Scarlet Fever

Scarlet fever, also known as scarlatina, is a bacterial infection that can cause a range of symptoms, including a characteristic red rash, fever, and sore throat. It is most common in children but can affect people of all ages. Understanding the scarlet fever causes, symptoms, and treatment options is crucial for early diagnosis and effective management of the condition.

What is Scarlet Fever?

Scarlet fever is caused by an infection with group A Streptococcus bacteria, the same bacteria responsible for strep throat. When the bacteria release a specific toxin, it triggers the development of the characteristic red rash associated with scarlet fever. The illness is highly contagious and can spread through respiratory droplets when an infected person coughs or sneezes. Children between the ages of 5 and 15 are most susceptible to scarlet fever, particularly if they have a history of strep throat or strep skin infections. While the condition is generally manageable with antibiotics, it is essential to recognise the scarlet fever's early signs and symptoms to prevent complications and the spread of the infection to others.

The scarlet fever symptoms usually develop within 1 to 2 days of infection and can include:

1. Red Rash: A characteristic red, sandpaper-like rash that typically begins on the chest and stomach before spreading to other parts of the body. The rash may be more difficult to see on darker skin tones, but the rough texture remains noticeable.

2. Strawberry Tongue: The tongue may initially appear white and coated before turning red and bumpy, resembling a strawberry.

3. Flushed Face: The face may appear flushed with a pale area around the mouth.

4. High Fever: A fever of 101°F or higher is common, often accompanied by chills.

5. Sore Throat: The throat may feel sore and appear red, sometimes with white or yellow patches.

6. Swollen Glands: The lymph nodes in the neck may become swollen and tender to the touch.

7. Other Symptoms: Some individuals may experience nausea, vomiting, abdominal pain, headaches, and a general feeling of being unwell.

As the illness progresses, the skin may begin to peel, particularly on the fingertips, toes, and groin area. This peeling usually occurs after the rash has subsided, about a week after the onset of symptoms. Seeking medical attention and receiving appropriate scarlet fever treatment can help alleviate symptoms and prevent the spread of the infection to others.

Scarlet fever is caused by a bacterial infection with group A Streptococcus. The bacteria produce a toxin that triggers the characteristic red, bumpy rash associated with the disease.

The infection is typically transmitted through respiratory droplets released when an infected person coughs or sneezes. It can also spread through contact with contaminated surfaces or by touching someone who has the infection. In rare instances, consuming improperly handled food can cause scarlet fever, although this is very uncommon.

Several factors can increase the risk of developing scarlet fever, particularly among certain age groups and in specific settings.

Who's at Risk?

• Children between the ages of 5 and 15 are most susceptible to scarlet fever, although it can affect people of all ages.

• People who have close contact with someone infected with scarlet fever are at a higher risk of contracting the disease.

• Outbreaks of scarlet fever can occur in schools, daycare centres, and other environments where people are in close proximity to each other.

• Family members of an infected person are at risk, particularly if they share utensils and drinking glasses or have close contact.

Recognising the risk factors associated with scarlet fever can help individuals take appropriate precautions to prevent the spread of the disease and seek prompt medical attention if symptoms develop.

If left untreated or if the infection spreads to other parts of the body, scarlet fever can lead to several serious complications. Some potential complications of scarlet fever include:

• Rheumatic Fever: It is one of the most concerning complications, as it can cause inflammation and damage to the heart valves.

• Glomerulonephritis: The bacteria can also spread to the kidneys, causing inflammation and reduced function, a condition known as post-streptococcal glomerulonephritis.

• Abscesses: Collections of pus that can develop near the tonsils, leading to pain and difficulty swallowing.

• Pneumonia: If the bacteria spread to the lungs, it can cause pneumonia, a serious respiratory infection.

• Joint Pains: The bacteria can cause inflammation and pain in the joints, a condition known as post-streptococcal reactive arthritis.

• Middle-ear Infections: The bacteria can also cause middle-ear infections, leading to pain, fever, and difficulty hearing.

