SCARLET FEVER

DEFINITION

Scarlet fever is an infection caused by a bacterium called Streptococcus (pronounced strep-tuh-KOK-us). The disease is characterized by a sore throat (see sore throat entry), fever, and a sandpaper-like rash on reddened skin. It is primarily a childhood disease. If scarlet fever is not treated, serious complications, including rheumatic fever (a heart disease; see rheumatic fever entry) and inflammation of the kidney, can result.

DESCRIPTION

Scarlet fever gets its name from the appearance of the patient's skin, especially around the cheeks, which becomes red and flushed. Scarlet fever is accompanied by a sore throat, fever, sluggishness, and a raised rash over much of the body.

The fever that accompanies scarlet fever usually lasts only a few days. By the end of two weeks, the disease has usually run its course. At that point, skin begins to peel off. The most dramatic peeling occurs on the palms of the hands and the soles of the feet.

Scarlet fever 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. The incubation period is the time between infection and the first appearance of symptoms. The symptoms of scarlet fever usually last four to ten days.

At one time, scarlet fever was a very common disease, but it has since become quite rare. This is due in part to the availability of antibiotics that are able to kill off the infection. Some scientists believe another reason for the decline is that the organism that causes scarlet fever became weaker.

CAUSES

Scarlet fever is caused by an organism known as Group A streptococcal bacterium. Other organisms of this kind also cause sore throats, skin infections, pneumonia (see pneumonia entry), and serious kidney infections. The bacteria that cause scarlet fever produce a toxin (poison) that causes skin to turn red.

SYMPTOMS

The main symptoms of scarlet fever are fever, lethargy (sluggishness), sore throat, and a bumpy rash that turns white under pressure. The rash first appears on the upper chest then spreads to the neck, abdomen, legs, arms, armpits, and groin. The patient's cheeks become flushed, but the skin around the mouth tends to be pale. The patient usually has a "strawberry tongue." This name comes from the fact that there are inflamed bumps on the tongue on top of a bright red coating.

DIAGNOSIS

Diagnosis of scarlet fever also depends on eliminating other possible diseases with similar symptoms. For example, measles (see measles entry) has many of the same symptoms as scarlet fever. However, a scarlet fever rash looks quite different from a measles rash. Also, scarlet fever is usually accompanied by a sore throat, and measles is not.

Some symptoms of strep throat (see strep throat entry), such as a sore throat and fever, are also similar to those of scarlet fever. But the two diseases are easily distinguished from each other by the appearance of the sandpaper-like rash that is associated with scarlet fever.

Scarlet fever rash is caused by a streptococcal infection. (Reproduced by permission of

Custom Medical Stock Photo

)

A doctor looks for the characteristic rash as well as the "strawberry tongue" (which only appears in children). If questions remain, laboratory tests can be used to make a final determination. Blood tests, for example, can distinguish between a bacterial infection (like scarlet fever) and a viral infection (like strep throat). A throat culture can also be used to do this.

A throat culture consists of a small amount of material taken from the patient's throat. with a cotton swab. The material is then allowed to grow in a warm place overnight before the culture is examined to determine whether the infection is caused by bacteria or a virus.

TREATMENT

Scarlet fever usually clears up on its own within a few days. However, treatment with antibiotics, such as penicillin, may be helpful. Antibiotics are substances derived from bacteria or other organisms that fight the growth of other bacteria or organisms. Antibiotics can reduce the severity of the symptoms, prevent complications, and prevent spreading the disease to others.

Penicillin is the drug of choice for treating scarlet fever. It can be injected or swallowed. For people allergic to penicillin, antibiotics such as erythromycin (pronounced ih-rith-ruh-MIS-in) or clindamycin (pronounced klin-duh-MI-sun) can be used as an alternative. As with all medications, the full course of treatment should be completed even if the patient seems well. Stopping a treatment too soon can result in complications such as rheumatic fever or kidney inflammation.

Bed rest is not necessary with scarlet fever, nor is isolation of the patient. Acetaminophen may be given for fever or relief of pain. Aspirin should not be given to children with fever due to the possibility of developing Reye's syndrome (see Reye's syndrome entry).

PROGNOSIS

Full recovery is expected if the disease is treated promptly with antibiotics. A person who has had scarlet fever can not get the disease again.

PREVENTION

The best method of prevention is to avoid others who have the disease.

FOR MORE INFORMATION

Periodicals

Pellman, Harry. "The Sick Child that Has a Rash." Pediatrics for Parents (July 1995): p. 4–6.

Web sites

"Scarlet Fever." KidsHealth.org. [Online] http://kidshealth.org/parent/common/scarlet_fever.html (accessed on November 2, 1999).