The Complete Guide to Scarlet Fever


We should be glad we live in a modern world where we can get relief from many dreaded diseases which were not available in older times. Parents, especially, are stressed when their children are infected with an illness, keeping them at all times vigilant and hoping such illnesses don’t get worse. These must have been the sentiments of parents in the past and scarlet fever was one such illness that affected mostly children physically and parents emotionally. As a matter of fact, scarlet fever epidemics were common in the early twentieth century.

Early in the twentieth 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’s 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.

Scarlet fever begins with a nasty microorganism from the group A Streptococcus bacteria and it typically affects a small percentage of individuals who have either have streptococcal pharyngitis (strep throat) or streptococcal wounds or skin infections. In older articles, scarlet fever was also called scarlatina because of the illness, which affected mostly children, was characterized by the child’s flushed cheeks. The sun-burned color of the skin and sandpaper-like rashes accompanied by fever are common symptoms of scarlet fever.

The Causes and Risk Factors of Scarlet Fever

The Group A Streptococcus bacteria are also referred to as the group A strep or GABHS (group A beta-hemolytic streptococcus). These are oval-shaped, gram-positive bacteria. They can inflict damage to the body by producing an erythrogenic toxin which is the one responsible for causing red-colored skin rashes that have sandpaper-like textures. These skin conditions are common in individuals who have scarlet fever.

The latest research on scarlet fever has indicated that around 80% of young children who are aged 10 and above have naturally developed their own protective antibodies against streptococcus exotoxins. However, the organisms can still cause some other diseases such as impetigo, myositis, skin desquamation, necrotizing fasciitis, and acute rheumatic fever.

To reiterate, children are the usual victims of scarlet fever and the illness can happen at any time, although most cases are more common during spring and winter. It’s highly contagious and is spread by coughing, sneezing, or direct contact with secretions or an infected person.  A person can even spread the disease even without knowing he’s a carrier. Food-borne spreading is rare. Invariably, the spread is more likely in crowded situations where persons come in close contacts with each other like daycare centers and schools.

There are different ranges of incubation for scarlet fever. Some peg it at 12 hours up to a week. Others from three to five days, with symptoms usually beginning on the second day of the disease. In any case, those who are infected will become most contagious during the first incubation or subclinical period and during the period of acute illness. Keep in mind that those rashes that appear aren’t contagious. It is the primary strep infection that is contagious.

The greatest chances that one can get infected with scarlet fever are overcrowded environments like movie houses, schools, dormitories, and more. Again, children between the ages of five and fifteen are the most susceptible to scarlet fever, although those outside this range can also be infected. The illness is rare in children who are younger, especially newborns because they have their own natural protection in their mother’s milk.

The most contagious period for this condition is during the subclinical phase and that can range from 12 hours to several days after getting exposed to the streptococcus bacteria. It’s also most contagious during its acute phase where the person develops rashes with an accompanying fever.

How Does Scarlet Fever Spread?

One of the main causes of the transmission of scarlet fever is through fluids from an infected person’s nose and mouth. So when someone who has this illness sneezes or coughs, the bacteria go into the air in the form of water droplets. Then the people in the surroundings can catch scarlet fever when they inhale those airborne droplets. They can also get infected when they touch objects which the droplets land on then they touch their mouth or nose.

Another way that this illness can spread is when someone touches the skin of a person who has a streptococcal skin infection. And when people share clothes, baths, bed linens, towels, and other personal items, this increases the risk of spreading the disease.

If someone suffers from scarlet fever, it’s vital that he gets treated right away. Otherwise, he will be contagious for a number of weeks even after he stops manifesting the symptoms. A few lucky individuals may not react to the toxin. Instead, they would simply be carriers and spread the infection to others without manifesting any symptoms. This is because only the people who react to the toxin will develop and show the signs and symptoms of scarlet fever. Because of this, it’s quite difficult for some people to even become aware that they’ve been exposed to the illness.

