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Scarlet Fever on Children

Scarlet Fever is an infectious bacterial childhood disease characterized by a skin rash, sore throat, and fever. It is much less common and dangerous than it once was. No longer a reportable disease, no one knows for sure how many cases occur today in the United States, although it is believed that the disease has been on the increase in the past few years.

In the past the disease was associated with poor living conditions that once swept through large cities, killing large numbers of children. Inexplicably, by the 1920s the death rate of the disease dropped to 5 percent, for reasons that are still not completely understood. It is believed that the bacteria underwent a natural mutation
that made it less deadly.

The introduction of penicillin reduced the death rate even more. Today most cases occur in middle-class suburbs, not in inner cities. Because it is possible to get strep infection and scarlet fever more than once, and because the incidence of all strep infections is rising, prompt medical attention is important when strep is suspected. A child with a sore throat or skin rash should see a doctor.

What causes Scarlet Fever?

Scarlet fever is caused by an infection with group A Streptococcus. Scarlet fever strains of the bacteria produce toxins that are released in the skin, causing a bright red rash that feels a bit like sandpaper. The disease is spread in droplets during coughing or breathing, or by sharing food and drink. When bacteria particles are released into the air, they can be picked up by others close by. For this reason, some experts advise children to avoid drinking fountains.

Scarlet Fever Symptoms

After an incubation period of two to four days, the first signs of illness are usually a fever of 103°F and a severe sore throat. This is followed by fatigue, facial flushing, and a white tongue coating with red spots. Twelve to 18 hours after the fever appears, a rash appears as a mass of rapidly spreading tiny red spots on the neck and upper trunk. Other common symptoms include headache, chills, vomiting, tiny white lines around the mouth, fine red striations in the creases of the elbows and groin. After a few days, the tongue coating peels off, followed by a drop in fever and fading rash. Skin on the hands and feet often peel as well.

Complications of Scarlet Fever

As with other types of sore throat caused by the strep bacteria, untreated infection carries the risk of rheumatic fever or kidney inflammation.

Scarlet Fever Treatment

A 10-day course of antibiotics with rest, liquids, and acetaminophen is used to treat scarlet fever. Children are contagious for a day or two after they begin antibiotic treatment, but after that they can return to school. Alternative treatment is a shot of long-acting penicillin, which slowly releases the antibiotic over several weeks. Anyone can develop scarlet fever, but most cases occur among children aged four to eight.