.^[1] Once a major cause of death, it is now effectively treated with antibiotics. The term scarlatina may be used interchangeably with scarlet fever, though it is most often used to indicate the less acute form of scarlet fever seen since the beginning of the twentieth century.^[2]

Contents 1 Symptoms 2 Treatment 3 History 4 See also 5 Literature 6 References

Symptoms

It is characterized by:

• Sore throat
• Fever
• Bright red tongue with a "strawberry" appearance
• Characteristic rash:

fine, red, and rough-textured; it blanches upon pressure.

• appears 12–72 hours after the fever.
• generally starts on the chest, armpits, and behind the ears.
• spares the face (although some circumoral pallor is characteristic).
• is worse in the skin folds. These Pastia lines (where the rash runs together in the armpits and groin) appear and can persist after the rash is gone.
• may spread to cover the uvula.

• 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."^[3] Peeling also occurs in axilla, groin, and tips of the fingers and toes.^[4]

Diagnosis of scarlet fever is clinical. The blood test shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (both indications of inflammation), 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 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 glomerulonephritis, rheumatic 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 eighteenth day of untreated scarlet fever.

The rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps, and it may itch. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks (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 complected skin) when pressed on. By the sixth day of the infection, the rash usually fades, but the affected skin may begin to peel. Usually there are other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever at or above 101 °F (38.3 °C), and swollen glands in the neck. Scarlet fever can also occur with a low fever. The tonsils and back of the throat may be covered with 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.

When scarlet fever occurs because of a throat infection, the fever typically stops 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 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.

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

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. Patients should no longer be infectious after taking antibiotics for 24 hours. People who have been exposed to scarlet fever should be watched carefully for a full week for symptoms, especially if aged 3 to young adult. It is very important to be tested (throat culture) and if positive, seek treatment.

A drug-resistant strain of scarlet fever has emerged in Hong Kong in 2011, accounting for at least two deaths in that city - the first such in over a decade.^[5] The mutant strain of the bacterium is about 60% resistant to the antibiotics, says Professor Kwok-yung Yuen, head of Hong Kong University's microbiology department. This is compared to a previous strain of the disease, which demonstrated a 10-30% resistance. This new strain may have spread to neighboring Macau and mainland China.

History

Scarlet fever was feared in the pre-antibiotic era, as it was associated with the late post-streptococcal complications of glomerulonephritis and endocarditis leading to heart valve disease, all of which were protracted and often fatal afflictions at the time.
In Act II, Scene V of Rossini's opera, The Barber of Seville, Don Basilio is terrified and sent away to bed at a very crucial point in the plot under the false persuasion that he has contracted the dreaded "febbre scarlattina" (despite the fact that he is told he has turned yellow, rather than red).
Husband and wife Gladys Henry Dick and George Frederick Dick developed a vaccine in 1924, that was later eclipsed by penicillin in the 1940s.

See also

Wikimedia Commons has media related to: Scarlet fever

• List of cutaneous conditions

Literature

• Rolleston JD (November 1928). "THE HISTORY OF SCARLET FEVER". British Medical Journal 2 (3542): 926–9. doi:10.1136/bmj.2.3542.926. PMC 2456687. PMID 20774279. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2456687. 

References

1. ^ Only lysogenized streptococci produce the erythrogenic toxin (pyrogenic exotoxin) which causes the skin rash of scarlet fever
2. ^ Scarletina (Scarlet Fever)
3. ^ Dyne P and McCartan K (October 19, 2005). "Pediatrics, Scarlet Fever". eMedicine. emerg/402. 
4. ^ Balentine J and Kessler D (March 7, 2006). "Scarlet Fever". eMedicine. emerg/518. 
5. ^ "Second HK child dies of mutated scarlet fever". Associated Press (online). 22 June 2011. http://www.salon.com/wires/health/2011/06/22/D9O0TMJO0_as_hong_kong_scarlet_fever/index.html. Retrieved 23 June 2011. 