Some Facts About Scarlet Fever

If a person wants to understand an illness such as scarlet fever completely, it’s important to learn everything about it. Being well-informed will help the person become more aware of the illness and, in turn, be able to prevent it more effectively. With that in mind, here are some facts about scarlet fever one should know about:

  • Scarlet fever is actually a bacterial infection which results in a fever and a rash. It’s caused by the group A Streptococcus bacteria.
  • The bacteria which cause scarlet fever produces an erythrogenic toxin in the body.
  • Scarlet fever has an incubation period which can be as short as 12 hours and as long as a whole week.
  • Some of the common risk factors for this illness are the communal use of towels, utensils, and other personal items or overcrowding. The latter is especially risky for young children.
  • Scarlet fever also has a contagious period which ranges from up to 12 hours after the person gets exposed to the bacteria. In some cases, the person may not show any symptoms of the illness during this period. It’s also highly contagious while in the acute phase when the person has a fever and a rash. Then the contagiousness of the illness ends when the fever is already gone.
  • Diagnosing scarlet fever typically involves a physical exam and the doctor asking about the patient’s medical history. This is especially true if the person experiences a fever and has a rash.
  • The most common way to treat this illness is by taking antibiotics. Such medications are very effective against the streptococci which are infecting the body.
  • If left untreated, scarlet fever may lead to complications such as kidney problems, rheumatic fever, and other such severe health issues.
  • If diagnosed early and treated effectively, the prognosis of this particular illness is quite good. This is because the treatment would prevent any complications. But if they do develop, the prognosis starts to decrease depending on the severity of the complication.
  • Fortunately, it’s possible to reduce or even prevent the risk of getting this disease simply by following some simple tips. We’ll discuss these in detail in the next section.

Signs and Symptoms of Scarlet Fever

The signs and symptoms of scarlet fever may include a sore throat, a fever, and a red rash that’s widespread and has a texture similar to sandpaper. One may also notice that his tongue looks like a strawberry, red-colored with small bumps. For some people, their throat or tongue may also have a coating that’s whitish in color.

Scarlet fever, sometimes called scarlatina usually starts from an infection in the throat caused by the streptococcus bacteria. Some common symptoms include a sore throat, headache, tonsils which appear enlarged, chills, and fever. These symptoms may be accompanied by abdominal pain, nausea, and vomiting. Aside from the tongue having a strawberry-like appearance, the illness also has the hallmark symptom of a rash. It would usually start as small, flat, and red areas on the person’s skin. Then these develop into small, bumpy, and red areas. The rash typically starts on the person’s trunk and chest then extends to his legs and arms. However, the soles of his feet and his palms are usually spared from the rash. If one touches the rash, it would feel like sandpaper. Also, the creases of the skin may appear redder in color than normal. Then as the rash fades, the skin may start peeling.

Normally, the signs and symptoms of scarlet fever would emerge from 1-4 days after the person gets exposed to the infection. This is known as the incubation period. In most cases, scarlet fever occurs along with a streptococcal infection in the throat. This is why a lot of the signs and symptoms of the illness are similar to strep throat.

Diagnosis of Scarlet Fever

Health care providers can make a diagnosis if the child has scarlet fever based on certain information. This includes a physical examination, laboratory results, and the medical history of the child. Since scarlet fever is caused by a streptococcus bacteria, the health provider will most likely get a swab sample from the back of the throat and tonsils using a cotton swab. This will be used in the laboratory to evaluate the illness. There are several tests to determine the presence of scarlet fever:

Physical examination. A doctor will check the mouth, tongue, tonsils, and throat. He will be paying close attention to swollen glands, yellow or white specks in the throat and mouth.  Fever, chills, and body aches are also checked. The doctor may inquire if the child has been recently vomiting, is losing his appetite or experiencing nausea.

Rapid Strep Test. For fast results, the sample may be subjected to a rapid antigen test also known as the rapid strep test. Results can be provided by this test in just a few minutes.

This test is fast and a convenient way to find out if the child harbors the bacteria which causes strep and scarlet fever. In case the test comes out negative, the swab will be sent to a laboratory for further tests. Taking a throat culture is a more thorough test to determine if the bacteria is really present.

Throat swab. If the doctor thinks that strep throat is the cause of the child’s illness, a swab of the tonsils and throat will be taken. This swab will collect materials that are suspect of containing the scarlet fever bacteria.

By contrast, this throat culture procedure, which is more sensitive, can yield results between 1-2 days.

  • Health providers may also opt for a blood chemistry procedure. This can include a complete blood count which will demonstrate any proof of infection.
  • Streptococcal antibody testing can also provide evidence if the patient has been previously infected. However, this test serves no value in the acute stage of infection.
  • The streptococcal infection may arise from a different source other than the usual mouth area. There is a test conducted on such areas to determine if such alternative areas are the source of infection.

