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Scarlet Fever: Causes, Symptoms, and Treatments

Written by Christian NordqvistReviewed by University of Illinois-Chicago, School of
MedicineLast updated: Wed 23 Nov 2016 email
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Scarlet fever, also known as scarlatina, is a disease caused by a toxin released by the bacteria
Streptococcus pyogenes, the same organism that causes strep throat. Scarlet fever mainly affects
children and is characterized by a distinctive pink-red rash.
Although this condition is less common than it used to be, there are occasional, significant
outbreaks.

It is important to be aware of the signs and symptoms of scarlet fever so that it can be caught early
and treated with antibiotics as soon as possible.
The disease occurs in a small percentage of patients with strep infections, such as strep throat or
impetigo.
Although the term scarlatina can be used interchangeably with scarlet fever, scarlatina is more
commonly used to refer to the less acute form of scarlet fever.
Scarlet fever used to be considered a serious childhood illness but modern antibiotics have made it
a much rarer and less threatening disease. However, if left untreated, scarlet fever can sometimes
lead to serious complications.
Contents of this article:
Causes
Symptoms
Risk factors
Diagnosis
Treatments
Complications
Prevention
Fast facts on scarlet fever
Here are some key points about scarlet fever. More detail and supporting information is in the

main article.
Scarlet fever is less common than it was in the past; however, outbreaks do occur
The bacteria that causes strep throat is also responsible for scarlet fever
The condition can be successfully treated with antibiotics
The primary symptoms are rash, sore throat, and fever
Causes of scarlet fever
A young girl feeling ill
Scarlet fever is more common in children aged from 5-15.
Scarlet fever is caused by the bacterium Streptococcus pyogenes, or group A beta-hemolytic
streptococcus. This is the same bacterium that causes strep throat.
When the bacteria release toxins, scarlet fever symptoms occur.
Scarlet fever transmits from human-to-human by fluids from the mouth and nose. When an
infected individual coughs or sneezes, the bacteria become airborne in droplets of water and can
be inhaled.
The bacteria can land on surfaces, such as drinking glasses, work surfaces, and doorknobs, and
infect people who touch them with their hands and then touch their own nose or mouth. The
bacteria may also be inhaled.
If someone touches the skin of an individual with a streptococcal skin infection, there is a risk of
becoming infected. People who share towels, baths, clothes, or bed linen with an infected person
are at risk.
A person with scarlet fever who is not treated may be contagious for several weeks, even after
symptoms have gone. Additionally, some individuals can carry the infection and be contagious,
without ever showing any symptoms - only people who are susceptible to the toxins released by
streptococcal bacteria develop symptoms.
These factors make it harder for individuals to know whether they have been exposed.
Although much less common, people may become infected by touching or consuming
contaminated food, especially milk.
Symptoms of scarlet fever
Signs and symptoms generally appear about 1-4 days after initial infection. The first symptoms of
scarlet fever are usually:
A very sore and red throat (sometimes with white or yellowish patches).
A fever of 101 Fahrenheit (38.3 Celsius) or higher, frequently with chills. 12-48 hours later, the
rash will appear.
Rash - red blotches appear on the skin; they then turn into a fine pink-red rash that looks like
sunburn. The skin feels rough like sandpaper when touched.

The rash spreads to the ears, neck, elbows, inner thighs and groin, chest, and some other parts of
the body. Although the rash does not usually appear on the face, the patient's cheeks will become
flushed, and the area around their mouth becomes pale.
If a glass is pressed on the skin, the rash will turn white (blanche).
After about 6 days, the rash usually fades. In milder cases, such as scarlatina, the rash may be the
only symptom.
Other potential symptoms of scarlet fever include:
[Man with serious stomach problem]
Stomachache is a common symptom of scarlet fever.
Difficulty swallowing
General malaise
Headache
Itching
Loss of appetite
Nausea
Pastia's lines - broken blood vessels in the folds of the body, for example, the armpits, groin,
elbows, knees, and neck
Stomachache
Swollen neck glands (lymph nodes) that are tender to the touch
A white coating forms on the tongue - this eventually peels away leaving a strawberry tongue; the
tongue is red and swollen
Vomiting
If the patient has other symptoms, such as severe muscle aches, vomiting, or diarrhea, the doctor
will need to rule out other possible causes, such as toxic shock syndrome.
The skin of the hands and feet will peel for up to 6 weeks after the rash has gone.
Risk factors for scarlet fever
Children aged 5-15 have a higher risk of developing scarlet fever compared with other age groups.
Around 80 percent of cases occur in children under 10.
Close contact - the strep bacteria can spread more easily among people in close contact, for
instance at school, home, or work.
Diagnosing scarlet fever
The characteristic rash and symptoms usually make it fairly easy for a doctor to diagnose scarlet
fever. The doctor may take a throat swab to determine which bacteria caused the infection.
Sometimes a blood test is also ordered.
In a rapid DNA test, a throat swab is taken. Results are returned in less than 24 hours.
Treatments for scarlet fever

