Scarlet Fever

Scarlet Fever A disease caused by an infection with group A B-hemolytic streptococcal bacteria that occurs in a small percentage of people with strep throat. When we hear the words “Scarlet Fever” we often tend to think of a deadly disease that doctors have no cure from. But it is quite the contrary, scarlet fever is just a serious case of strep throat and the medication prescribed by doctors, cures within days. But the symptoms unfortunately are not very pleasant and having Scarlet Fever is not just a walk in the park. After reading up on the disease hopefully the importance of prevention and symptoms will be understood and no more cases of Scarlet Fever will creep up. Scarlet fever was once a common, that usually affects children between the ages of two and ten, disease but now is easily treatable.

The organism usuallly enters the body through the mouth or nose. It is generally transmitted from person to person by direct contact. That is, from the sprays of a sneeze from an infected person, or by any indirect contact through door handles previously touched by an infected person. The bacteria produces a toxin that causes a rash that initially appears on the neck and chest, then spreads over the body. The rash of scarlet fever usually begins like a bad sunburn with tiny bumps (papules), and it may itch.

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The rash usually appears on the second day of a Group A streptococcal throat infection, and the incubation period for Group A strep throat is usually 2-7 days after exposure. Typically the rash begins as small red macules which gradually become elevated. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks called Pastia’s lines. Areas of rash usually blanch (turn white) when you press on them.

By the sixth day of a strep infection the rash usually fades, but the affected skin may begin to peel. As the rash fades, peeling (desquamation) may occur around the finger tips, toes, and groin area. This peeling may last up to ten days. Risk factors are strep throat infection, although less than 50% of the patient’s who develop scarlet fever have a history of a sore throat. Not all streptococci produce this toxin and not all persons are sensitive to it.

Two children in the same family may both have strep infections, but one (who is sensitive to the toxin) may have the rash of scarlet fever and the other may not. Prevention is the early treatment of strep throat. Bacteria are spread by direct contact with infected persons or by droplets exhaled by an infected person. Avoid contact with infected persons. In everyday life, there is no perfect way to avoid the strep infections that cause scarlet fever.

At home, when someone is sick with a strep throat, it’s always safest to keep drinking glasses and eating utensils separate from those of other family members, and to wash these items thoroughly in very hot soapy water. Use antibacterial soap if possible. Wash your own hands frequently as you care for a child with a strep infection. Symptoms sore throat fever Vomiting Loss of appetite rash on neck and chest small red macules that become elevated fading in about 3 days to leave a rough “sandpaper” feel to the skin peeling (desquamation) of the finger tips, toes, and groin swollen, red tongue (strawberry tongue) Pastia’s lines (bright red colour in the underarm and groin creases) Chills Tonsils swell and form a white coating headache generalized discomfort From two to three days after the first appearance of symptoms, red spots may appear on the palate; bright red papilla emerge on the tongue, giving it the well known description of strawberry tongue. A characteristic skin eruption appears on the chest and usually spreads all over the body except the face.

This rash fades on pressure. The fever can run as 40 to 40.6 degrees Celsius (104 to 105 F) generally lasts only a few days but has the ability to remain for a week. The rash fades within a week or so, and at that time the skin begins to peel. Estimates are that in a home where someone already has a strep throat infection, about one out of every four family members will get it too. There are also cases where persons, especially children, can be carriers of strep bacteria without having any symptoms. Among school-aged children, 15-20 percent may be asymptomatic carriers of strep bacteria.

Treatment Signs and Tests physical examination throat culture positive for Group A Strep This disease may also alter the results of the following tests: febrile/cold agglutinins ASO The objective of therapy is to treat the infection with antibiotics (usually penicillin), and relieve symptoms with analgesics, rest, and plenty of fluids. This is usually not a serious illness when treated and lasts a week or less. Call your health care provider if symptoms of scarlet fever develop, or if symptoms do not subside 24 hours after treatment starts. Very rarely does the bacteria spread to other parts of the body, if treated. If its does, the result may be ear infections, sinusitis, rheumatic fever or acute glomerulonephritis.

Scarlet fever may be complicated by an infection of the middle ear mastoids or sinuses, or even by pneumonia. Occasionally, inflammation of the kidneys may develop after scarlet fever. Since the introduction of penicillin, most instances of scarlet fever can be cured without any permanent after-effects. If your doctor suspects that your child has scarlet fever due to a strep throat infection, he or she will usually take a throat culture (a painless swab of throat secretions) to see if Group A streptococcal bacteria grow in the laboratory. If they do grow, this will confirm that a Group A strep throat infection is the cause of your child’s scarlet fever rash. It will also be the basis for your doctor’s ordering a full course of antibiotic treatment.

In addition to the throat culture, some doctors also use an “instant” strep test that can confirm a strep infection. Once a strep infection is confirmed, it is treated with penicillin or another antibiotic that may either be injected or taken by mouth. Since the risk of allergic reactions may be lower when oral medication is given, many doctors prefer to give an antibiotic prescription to be taken at home. They depend on the patient’s parents and caregivers to make sure that the full course of antibiotics is taken – and this usually means up to 10 days of medicine at home. Your doctor may also prescribe medicines to care for the scarlet fever rash itself, or suggest over-the-counter brands that you can purchase in your drugstore or supermarket. Within 10 to 30 minutes during your office visit. This test is also taken from a painless throat swab.

Possible Complications Without Treatment: Rheumatic fever. Impaired hearing. Glomerulonephritis. Meningitis. Pneumonia. Encephalitis.

It is very clear that Scarlet Fever is usually not life threatening, but it is very hard on our bodies. The symptoms are very stressful and uncomfortable. It wears the body down and weakens it tremendously. But if the virus is caught quick enough then, no more than a strep throat will occur. And so, the prevention is key in the fight against strep throat.

So be sure to see your doctor if you get anything more than a tickle in your throat and watch out for the famous rash and your sure to stay healthy! Bibliography “Scarlet Fever”, Britannica”, Encyclopaedia, New York, 1996 “Scarlet Fever”, World Book” Encyclopaedia, New York, 1999 “Scarlet Fever”, Junior Encyclopaedia Of Canada, pg. 43, Toronto, 1989 www2.adam.com, “Diseases & Conditions” www.health.yahoo.com/health, “Health Research”, www.kidshealth.org, “Childhood Infections”.