Health providers can turn to a patient’s medical history as well as a physical examination to make an early diagnosis of the condition. A physical exam, for instance, can reveal that the patient has Thompson’s signs or Patia’s signs. These are either red or pink lines that form in the skin folds of the groin and armpits. These lines usually develop before the occurrence of rashes and will stay on the skin as pigmented lines even after the skin peels off in a process known as desquamation.

A doctor can get a throat swab or culture and have this tested in the laboratory to determine the presence of GABHS. As earlier stated, this group A beta-hemolytic streptococcus are bacteria responsible for scarlet fever. The problem here is that this same bacteria can also be the cause of other types of infections such as measles which manifest both fever and rashes. In such cases, the GABHS needs to be isolated to make sure that the diagnosis is that of scarlet fever. For this, the services of a specialist in infectious diseases will be needed, especially if the person develops any complications. If the GABHS isn’t present in the conducted tests, then it’s most probable that the signs and symptoms are caused by some other underlying problem. If one’s child develops a sore throat, accompanied by rashes and a fever, call the doctor immediately.

Treatment of Scarlet Fever

Antibiotics against GABHS are the most effective defense for treating scarlet fever. A penicillin medication administered orally for 10 days is an effective treatment. If the patient is having problems retaining oral antibiotics, then the patient can receive treatment in the form of a penicillin G benzathine injection, but these injection cases are rare. Antibiotics of the cephalosporin family are also as effective. In fact, these were used in the latest outbreak of scarlet fever in China because the GABHS have shown resistance to the antibiotics that were typically used.

Scarlet fever seems less of a problem now because of antibiotics. It’s the most effective drug used against the illness. Furthermore, antibiotics can prevent potential complications that usually accompany a streptococcal infection (rheumatic fever for one). Their use can also cut down the duration of the disease’s symptoms and can lessen its contagiousness. On the average, an infected person who has taken the antibiotic for at least a whole day will no longer be a threat in transmitting the disease.

We have always associated antibiotics with the treatment of infections. Rightly so because it’s the most popular for dealing with such problems. The most widely-used antibiotic is penicillin VK, which is administered orally for 10 days and penicillin G benzathine, which is administered in a one-time intra-muscular injection. Cephalosporin drug class is an alternative antibiotic. Keep in mind the importance of completing the entire course of the antibiotic that is prescribed to a person. Not finishing the course leads to an inadequate treatment of the infection and this could lead to the development of potential complications.

Other Therapies Or Treatment Options For Scarlet Fever

The recommendation and prescription of antibiotics are necessary for dealing with a medical problem that already exists. Actually, these may not even be needed if one can keep his immune system healthy, especially for people who are prone to catching whatever disease is making the rounds.

Dietary modifications. There are many foods out there that contain antioxidants, minerals, and vitamins, all of which can help in boosting the immune system. Some of these are vegetables, fruits, whole grains, nuts, seeds, and legumes. Herbs and spices like onions, ginger, and garlic are also excellent dietary additions because they contain antibiotic properties.

Adequate rest and sleep. Nobody needs to tell people about the importance of sleep and rest when they’re under the weather. Remember that sleep time is also the time for the body to grow and repair damaged tissues. Sleep is important, make it a point to sleep at least 8 hours every night. When a person is deprived of it, the immune system is weakened and will be producing fewer killer cells necessary to eliminate the cells that have been infected by bacteria and/or viruses.

Supplements. The foods we eat may not be able to provide all the nutrients that the body needs and we turn to supplements to fill up the void. To build up a healthy immune system, we can use a Chinese herb called astragalus during the flu and cold seasons. This herb which is available in tincture or capsule form is a supplement that can further boost the immune system. It’s safe for daily use even for children. Another supplement worth considering is one which contains a number of species of mushrooms which can boost the immune system and which can further enhance resistance to illnesses. Again, this is also safe for both adults (to take a full dose) and children (to take a half dose).

Prevention. Scarlet fever can easily be spread around through respiratory secretions of an infected person. Any infected surface becomes a source of the disease as the secretions will contain millions of bacteria.

Properly washing one’s hands is one of the best ways to prevent transmission. When we are in close proximity to sick persons, make sure to wash hands afterward. This goes the same for all members of the household. Remind them that scarlet fever is a highly contagious disease.

Other precautions include covering one’s nose and mouth when sneezing or coughing, not sharing the same eating utensils and glasses, and avoiding contact with the sick person. Those who have been infected should get rid of their toothbrushes too. Then purchase a new replacement.