The majority of mild cases of scarlet fever resolve themselves within a week without treatment,
but it is important to get treatment as this will accelerate recovery and reduce the risk of
complications. Patients generally recover about 4-5 days after treatment begins.
Antibiotics - a 10-day course of antibiotics is the most common treatment for scarlet fever. This
normally involves taking oral penicillin. Patients who are allergic to penicillin may take
erythromycin instead. Patients are advised to stay at home during the course of the antibiotic
treatment.
The fever will usually go within 12-24 hours of taking the first antibiotic medication.
A child with scarlet fever may be prescribed one of the following antibiotics:
Penicillin, in pill form or by injection
Amoxicillin (Amoxil, Trimox)
Azithromycin (Zithromax)
Clarithromycin (Biaxin)
Clindamycin (Cleocin)
A cephalosporin such as cephalexin (Keflex)
It is important to take the full course of antibiotics, even if symptoms go away before it is finished.
Otherwise, the infection may not be completely eradicated, raising the risk of subsequent poststrep disorders.
If the patient does not start feeling better within 24-48 hours after starting the antibiotic treatment,
a doctor should be called.
Within 24 hours of starting the antibiotics, the patient will no longer be contagious.
How to soothe scarlet fever at home
Although a visit to the doctors is essential, there are some ways to soothe symptoms at home. It is
important to drink plenty of liquids, especially if there is no appetite, and the environment should
be kept cool.
Tylenol (acetaminophen) may help relieve aches and pains, as well as bringing the fever down.
Calamine lotion can help with itchy skin.
Possible complications of scarlet fever
In the majority of cases, there are no complications; however, the following can occur:
Ear infection, including otitis media.
Pneumonia.
Throat abscess - a pus-filled sac in the throat.
Sinusitis.

Inflammation of the kidney(s) - post-streptococcal glomerulonephritis, resulting from certain

immune responses to strep bacteria. In some cases, there may be long-term kidney disease.
Rheumatic fever.
Some skin infections.
The following complications are possible, but very rare:
Acute kidney (renal) failure.
Meningitis - inflammation of the membranes that surround the brain and spinal cord.
Necrotizing fasciitis - commonly known as flesh-eating disease.
Toxic shock syndrome.
Endocarditis - infection of the heart's inner lining.
Infection of the bone and bone marrow (osteomyelitis).
PANDAS (Pediatric autoimmune neuropsychiatric disorders associated with streptococcal
infections) - some research has indicated that strep bacterial infection may trigger an autoimmune
response that exacerbates symptoms of certain childhood disorders, such as OCD (obsessivecompulsive disorder), Tourette syndrome, and ADHD (attention deficit hyperactivity disorder).
The increase in symptoms does not usually last for more than a few weeks or months.
Preventing scarlet fever
The best prevention strategies for scarlet fever, as with all highly infectious diseases, are:
Isolation - keep the patient away from other people. Keep the child away from school.
Handkerchiefs or tissues that the patient has used should be washed or disposed of immediately. If
you have touched any of these wash your hands thoroughly with warm water and soap.
Handwashing - the patient, usually a child, should be taught to wash their hands thoroughly and
frequently.
Dining utensils - do not share drinking glasses or eating utensils with the patient.
Coughing and sneezing - the patient should be taught to cover their mouth and nose when
coughing and sneezing. This should be done into a tissue or handkerchief. If one is not available, it
is better to cough or sneeze into the inside of the elbow - coughing into one's hands raises the risk
of contaminating things when they are touched.
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Additional informationReferencesCitations
Article last updated on Wed 23 November 2016.
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