Scarlet Fever (Scarlatina)

Scarlet Fever (Scarlatina)

Defining scarlet fever

A bright red rash that feels a lot like sandpaper could be an indication that either you or your child have contracted an infection, known as scarlet fever. Also known as scarlatina, scarlet fever typically occurs in those who have strep throat.

A group of bacteria, known as streptococcus pyogenes bacteria (group A strep or group A beta-haemolytic streptococcus), also cause strep throat, producing a toxin in the body that ultimately causes a rash breakout on the body (a distinct scarlet coloured rash) and sometimes even a red-dotted tongue. The scarlet fever rash typically resembles sunburn as it begins to develop and progresses to inflamed bumps. It usually develops on the neck, chest, back and stomach and then spreads to the rest of the body. A high fever and sore throat are other key symptoms you may experience if infected with this bacterium.

An infection with scarlet fever is not all that common, but does tend to affect children between the ages of 5 and 15 years more often than adults or babies. A strep throat infection, however, appears to be more prevalent in adults (and children) and researchers are not entirely sure as to why, since the two are caused by the same group of bacteria.

A child that develops a strep throat infection is at higher risk of scarlet fever too. As it is a bacterial illness, burns and wounds that become infected can also develop into scarlet fever. If left untreated, a scarlet fever infection can lead to serious complications affecting the kidneys or heart. It is advisable to have a medical professional assess a rash that develops as soon as possible so as to avoid any potential complications if left too late.

Is scarlet fever contagious?

Streptococcus pyrogenes bacteria causing scarlet fever, can thrive in a person’s nasal passages and mouth. For this reason, an infection is easily transmitted. Scarlet fever can be spread through contact with moisture droplets from an infected person. Contact can be as a result of inhaling airborne droplets from sneezing or coughing, or via touching something that has infected fluids from an infected person on it and then touching one’s own nose, mouth or eyes.

Scarlet fever can also be contracted if you share drinking cups or glasses, as well as eating utensils, such as plates and cutlery. In some cases, touching the skin of an infected person can also lead to the spread of scarlet fever. This makes sharing clothes, bed linen, towels, and even baths a risk for contracting an infection as well.

A person infected with scarlet fever is usually contagious between 2 and 4 days following exposure to the bacteria.

If left untreated, an incubation period (length of time an infected person is contagious) can continue for several weeks, even after symptoms have cleared. Others have been known to carry an infection without ever showing obvious symptoms, but are still able to spread the condition while an infection is active.

Ill child with a high fever laying in bed, and a doctor taking her temperature

Signs and symptoms of scarlet fever

Many who have been infected with scarlet fever typically describe the primary symptom of a rash as one that “looks like sunburn and feels like sandpaper”.

Areas you may first notice a rash developing include the neck, chest, back and stomach. It can quickly begin to spread to the rest of the body, including the folds of skin around the knees, elbows and armpits. You may also note that the pink-red colour begins to deepen and become a scarlet shade (deep red colour that inclines towards orange), particularly in the folds of skin the rash develops into.

A rash can also develop little inflamed bumps on the skin, which gives it the feeling of sandpaper, and typically lasts between 2 and 7 days. The rash can also become itchy. If you press on the inflamed area, skin typically changes colour and becomes white (pale) while pressure is applied. Once treated and the rash begins to clear, affected skin may peel as it heals (for up to 6 weeks), especially around the toes, fingertips and groin areas.

Other than a bright red rash, other symptoms you may experience include:

  • Headaches
  • A high fever (of at least 38.3 degrees Celsius or 101 degrees Fahrenheit, and higher)
  • Body chills
  • A sore throat (which may be accompanied by red and inflamed skin, as well as white and yellow patches)
  • Swollen tonsils and glands (lymph nodes) in the back of the neck (there may also be a white coating on the tonsils and inside of the throat)
  • Difficulty swallowing
  • Nausea and vomiting
  • Abdominal pain (stomach ache)
  • A flushed complexion (face)
  • A pale line of skin surrounding the lips
  • A swollen white tongue (white coating) with red dots or bumps (also known as strawberry tongue)
  • Loss of appetite and general malaise (feeling unwell)

Symptoms will typically become apparent within 1 and 4 days following contact with infected bacteria. You may initially notice a sore throat which looks and feels inflamed. Sometimes white and yellow-ish looking patches can also appear on the throat. Not long after that a fever may develop, followed by a rash on the face, neck, chest, back and stomach.

