Scarlet fever

August, 10th, 2023

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Scarlet fever is a bacterial illness that develops in some people who have strep throat. Also known as scarlatina, scarlet fever features a bright red rash that covers most of the body. Scarlet fever almost always includes a sore throat and a high fever.

Scarlet fever is most common in children 5 to 15 years of age. Although scarlet fever was once considered a serious childhood illness, antibiotic treatments have made it less threatening. Still, if left untreated, scarlet fever can result in more-serious conditions that affect the heart, kidneys and other parts of the body.

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The signs and symptoms that give scarlet fever its name include:

• Red rash. The rash looks like a sunburn and feels like sandpaper. It typically begins on the face or neck and spreads to the trunk, arms and legs. Pushing on the reddened skin makes it turn pale.
• Red lines. The folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the other areas with the rash.
• Flushed face. The face may appear flushed with a pale ring around the mouth.
• Strawberry tongue. The tongue generally looks red and bumpy, and it’s often covered with a white coating early in the disease.

Signs and symptoms of scarlet fever also include:

• Fever of 100.4 F (38.0 C) or higher, often with chills
• Very sore and red throat, sometimes with white or yellowish patches
• Difficulty swallowing
• Enlarged glands in the neck (lymph nodes) that are tender to the touch
• Nausea or vomiting
• Belly (abdominal) pain
• Headache and body aches

The rash and the redness in the face and tongue usually last about a week. After these signs and symptoms have gone away, the skin affected by the rash often peels.

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When to see a doctor

Talk to your health care provider if your child has a sore throat with:

• A fever of 100.4 F (38.0 C) or higher
• Swollen or tender glands in the neck
• A red rash

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Signs and symptoms that need emergency evaluation

In children and teens, any of the following symptoms need emergency evaluation:

• New shortness of breath at rest
• Trouble breathing (grunting, pulling-in chest muscles between the ribs, nostril flaring)
• Noisy, wheezy or raspy breathing that does not clear with coughing
• Rapid breathing
• Chest pain
• Inability to swallow liquids or saliva, muffled voice, or inability to open mouth fully
• Confusion, lack of energy, or inability to stay alert and awake
• Dizziness when sitting or standing
• Drooling (if age 3 years or older)
• Persistent or severe vomiting or diarrhea
• Dehydration

For infants less than 2 months old, additional symptoms needing emergency evaluation include:

• Inability to be comforted
• Breathing that repeatedly starts and stops
• Temperature less than 96.0 F (35.5 C) or greater than 100.4 F (38 C)

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Causes

Scarlet fever is caused by the same type of bacteria that causes strep throat — group A streptococcus (strep-toe-KOK-us), also called group A strep. In scarlet fever, the bacteria release a toxin that produces the rash and red tongue.

The infection spreads from person to person by droplets released when an infected person coughs or sneezes. The incubation period — the time between exposure and illness — is usually 2 to 4 days.

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Risk factors

Children 5 to 15 years of age are more likely than are other people to get scarlet fever. Scarlet fever germs spread more easily among people in close contact, such as family members, child-care groups or classmates.

Scarlet fever most often occurs after a strep throat infection. Sometimes scarlet fever may occur after a skin infection, such as impetigo. People can get scarlet fever more than once.

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Complications

If scarlet fever goes untreated, the bacteria may spread to the:

• Tonsils
• Skin
• Blood
• Middle ear
• Sinuses
• Lungs
• Heart
• Kidneys
• Joints
• Muscles

Rarely, scarlet fever can lead to rheumatic fever, a serious inflammatory disease that can affect the heart, joints, nervous system and skin.

A possible relationship has been suggested between strep infection and a rare condition called pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS). Children with this condition experience worsened symptoms of neuropsychiatric conditions, such as obsessive-compulsive disorder or tic disorders, with strep. This relationship currently remains unproved and controversial.

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Prevention

There is no vaccine to prevent scarlet fever. The best ways to prevent scarlet fever are the same as the standard precautions against infections:

• Wash your hands. Show your child how to wash hands thoroughly with warm soapy water for at least 20 seconds. Alcohol-based hand sanitizer can be used if soap and water are not available.
• Don’t share dining utensils or food. As a rule, your child shouldn’t share drinking glasses or eating utensils with friends or classmates. This rule applies to sharing food, too.
• Cover your mouth and nose. Tell your child to cover the mouth and nose when coughing and sneezing to prevent the potential spread of germs.

