14 Dec 2024

Scarlet Fever: A Comprehensive Guide

Introduction

Scarlet fever, also known as scarlatina, is a bacterial infection particularly affecting those with strep throat. It is characterised by bright red rashes covering most of the body. The condition is serious for children, though antibiotic treatments can effectively reduce associated health risks.

What is Scarlet Fever?

Scarlet fever is a bacterial infection resulting from group A Streptococcus bacteria contamination. This bacterium, responsible for strep throat, contains a toxin producing bright red rashes across the body, hence the name.

The rashes may appear bumpy and begin at the head and neck, gradually spreading to the chest, arms and legs. This contagious infection particularly affects young children, though antibiotics offer effective treatment.

Causes

The primary cause is group A beta-haemolytic Streptococcus bacteria, which also causes strep throat and can lead to rheumatic fever. Transmission occurs through toxin spread between individuals, with an incubation period of 2 to 4 days.

The bacteria reside in the nose, throat, ears and skin. Transmission typically occurs through:

• Inhalation of infected respiratory droplets
• Contact with contaminated surfaces followed by mouth/nose touching
• Sharing utensils with infected individuals
• Contact with bacterially infected skin sores

Streptococcus contamination rarely occurs through improperly handled food.

Symptoms

Primary Symptoms

• Fever
• Sore throat
• Red, bumpy rashes

Rash Characteristics

• Initially appears on head, neck and chest
• Spreads to face, arms, legs and back
• Causes perioral pallor (pale area around mouth)
• Creates small red/purple bumps in skin folds
• Causes pronounced groin redness
• Results in skin peeling for 7-10 days post-rash

Oral/Throat Symptoms

• White tongue coating
• Red, swollen 'strawberry tongue'
• Flushed face with pale ring around mouth
• Inflamed throat and tonsils
• Yellow/white tonsillar coating
• Dysphagia (difficulty swallowing)

Additional Symptoms

• High temperature
• Chills
• Nausea/vomiting
• Abdominal pain
• Myalgia (muscle pain)
• Headache
• Reduced appetite
• Swollen lymph nodes
• Palatal petechiae (purple/red spots on mouth roof)

Scarlet Fever Tongue

A characteristic 'strawberry tongue' develops - red, swollen and bumpy in appearance.

Rash Identification

The rash initially presents as tiny, flat splotches before developing into fine bumps resembling sunburn. The texture often feels like sandpaper.

Transmission and Risk Groups

• Highly contagious through respiratory droplets
• Most common in children aged 5-15
• Adults in frequent contact with affected children face increased risk
• Children under 5 typically less affected
• Higher transmission rates in communal settings (schools, nurseries)

Diagnosis

Healthcare providers will:

• 1. Conduct physical examination
• 2. Perform rapid strep test
• 3. Collect throat swabs
• 4. Consider throat culture if rapid test is negative

Treatment

Primary treatment involves antibiotics to:

• Reduce bacterial load
• Alleviate symptoms
• Prevent transmission

Prevention

• Avoid contact with infected individuals
• Practice proper hand hygiene (20-second washing)
• Use alcohol-based hand sanitiser
• Cover mouth/nose when coughing/sneezing
• Isolate personal items of infected individuals
• Self-isolate to prevent transmission

Self-Care Measures

• Consume cool fluids
• Eat soft foods
• Use appropriate over-the-counter medicines
• Apply anti-itch treatments as needed

Duration

Typically lasts one week with antibiotic treatment, though skin peeling and gland swelling may persist longer.

Complications

Rare complications include:

• Lymphadenopathy
• Tonsillar abscess
• Mastoiditis
• Otitis media
• Pneumonia
• Sinusitis
• Nephritis
• Rheumatic fever
• Osteomyelitis
• Septicaemia
• Meningitis
• Dermatological infections
• PANDAS
• Obsessive-compulsive disorder

Pregnancy Considerations

Whilst no direct evidence suggests foetal risk, pregnant women should:

• Avoid contact with infected individuals
• Consult healthcare providers before taking medications

When to Seek Medical Care

Consult a healthcare professional:

• Upon initial symptom presentation
• If no improvement occurs within 24 hours of treatment
• If symptoms worsen during treatment

Key Points

Prompt treatment is essential for this serious childhood illness. Seek professional medical advice for fever, red rashes, or sore throat symptoms.