Home Remedies and Follow-up Care for Scarlet Fever

The doctor can help one prepare in case his child has been diagnosed with this condition. These can include various measures to ease the symptoms of the illness and to hasten the recovery time at home. Nowadays, complications resulting from the disease are rare. Most cases now are treated and managed in the comfort of their own home. Here are some home remedies for scarlet fever:

  • Over-the-counter medications for fever reduction and pain control can be purchased at the local drugstore. Ibuprofen (Motrin or Advil) or acetaminophen (Tylenol) are the most common pain relievers.
  • Sufficient rest and an increased intake of fluids. These factors are very important, especially in promoting rapid recovery.
  • Gargling or sucking on lozenges. There is that old remedy of gargling with warm water and salt which can offer relief as well. For those who contract pharyngitis, throat lozenges are the most popular for temporary relief from sore throats.
  • Make it a point to include follow-up visits to the health provider. This will ensure, through regular monitoring, that the recovery process will be complete with no complications. If one is diagnosed with the illness but the recommended remedies aren’t working and the conditions are still getting worse, promptly consult with a health provider.

Many of us who have been diagnosed with a positive rapid strep may expect immediate relief when treated with antibiotics. This might not always be the case but one thing for sure is that the antibiotic will cut down the time that the person may be spreading the disease to other people. Taking the antibiotic will also reduce the risk of the disease spreading to the person’s other body parts.

Delaying the treatment of scarlet fever for one or two days isn’t really a cause for alarm. That’s just the right amount of time for the results of a throat culture test. Antibiotics can also prevent the occurrence of rheumatic fevers even if they are started up to nine days after the symptoms start to manifest themselves. There are other strategies which can help in relieving the disease’s symptoms:

  • Drinking plenty of fluids, even when there’s no appetite.
  • Living conditions should be kept cool.
  • Medications can help relieve pains and fever.
  • Applying calamine lotion can reduce the itching.

Possible Complications of Scarlet Fever

If scarlet fever is left unchecked or not properly treated, complications may arise which may include post-streptococcal glomerulonephritis, a type of kidney disease. Rheumatic fever can also occur. This is a type of inflammatory disease caused by a cross-reactivity of antibodies which can affect the heart, skin, brain, and joints.

Rheumatic complications may start 2-3 weeks after initial exposure to the disease. Children between 6-15 are the most vulnerable to the development of rheumatic fever. Glomerular complications can begin 2-3 weeks after the throat has been infected or 3-6 weeks after the skin has been infected. These complications may cause more issue in adults than in children. Although most will not experience these complications, the following illnesses can occur:

  • Ear infections like otitis media
  • Pneumonia
  • Throat abscesses
  • Sinusitis
  • Inflamed kidneys caused by the immune system’s response to the strep bacteria
  • Possible long-term kidney disease
  • Rheumatic fever
  • Skin infections

This next list of complications are also possible, but they are extremely rare:

  • Acute kidney failure
  • Meningitis or the inflammation of the membranes that surround the spinal column or the brain
  • Necrotizing fasciitis, which is a very serious flesh-eating disease
  • Toxic shock syndrome
  • Endocarditis, which is an infection of the heart’s inner linings
  • Infection of the bones and the bone marrows. This is a condition known as osteomyelitis.

Another risk that can be attributed to streptococcal infections is a pediatric autoimmune neuropsychiatric disorder. This is a behavioral disorder that begins before puberty and is associated with GABHS infections. The disorders can include obsessive-compulsive disorders (OCD), Tourette’s syndrome, and attention deficit hyperactivity disorder (ADHD). The increase in symptoms usually goes away after a few weeks or months.

The Prognosis of Scarlet Fever

If scarlet fever is treated properly, the prognosis for the disease is generally excellent. This means that the infected patients will recover fully and their skin symptoms and conditions will decrease over the next few weeks. Conversely, untreated cases will have a dire prognosis. Before the advent of antibiotic medications, this illness had a mortality rate of up to 20%. Compared to the present where the mortality rate is even less than 1%. This is because of the early diagnosis and treatment of the disease. Antibiotics play the biggest role in the abrupt decrease in mortality. Early diagnosis and treatment of scarlet fever will result in a few if any, long-term effects.

Proper treatments for scarlet fever patients can only yield excellent prognoses. In actuality, there are no long-term consequences in most scarlet fever cases. Improvement starts in a few days after taking antibiotics. Nowadays, serious complications are rare as a result of scarlet fever and any streptococcal infections.

Can You Prevent Scarlet Fever?

