Scarlet fever (Scarlatina)

Scarlet fever (Scarlatina)

There is an important chapter in this website on Group A Streptococcus which focuses on a throat infection from this common bacteria (here is the link).

However, sometimes the same sore throat will be accompanied by a typical rash which the physician will diagnose as Scarlet fever (scarlatina).

What causes scarlet fever?

Scarlet fever is caused by streptococcus pyogenes bacterium infection (streptococcus A). Usually the infection in children is in the throat.

What determines if this is a simple throat infection or scarlet fever? The types of the Strep’. Some of which secretes specific toxins that cause scarlet.

The disease is prevalent in young children who do not have immunity to these toxins.

What are scarlet fever symptoms that can be found in a physical examination?

Usually high fever combined with pain when swallowing. In addition:
Red lips and strawberry red tongue.
A rash that usually begins in the upper body and spreads out to the limbs. The rash is often simulated to sandpaper as it is very easy to feel. See the first photo.
Brightness around the mouth and red cheeks (see the second photo).
Pastia lines (red streaks) – can be found in folds of skin, mostly around the inside of the elbows and armpits.
Since most cases are caused by streptococcus in the pharynx, it is possible to see red tonsils with exudate in a throat examination.

Perioral pallor

What not to miss when seeing a child with scarlet fever?

There are several diseases in pediatric medicine with symptoms such as fever and rash, which are sometimes similar to scarlet fever rash.
Some are significant diseases including Kawasaki (read more here) or toxic shock syndrome. Therefore, the examining physician should be confident they are treating a child with scarlet and not another disease.

What is the treatment in scarlet fever in children and adults?

The treatment is in fact the same as anyone would have received if he had not had the typical scarlet fever rash. Meaning, in case of a throat infection the treatment is Amoxicillin for 10 days as usual.
A diagnosis of scarlet fever in a child with a sore throat does not change the treatment beyond the usual treatment.
The disease is not expected to be much more severe than regular streptococcus throat infection.
In case the doctor does not identify the primary site where the strep is “hiding”, I recommend to be convinced this is a case of scarlet fever and not something similar, often more significant.

Should a throat swab be taken in case of scarlet fever and throat infection?

I always recommend taking a throat swab before starting antibiotic treatment, even in typical cases.

What might happen after recovering from scarlet fever?

After a few days / weeks there might be peeling of the skin similar to skin peel after suntanning. Such peeling can be found also in the tip of the fingers.

How many times can a child get scarlet fever?

Up to 3 times, which is the number of toxins the bacterium can secrete.

So what did we learn about scarlet fever?

We learned that scarlet fever is a type of infection caused by specific group A streptococcus. In case the diagnosis is straight forward, there is no reason to be alert. There is only need for a proper treatment which is usually simple.

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