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An acute exanthematous disease, caused by infection with streptococcal organisms producing erythrogenic toxin, marked by fever and other constitutional disturbances, and a generalized eruption of closely aggregated points or small macules of a bright red color followed by desquamation in large scales, shreds, or sheets; mucous membrane of the mouth and fauces is usually also involved. Syn: Scarlatina.

Alternative Name: Scarlatina, strep rash.

Terminology related with scarlet fever:

    Anginose scarlatina.

  • Scarlatina hemorrhagica.

  • Scarlatina latens.

  • Scarlatina maligna.

  • Scarlatina rheumatica.

  • Scarlatina simplex.

In the past century, the number of cases of scarlet fever has remained high, with marked decrease in case-mortality rates secondary to widespread use of antibiotics. Transmission usually occurs via airborne respiratory particles that can be spread from infected patients and asymptomatic carriers. The infection rate increases in overcrowded situations (eg, schools, institutional settings). Immunity, which is type specific, may be induced by a carrier state or overt infection. In adulthood, incidence decreases markedly as immunity develops to the most prevalent serotypes.

Peak incidence of scarlet fever occurs in children aged 4-8 years. By the time children are 10-years-old, 80% have developed lifelong protective antibodies against streptococcal pyrogenic exotoxins. Scarlet fever is rare in children younger than 2 years because of the presence of maternal antiexotoxin antibodies and lack of prior sensitization.

The incubation period is usually two to four days. If scarlet fever isn’t treated, a person may be contagious for a few weeks even after the illness itself has passed. And someone may carry scarlet fever strep bacteria without being sick. Therefore, it’s difficult to know if you’ve been exposed.

Complications of scarlet fever include infection of the middle ear, sinusitis, and pneumonia. In rare cases, a more serious infection may develop, such as rheumatic fever or rheumatic heart disease. Most cases of scarlet fever can be cured without any permanent complications.


The time between becoming infected and having symptoms is short, generally 1 – 2 days. The illness typically begins with a fever and sore throat.

The rash usually first appears on the neck and chest, then spreads over the body. It is described as "sandpapery" in feel. The texture of the rash is more important than the appearance in confirming the diagnosis. The rash can last for more than a week. As the rash fades, peeling (desquamation) may occur around the fingertips, toes, and groin area.

Other symptoms include:

    Abdominal pain.

  • Bright red color in the creases of the underarm and groin (Pastia’s lines).

  • Chills.

  • Fever.

  • General discomfort (malaise).

  • Headache.

  • Muscle aches.

  • Sore throat.

  • Swollen, red tongue (strawberry tongue).

  • Vomiting

Causes and Risk factors:

A bacterium called Streptococcus pyogenes, or group A beta-hemolytic streptococcus, causes scarlet fever. This is the same bacterial infection that causes strep throat, but the strain of bacteria causing scarlet fever releases toxins that produce the rash, Pastia’s lines, flushed face and red tongue.

Strep bacteria that cause scarlet fever spread from one person to another by fluids from the mouth and nose. If an infected person coughs or sneezes, the bacteria can become airborne, or the bacteria may be present on things the person touches — a drinking glass or a doorknob. If you’re near an infected person, you may inhale airborne bacteria. If you touch something an infected person has touched and then touch your own nose or mouth, you could pick up the bacteria.

Scarlet fever strep bacteria can also contaminate food, especially milk, but this mode of transmission isn’t as common.

Rare causes of scarlet fever are other strains of Streptococcus pyogenes associated with either a skin infection (impetigo) or a uterine infection contracted during childbirth. These cases result in the characteristic fever, rash and other "scarlet" signs and symptoms but not those associated with a throat infection.


Throat culture remains the criterion standard for confirmation of group A streptococcal upper respiratory infection. Throat cultures are approximately 90% sensitive for the presence of group A beta-hemolytic streptococci in the pharynx. However, because a 10-15% carriage rate exists among healthy individuals, the presence of group A beta-hemolytic streptococci is not proof of disease.To maximize sensitivity, proper obtaining of specimens is crucial. Sometime streptococcal antibody tests are used to confirm previous group A streptococcal infection.The most commonly available streptococcal antibody test is the antistreptolysin O test.

Complete blood count: White blood cell (WBC) count in scarlet fever may increase to 12,000-16,000 per mm3, with a differential of up to 95% polymorphonuclear lymphocytes. During the second week, eosinophilia, as high as 20%, can develop.


The goals when treating scarlet fever are:

  • Prevent acute rheumatic fever.

  • Reduce the spread of infection.

  • Prevent suppurative complications.

  • Shorten the course of illness.

Penicillin remains the drug of choice (documented cases of penicillin-resistant group A streptococci infections still do not exist). A first-generation cephalosporin may be an effective alternative, as long as the patient does not have any documented anaphylactic reactions to penicillin. If this is the case, erythromycin can be considered as an alternative.

Home Remedies:

    Treat fever and pain: Consult your doctor about using ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) to control the fever and minimize throat pain. You may also put a lukewarm cloth on your child’s forehead to cool the fever if he or she doesn’t have chills.

  • Provide adequate fluids: Give your child plenty of water to keep the throat moist and prevent dehydration.

  • Prepare a saltwater gargle: If your child is able to gargle water, give him or her salty water to gargle and then spit out. This may ease the throat pain.

  • Humidify the air: Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat.

  • Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat.

  • Provide comforting foods: Warm liquids such as soup and cold treats like popsicles can soothe a sore throat.

  • Avoid irritants: Keep your home free from cigarette smoke and cleaning products that can irritate the throat.

Medicine and medications:

    Penicillin VK (Veetids, Beepen-VK).

  • Penicillin G benzathine (Bicillin L-A).

  • Erythromycin (EES, E-Mycin, Ery-Tab).

Other medications include:

    Amoxicillin (Amoxil, Trimox).

  • Azithromycin (Zithromax).

  • Clarithromycin (Biaxin).

  • Clindamycin (Cleocin).

  • A cephalosporin such as cephalexin (Keflex).

Make sure your child completes the full course of prescribed antibiotics as directed by your doctor, even when your child is feeling better. Failure to follow the treatment guidelines may not completely eradicate the infection and will increase your child’s risk of developing post-strep disorders. If he or she isn’t feeling better within 24 to 48 hours after starting the medication, call your doctor.

Note: The following drugs and medications are in some way related to, or used in the treatment. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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