The main cause of scarlet fever is infection with group A streptococci bacteria.
The main cause of scarlet fever is infection with group A streptococci bacteria.

The main cause of scarlet fever is an infection with group A streptococci (group A strep) bacteria. While infecting a body site, it can produce an erythrogenic (producing a red-colored) toxin. This toxin is responsible for causing the sandpaper-like red-colored skin rash and fever:

  • The bacteria usually infect the throat (‘strep throat’) or skin (‘school sores’). The bacteria then release toxins that cause swelling of the skin and lead to the development of the rash.
  • This bacterium is usually found in the saliva and mucus of an infected person. When they cough, sneeze or talk, small droplets containing the bacteria are spread through the air and maybe breathed in by nearby people. It may also follow a respiratory tract infection.
  • Scarlet fever can also be linked to burns or wounds that become infected.
  • Only a very small number of people infected with group A strep will develop scarlet fever
  • If an individual develops scarlet fever, it usually takes 2-5 days for the symptoms to start after you get infected.
  • The infection is often passed between classmates at school or family members who are in close contact with each other. It's most often spread by contact with the droplets emitted when an infected person coughs or sneezes. It can even be spread if a person touches something like a plate or glass on which these droplets have landed.

What is scarlet fever?

Scarlet fever is a bacterial infection. The distinctive feature of scarlet fever is a sore throat followed by a rash made up of tiny pinkish-red spots that cover the whole body. Scarlet fever occurs mostly in children aged 4-8 years. By 10 years old, up to 80% of children may have developed lifelong protective antibodies against bacterial toxins. The symptoms include:

  • A sore throat that may have white or yellow patches
  • Fever of 101 degrees Fahrenheit or higher, often with chills
  • A whitish coating on the surface of the tongue. The tongue may look like a strawberry.
  • A rash first appearing as tiny red bumps on the chest and abdomen. The rash may then spread over the body, lasting about two to five days. After the rash, often the skin on the tips of the fingers and toes will peel.
  • Flushed face with a pale area around the lips.
  • Swollen glands in the neck.
  • Weakness
  • Headache

What are the common treatment options for scarlet fever?

As scarlet fever is caused by bacteria, once the infection is confirmed, a course of antibiotics may be prescribed, usually penicillin, for up to 10 days. In some situations, a single dose of penicillin may be given by intramuscular injection. Patients allergic to penicillin may be treated with an alternative antibiotic, such as erythromycin. The patients must be instructed to complete the course of antibiotics irrespective of the healing of symptoms. Hygiene practices like hand wash, using separate towels, and sheets must be stressed upon.

Other common treatments include:

  • Paracetamol when necessary for fever, headache, or throat pain.
  • Eating soft foods and drinking plenty of cool liquids, particularly if the throat is very painful.
  • Oral antihistamines and emollients to relieve the itch of rash.
  • Fingernails may be required to be short on young children to prevent them from damaging the skin due to itching.
  • The fever usually improves within 12-24 hours after starting antibiotics and most patients recover after 4-5 days with the clearing of skin symptoms over several weeks.

However, if left untreated, scarlet fever can lead to kidney diseases, ear infections, pneumonia, and arthritis. It is very important that you complete the entire antibiotic course.

When and for how long is a person able to spread the scarlet disease?

If scarlet disease or fever is left untreated, people can spread the bacteria for 10 to 21 days; in some cases, they may spread the bacteria for weeks or months. If treated, the ability to spread the illness to others usually ends after 24 hours.

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Medically Reviewed on 9/4/2020
References
Scarlet fever: (https://dermnetnz.org/topics/scarlet-fever/)