The rash may then spread around the body, affecting the ears, elbows, inner thighs, groin area (genitals), fingers and toes etc. You will also notice that your face begins to flush but the area of skin around the lips become pale. Once the rash spreads to various folds of skin, red lines develop. These are known as Pastia’s lines (broken blood vessels).

Severe muscle aches, diarrhoea and vomiting along with any other symptoms will need prompt medical assistance, as this could potentially be a sign of another health condition, such as toxic shock syndrome (TSS).

Diagnosing and treating scarlet fever

Doctor examining the ear of a male patient during a physical exam

How is a diagnosis made?

Symptoms experienced are most often mild, but any appearance of rash should be assessed by a medical professional, especially if an infection is bacterial, fungal or viral.

At your consultation, your doctor will conduct a short, but detailed interview regarding your reasons for being there. He or she will assess your symptoms and ask a series of questions to gain an understanding of your medical history, and that of your family, as well as the overall nature of your symptoms.

Some questions that can come up include:

  • When did you first begin experiencing symptoms?
  • What symptoms are you experiencing other than a rash?
  • Have you been finding it difficult to swallow?
  • Has your throat been a little tender or sore?
  • Have you been feeling a little feverish? If yes, have you tried to take your temperature? How high was (or is) your fever and how long did it last?
  • Have you experienced any loss of appetite, nausea, vomiting or tummy pain?
  • Have you had headaches recently?
  • Have you had, been treated for or recently recovered from a strep throat infection?
  • Have you been around anyone who has a strep throat infection recently?
  • Do you have any other known health conditions or allergies?
  • Are you taking any medications or supplements? (prescription and over-the-counter)

Following a short discussion, your doctor will request a physical exam and look at the various parts of your body affected by rash and bumps. Texture and appearance will be physical elements your doctor will want to assess. He or she will also assess the condition of your throat, tongue and tonsils, and also check the lymph nodes in your neck to see if they are enlarged (swollen). Signs your doctor will look out for include white or yellow specs in the throat and mouth, as well as symptoms of fever, body aches and chills.

Your doctor may wish to perform a few tests to confirm an infection, whether it be scarlet fever or strep throat. He or she may request a throat swab (swabbing the back of the throat), throat culture or rapid strep test (results are returned in less than 24 hours) to collect bacterial material (cells) which can be tested for infection. The laboratory will assess the sample for signs of group A streptococcus bacterium. In some instances, a blood test may be requested to determine an infection.

Your doctor will want to be sure of the infection causing you to feel unwell. Although strep throat and scarlet fever are caused by the same bacteria, treatment methods are not entirely the same. Strep throat doesn’t typically involve symptoms of rash. Both, however, will be treated with antibiotics to combat the same bacteria in the body.

Treatment for scarlet fever

A bacterial infection, scarlet fever is typically treated with antibiotics, which kill bacteria and enable the body’s immune system to fight off the infection. Your doctor will prescribe an antibiotic at a specific dosage. It is important to complete the entire course of an antibiotic, even if you begin to feel better while taking it as this helps to prevent an infection recurrence.

Your doctor may recommend over-the-counter medications to help control symptoms of fever and a sore throat. Ibuprofen or aspirin may be recommended. A doctor will never recommend aspirin to a child younger than 18 years of age who is suffering from a viral infection as the risk for the potentially life-threatening condition, Reye’s syndrome is very high.

Once your fever has broken and you have been taking antibiotics for 24 hours, you should be able to return to normal daily life (work or school). Once the infection is under control with the use of antibiotics, you should no longer be contagious. A full course of treatment should clear a scarlet fever infection in at least 4 to 5 days and a fever should reduce within 12 to 24 hours. Antibiotics, however, may be prescribed for 10 days and sometimes includes taking oral penicillin (for those who are not allergic to penicillin).

If you do not begin to feel better within 24 hours of taking your antibiotic, consult your doctor for a check-up to ensure that nothing is wrong and to determine if there is any reason you may not be responding to treatment.

Other home-care tips your doctor may recommend include:

  • For throat tenderness and pain: Make a solution of warm, salty water to gargle with. You can also use a cool mist humidifier to help ease discomfort. Soothing drops (in individuals older than 4 years of age), soups, broths and ice pops or lollies can also provide relief. Throat lozenges (for those older than 4 years of age) can also alleviate tenderness and discomfort in the throat. You can try using a cool mist humidifier to open up the airways and provide some relieve to a sore throat and prevent further irritation as well.
  • To alleviate dehydration and lack of appetite: Drink plenty of fluids to keep your mouth and throat moist. Soups and broths can also help to give the body nourishment if you are struggling to consume full meals.
  • To relieve rash itchiness: Trim your nails to avoid doing yourself any harm if you do happen to scratch. You can also apply calamine lotion to the inflamed areas of skin to help alleviate itching while the rash heals.