Prompt diagnosis and treatment of scarlet fever with antibiotics can help prevent the development of these complications and ensure a full recovery.

Preventing the spread of scarlet fever is crucial to reduce the incidence of this bacterial illness. Some of the scarlet fever prevention measures that we can adopt are as follows:

• Good Hand Hygiene: It is one of the most effective ways to prevent transmission. Washing hands frequently with warm, soapy water for at least 20 seconds or using alcohol-based hand sanitisers can help eliminate the group A streptococcal bacteria that cause scarlet fever.

• Respiratory Etiquette: Habits such as covering the mouth and nose when coughing or sneezing, using a handkerchief, or coughing/sneezing into the inside of the elbow can also prevent the spread of the bacteria.

• Avoid Sharing Personal Items: Avoiding the sharing of personal items like dining utensils, food, or drinking glasses is another important preventive measure.

• Precautionary Measures for Infected Individuals: Individuals diagnosed with scarlet fever should stay home from school, work, or daycare until they are fever-free and have been on appropriate antibiotic therapy for at least 12-24 hours.

• Environmental Hygiene: Proper environmental hygiene, such as washing drinking glasses and utensils in hot, soapy water or a dishwasher after use by an infected person, can further help prevent the spread of scarlet fever.

Diagnosing scarlet fever involves a combination of clinical evaluation and laboratory tests.

• Clinical Evaluation: During a physical examination, doctors look for characteristic symptoms of scarlet fever, such as a red, sandpaper-like rash, strawberry tongue, red lines in the skin folds (Pastia's lines), and a flushed face with a pale ring around the mouth.

• Laboratory Tests: To confirm the presence of group A streptococcal bacteria, a throat swab (rapid antigen detection test or RADT) is performed. If the RADT is negative but the child is older than three years and symptomatic, a throat culture may be necessary to confirm the diagnosis. In some cases, a blood test may also be ordered to support the diagnosis of scarlet fever.

The primary approach to managing scarlet fever is antibiotic treatment, along with supportive care.

Medication for Scarlet Fever

Penicillin or amoxicillin is the antibiotic of choice for managing scarlet fever. The dosage, however, varies by age and weight. For individuals allergic to penicillin, alternative antibiotics such as azithromycin, cefadroxil, clarithromycin, cephalexin, clindamycin, or erythromycin may be prescribed.

Supportive Care for Scarlet Fever

Supportive care measures include rest, hydration, and the use of acetaminophen or ibuprofen to manage fever and throat pain. Antihistamines may help relieve itching associated with the rash. For relieving throat pain, a saltwater gargle can be used by mixing 1/4 teaspoon of table salt in warm water, gargling with the solution, and then spitting it out.

In rare cases where complications like rheumatic fever or post-streptococcal glomerulonephritis occur, additional treatment and monitoring may be necessary. It is essential to complete the full course of antibiotics as prescribed, even if symptoms improve, to prevent complications and reduce the risk of antibiotic resistance. While medication is essential for managing scarlet fever, it is also important to know when to seek further medical attention.

It is crucial to see a doctor if you or your child exhibits the following symptoms:

• Severe pain or symptoms that last for more than 5 to 7 days

• If your child has difficulty swallowing, is drooling excessively, or isn't drinking enough to stay hydrated

• If your child has blood in their urine, a fever that persists despite antibiotic treatment, or develops additional symptoms such as swollen glands, nausea, vomiting, stomach pain, headache, or body aches

• Scarlet fever is caused by group A streptococcus, the same bacteria that causes strep throat and is diagnosed through a throat swab or rapid strep test.

• Symptoms of scarlet fever include a bright red, bumpy rash (often described as a "sandpaper rash"), fever, sore throat, swollen glands, nausea, vomiting, stomach pain, headache, and body aches. The tongue may appear red and swollen with white spots.

• Treatment involves antibiotics, primarily penicillin or amoxicillin, to eliminate the bacterial infection. Alternatives are available for those with penicillin allergies.

• Over-the-counter scarlet fever medications can help manage fever and throat pain, while saltwater gargles can provide relief for throat discomfort.