scarlet fever

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

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.

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]

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 and external resources
ICD-10	A38.
ICD-9	034
DiseasesDB	29032
MedlinePlus	000974
eMedicine	derm/383 emerg/402, emerg/518
MeSH	D012541

Scarlet fever is a disease caused by an erythrogenic exotoxin released by Streptococcus pyogenes. The term Scarlatina may be used interchangeably with Scarlet Fever, though it is commonly used to indicate the less acute form of Scarlet Fever that is often seen since the beginning of the twentieth century.^[1]

It is characterized by:

• Sore throat
• Fever
• 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, armpits, and behind the ears
• spares the face (although some circumoral pallor is characteristic)
• is worse in the skin folds. These are called Pastia lines (where the rash runs together in the arm pits and groins) 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."^[2] Peeling also occurs in axilla, groin, and tips of the fingers and toes.^[3]

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), 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.

Scarlet Fever's pebbly, dry rash.

Symptoms

This 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 you press on them. By the sixth day of the infection the rash usually fades, but the affected skin may begin to peel.

Aside there are usually 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. A person with scarlet fever also 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 began, but skin that was covered by rash may begin to peel. This peeling may last 10 days. 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

Husband and wife Gladys Henry Dick and George Frederick Dick developed a vaccine in the 1920s that was later eclipsed by penicillin in the 1940s. 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. Persons 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's very important to be tested (throat culture) and if positive, seek treatment. For reasons unknown, toddlers rarely contract scarlet fever.

References

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

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