If your child has scarlet fever, wash drinking glasses and utensils in hot soapy water or in a dishwasher after your child uses them.

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Diagnosis

During the physical exam, your health care provider will:

• Look at the condition of your child’s throat, tonsils and tongue
• Feel your child’s neck to determine if lymph nodes are enlarged
• Assess the appearance and texture of the rash

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Throat swab

If your health care provider suspects strep is the cause of your child’s illness, your provider will swab the tonsils and back of your child’s throat to collect material that may have the strep bacteria.

A rapid strep test can identify the bacteria quickly, usually during your child’s appointment. If the rapid test is negative, but your health care provider still thinks strep bacteria is the cause of your child’s illness, a strep throat culture can be done. It can take longer to get the results of this test.

Tests for the strep bacteria are important because a number of conditions can cause the signs and symptoms of scarlet fever, and these illnesses may require different treatments. If there are no strep bacteria, then some other factor is causing the illness.

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Treatment

For scarlet fever, your health care provider will prescribe an antibiotic. Make sure your child takes all of the medication as directed. If your child doesn’t follow the treatment guidelines, treatment may not completely eliminate the infection, which can increase your child’s risk of developing complications.

Use ibuprofen (Advil, Children’s Motrin, others) or acetaminophen (Tylenol, others) to control the fever and minimize throat pain. Check with your child’s health care provider about the right dosage.

Your child can return to school after having taken antibiotics for at least 12 hours and no longer having a fever.

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Self care

During scarlet fever, you can take several steps to reduce your child’s discomfort and pain.

• Plan plenty of rest. Sleep helps the body fight infection. Have your child rest until feeling better. Also, keep your child at home until there’s no sign of fever and antibiotics have been taken for at least 12 hours.
• Encourage plenty of water. Keeping a sore throat lubricated and moist eases swallowing and helps prevent dehydration.
• Prepare a saltwater gargle. For older children and adults, gargling several times a day can help relieve throat pain. Mix 1/4 teaspoon (1.5 grams) of table salt in 8 ounces (237 milliliters) of warm water. Be sure to tell your child to spit out the liquid after gargling.
• Humidify the air. Adding moisture to the air can help ease discomfort. Choose a cool-mist humidifier and clean it daily because bacteria and molds can flourish in some humidifiers. Saline nasal sprays also help keep mucous membranes moist.
• Offer honey. Honey can be used to soothe sore throats. Don’t give honey to children younger than 12 months.
• Offer soothing foods. Easy-to-swallow foods include soups, applesauce, cooked cereal, mashed potatoes, soft fruits, yogurt and soft-cooked eggs. You can puree foods in a blender to make them easier to swallow. Cold foods, such as sherbet, frozen yogurt or frozen fruit pops, and warm liquids, such as broth, may be soothing. Avoid spicy foods or acidic foods such as orange juice.
• Avoid irritants. Cigarette smoke can irritate a sore throat. Also avoid fumes from substances that can irritate the throat and lungs. These substances can include paint, cleaning products, incense and essential oils.

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Preparing for your appointment

You’re likely to first see your family health care provider or your child’s pediatrician. However, when you call to set up your appointment, you may be urged to seek immediate medical care.

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What you can do

Before your appointment, you might want to make a list of questions for the health care provider. These may include:

• How soon after starting treatment will my child begin to feel better?
• Is my child at risk of any long-term complications related to scarlet fever?
• Is there anything I can do to help soothe my child’s skin while it heals?
• When can my child return to school?
• Is my child contagious? How can I reduce my child’s risk of passing the illness to others?
• Is there a generic alternative to the medicine you’re prescribing? What if my child is allergic to penicillin?

Don’t hesitate to ask additional questions during your appointment.

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What to expect from your doctor

Your health care provider is likely to ask you a number of questions. Your provider may ask:

• When did your child begin experiencing symptoms?
• Has your child had a sore throat or difficulty swallowing?
• Has your child had a fever? How high was the fever, and how long did it last?
• Has your child had abdominal pain or vomiting?
• Has your child been eating adequately?
• Has your child complained of headache?
• Has your child recently had a strep infection?
• Has your child recently been exposed to anyone with a strep infection?
• Has your child been diagnosed with any other medical conditions?
• Is your child currently taking any medications?
• Does your child have medication allergies?

Being ready to answer questions may reserve time to go over any points you want to talk about in-depth.