v d e Infectious skin disease: Viral cutaneous conditions, including viral exanthema (B00–B09, 050–059) DNA virus Herpesviridae Alpha HSV (Herpes simplex, Herpetic whitlow, Herpes gladiatorum, Herpetic keratoconjunctivitis, Herpetic sycosis, Neonatal herpes simplex, Herpes genitalis, Herpes labialis, Eczema herpeticum, Herpetiform esophagitis) · Herpes B virus (B virus infection) VZV (Chickenpox, Herpes zoster, Herpes zoster oticus, Ophthalmic zoster, Disseminated herpes zoster, Zoster-associated pain, Inflammatory skin lesions following zoster infection, Modified varicella-like syndrome) Beta Human herpesvirus 6/Roseolovirus (Exanthema subitum, Roseola vaccinia) Cytomegalic inclusion disease Gamma KSHV (Kaposi's sarcoma) Poxviridae Ortho Variola (Smallpox, Eczema vaccinatum, Alastrim) · MoxV (Monkeypox) · CV (Cowpox) · VV (Vaccinia, Generalized vaccinia, Progressive vaccinia) Buffalopox Para Farmyard pox: Milker's nodule · Bovine papular stomatitis · Pseudocowpox · Orf Sealpox Other Yatapoxvirus: Tanapox · Yaba monkey tumor virus MCV (Molluscum contagiosum) Papillomaviridae HPV (Wart/Plantar wart, Heck's disease, Genital wart (giant), Laryngeal papillomatosis, Butcher's wart, Bowenoid papulosis, Epidermodysplasia verruciformis, Verruca plana, Pigmented wart, Verrucae palmares et plantares ) BPV (Equine sarcoid) Parvoviridae Parvovirus B19 (Erythema infectiosum, Reticulocytopenia, Papular purpuric gloves and socks syndrome) RNA virus Paramyxoviridae MeV (Measles) Togaviridae Rubella virus (Rubella, Congenital rubella syndrome) · Alphavirus infection · Chikungunya fever Picornaviridae CAV (Hand, foot and mouth disease, Herpangina) · FMDV (Foot-and-mouth disease) · Boston exanthem disease Ungrouped unknown/multiple: Asymmetric periflexural exanthem of childhood · Post-vaccination follicular eruption · Lipschütz ulcer · Eruptive pseudoangiomatosis · Viral-associated trichodysplasia · Gianotti–Crosti syndrome M: VIR virs(prot)/clss cutn/syst (hppv/hiva, infl/zost/zoon)/epon drugJ(dnaa, rnaa, rtva, vacc) M: INT, SF, LCT anat/phys/devp noco(i/b/d/q/u/r/p/m/k/v/f)/cong/tumr(n/e/d), sysi/epon proc, drug (D2/3/4/5/8/11)

v d e Firmicutes (low-G+C) Infectious diseases · Bacterial diseases: G+ (primarily A00–A79, 001–041, 080–109) Bacilli Lactobacillales (Cat-) Streptococcus α optochin susceptible: S. pneumoniae (Pneumococcal infection) optochin resistant: S. viridans: S. mitis, S. mutans, S. oralis, S. sanguinis, S. sobrinus, milleri group β A, bacitracin susceptible: S. pyogenes (Scarlet fever, Erysipelas, Rheumatic fever, Streptococcal pharyngitis) B, bacitracin resistant, CAMP test+: S. agalactiae ungrouped: Streptococcus iniae (Cutaneous Streptococcus iniae infection) γ D, BEA+: Streptococcus bovis Enterococcus BEA+: Enterococcus faecalis (Urinary tract infection) · Enterococcus faecium Bacillales (Cat+) Staphylococcus Cg+ S. aureus (Staphylococcal scalded skin syndrome, Toxic shock syndrome, MRSA) Cg- novobiocin susceptible (S. epidermidis) · novobiocin resistant (S. saprophyticus) Bacillus Bacillus anthracis (Anthrax) · Bacillus cereus (Food poisoning) Listeria Listeria monocytogenes (Listeriosis) Clostridia Clostridium (spore-forming) motile: Clostridium difficile (Pseudomembranous colitis) · Clostridium botulinum (Botulism) · Clostridium tetani (Tetanus) nonmotile: Clostridium perfringens (Gas gangrene, Clostridial necrotizing enteritis) Peptostreptococcus (non-spore forming) Peptostreptococcus magnus Mollicutes Mycoplasmataceae Ureaplasma urealyticum (Ureaplasma infection) · Mycoplasma genitalium · Mycoplasma pneumoniae (Mycoplasma pneumonia) Anaeroplasmatales Erysipelothrix rhusiopathiae (Erysipeloid) M: BAC bact (clas) gr+f/gr+a(t)/gr-p(c)/gr-o drug(J1p, w, n, m, vacc)

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