Bowl of broth and fresh vegetables on wooden table

Is a follow-up appointment with the doctor necessary?

If treatment is effective and you don’t develop any new symptoms, it’s not likely that your doctor will request that you come back for a follow-up appointment. It rarely happens that an infection spreads to other parts of the body.

If other signs of infection develop, such as an ear infection or a respiratory condition, such as pneumonia, see your doctor as soon as possible. Any new symptoms or concerns should always be checked by your doctor.

Who is most at risk?

The most common age group affected by scarlet fever tends to be children between the ages of 5 and 15 years. Up to 80% of diagnosed cases are children under the age of 10. Thus, young children are typically most at risk. Anyone in close contact with an infected individual is also at higher risk of infection, particularly in households, schools or a place of work.

What are some of the most common complications?

If left untreated, there is a risk of an infection spreading to other areas of the body. Typically, further complications rarely happen, but if a case of scarlet fever isn’t effectively managed it can happen. Some areas of the body which are vulnerable to infection include:

  • The skin
  • The lungs
  • The tonsils
  • Middle ear
  • The kidneys
  • The blood

If infection spreading does occur, a person can be at higher risk of:

  • Rheumatic fever (affecting the joints, nervous system, heart and skin)
  • Kidney disease or inflammation of the kidneys (Acute kidney failure / renal failure can happen as well)
  • Skin or ear infections
  • Arthritis
  • Pneumonia
  • A throat abscess
  • Sinusitis
  • Toxic shock syndrome
  • Meningitis (infection of the spinal cord and brain’s membranes)
  • Endocarditis (infection of the heart’s inner lining)
  • Necrotising fasciitis (flesh-eating disease)
  • Osteomyelitis (bone and bone marrow infection)

Some illnesses can produce a rash similar to that of scarlet fever. If you develop further symptoms or your rash doesn’t clear following treatment, you doctor may keep the following similar condition in mind and potentially test for:

  • Slapped cheek syndrome
  • Measles
  • German Measles (Rubella)
  • Meningitis
  • Roseola (a mild infection typically caused by two strains of the human herpes virus 6 or 7)

In severe cases, any of the above health complications can lead to some long-term effects. If tended to by a doctor swiftly, risk should be significantly reduced.

Can scarlet fever be prevented?

Washing of hands with soap under running waterMost infections are best prevented with good hygiene practices. It is good to be mindful of practicing good hygiene, whether you are down with an infectious illness, as well as when you’re in peak condition. Tips for good hygiene include being mindful of handwashing habits (with soap and water) before and after meals or after using a toilet, as well as reducing the spread of germs by covering you nose and mouth when coughing or sneezing, and taking care not to share utensils, drinking glasses etc. with other individuals.

The spread of infection can also be halted by staying away from others when you’re ill with scarlet fever. Once you are no longer contagious and your doctor is satisfied that you are responding well to treatment, it won’t be necessary to remain isolated.

You can also be mindful of used tissues or handkerchiefs while you are ill. Ensure that you dispose of these quickly. This will also help stop infection from spreading by reducing the risk of others coming into contact by handling them. If you or anyone else has handled a used tissue etc., ensure that you wash your hands thoroughly afterwards with soap and water.

What happens if you get scarlet fever during pregnancy?

Pregnant woman consulting her doctor

A woman is most vulnerable to any infection at the beginning stages of her pregnancy. There are risks involved at early stages of pregnancy, but most especially during childbirth when a baby is vulnerable to being born with the infection and associated complications.

If you are pregnant and begin to feel unwell or suspect scarlet fever, seek treatment from your doctor as soon as possible. Currently, there’s little evidence that scarlet fever will cause harm to an unborn baby during pregnancy. Cases of scarlet fever during pregnancy are also few and far between (not all that common).

As with any infection doing the rounds, it is best for a pregnant woman to do what she can to avoid exposure and contact. If you do experience symptoms of scarlet fever, at any stage of your pregnancy, see your doctor as soon as possible for effective treatment. Your doctor will discuss any potential risks and prescribe antibiotics that are most safe for you to take. Risk may be associated with these, but your doctor will ensure to advise any treatment with the least amount of risk to you and your unborn baby.

If you have an infection when you give birth, risk to your baby is at its greatest. The baby could also be infected once born and will need to be promptly treated.


Disclaimer - is for informational purposes only. It is not intended to diagnose or treat any condition or illness or act as a substitute for professional medical advice.