What is scarlet fever?
Scarlet fever is caused by the same streptococcal bacteria in the pharynx which also cause tonsilitis. If antibiotics are not administered, the bacteria multiply, and produce toxins which enter the blood stream, and cause an infection, following an incubation period of 1 to 7 days. It usually affects children from 3 to 10 years of age.
How is it transmitted?
Transmission occurs from person to person through the secretions of the mouth. Two siblings may become infected by the same streptococcus bacteria, one of them may present with scarlet fever, and the other may not.
How does it manifest?
Scarlet fever symptoms vary from person to person. On the first day, the child has a high fever (which can reach 40 C), redness, and a sore throat. The child may also have a headache, stomachache, and vomiting.
Next, a bright red or purple rash appears on the child’s face, covering the whole face, except for the area around the mouth. The rash is also intense in the armpits and the groin area. Then, the rash, which can cause itching, spreads to the rest of the trunk and to the arms and legs of the child. In the meantime, the child’s temperature begins to fall, and his tongue acquires a bright red color. By the sixth day the rash subsides, and the skin may start peeling, mainly on the hands, arms and legs. The peeling may last another 10-14 days.
How is the diagnosis made?
A diagnosis is made from the history and the clinical picture of the child. The paediatrician can test the secretions of the throat with a special cotton swab.
What are the risks?
The two main, but rare risks, are rheumatic fever and a form of glomerulonephritis, (kidney damage). These may appear about 2-3 weeks after the onset of the rash.
How is scarlet fever treated?
Inform your paediatrician, who will probably prescribe an antibiotic for 10 days. It is important to follow the treatment for the full 10 days. Older children may be given an antiseptic mouthwash. Most children recover fully without consequences.
Staying at home, drinking plenty of fluids, thorough washing of the hands, rest if needed, and antipyretics are usually sufficient measures.
Don’t send the child to school/nursery school until he has taken antibiotics for at least 24-48 hours and has become apyrexial.
Stelios Papaventsis Paediatrician ΜRCPCH DCH 2010