Often times, the best solution is the simplest solution. How then can we prevent scarlet fever? By simply washing your hands and taking necessary precautions like staying away from the communal use of towels, utensils, and other such items. Since scarlet fever is transmitted from one person to another through small droplets, direct contact with those infected must be avoided. People who have taken antibiotics and don’t show any signs of fever for 24 hours are already considered not-contagious. Unfortunately, there are no vaccines available to prevent the illness.

The early and proper treatment with antibiotics is the best preventive way against scarlet fever. If this is accomplished, the chances of developing scarlet fever are decreased or even eliminated. Antibiotics have indeed turned the tables against scarlet fever because it has reduced its mortality rate significantly.

We’re all familiar with the adage “an ounce of prevention is worth a pound of cure.” This is so applicable with scarlet fever. In order not to contract the disease, we should avoid contact with persons who have been diagnosed with sore throats.  Don’t send the kids to school or the day-care center until the infected kids are treated with antibiotics for at least 24 hours. For the infected ones, they should practice some good hygiene practices like washing their hands frequently, covering their nose and mouth when sneezing or coughing, using separate utensils and cups, and so on.

Here are some more ways to prevent the transmission of scarlet fever and other infectious diseases to that matter:

  • Isolation or staying away from other people. For kids, stay away from school until he/she is no longer contagious.
  • Washing or disposing of tissues immediately after use. Also, wash hands thoroughly with warm water and soap.
  • Don’t share drinking glasses or eating utensils.
  • Cover mouth and nose when coughing or sneezing by using a handkerchief. One can also use the inside of his elbow when sneezing or coughing.

FAQs About Scarlet Fever for Parents

Scarlet fever was thought to have been eliminated like scurvy and rickets during the Victorian era. However, the assumption was wrong because scarlet fever made a comeback in the 1960s. To understand this illness more, let’s take a look at some FAQs about it:

What Is Scarlet Fever?

This is a disease caused by bacteria and targets mostly young children, those aged 10 years old and below. The most observable symptoms are skin infections, a sore throat,  and a rash that’s bright pink in color from where the disease got its name.

The symptoms usually start as red blotches. These eventually will turn into fine pinkish-red rashes with a sandpaper-like texture. This could be accompanied by a fever, a headache and at times, a swollen tongue. After one or two days, the rashes will develop followed by vomiting and nausea.

How Does One Catch Scarlet Fever?

As we stated earlier, this is a highly contagious disease which can be transmitted by direct sneezing, coughing, direct contact with an infected person, or handling objects that have been contaminated like beddings, bath towels, and more.

Scarlet fever can happen any time of year but most cases happen during spring and winter. Good hygiene practices can help prevent or lessen the spread of scarlet fever. Washing hands frequently, avoiding contact with contaminated objects, and such are simple practices that must be followed.

What Should A Person Do If He Thinks His Child Has Scarlet Fever?

During older times, those who were suspected of having scarlet fever were usually quarantined. Things are different now but it’s still essential that suspected carriers be diagnosed then treated. Aside from this, basic steps are also taken to make sure the disease is not transmitted. Most of the scarlet fever cases will have the disease clearing out on its own accord. However, it’s still advisable to consult with a doctor if one thinks his child has the disease.

How Is Scarlet Fever Treated?

To reiterate, antibiotics is the main course in treating scarlet fever. Taking this will ensure fast recovery, reduce the amount of time that one is contagious, and decrease the risk of complications that may arise. Treatment usually takes 10 days and treated children will usually start to feel better after only 24 hours. The symptoms should clear up after a couple of days. But be reminded of the entire course of treatment. Most doctors will recommend that infected persons being treated should stay home for 24 hours after starting on the antibiotics.

Can Scarlet Fever Become Serious?

Scarlet fever was one of the leading causes of death in the past where the mortality rate was up to 20%. Most of the victims were infants. Nowadays, people don’t worry too much about the disease because of antibiotics and some good hygiene practices that need to be followed. Frankly, scarlet fever isn’t at all terrifying and the vast majority who have experienced the disease recovered quickly without any complications. Only keep in mind that the treatment should be strictly followed to avoid any complications that may potentially occur.

Complications in the treatment of scarlet fever are rare but are still easily treatable if the symptoms are observed and treated early. In very rare cases, complications can happen, from relatively mild issues like ear infections or something as serious as kidney damage for more severe cases.

Always check with the doctor if one has health concerns about his child regarding scarlet fever. If the symptoms become worse, always bring the child to the doctor for further analysis as soon as possible.



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