Scarlet Fever - Causes, Symptoms and Treatment

Scarlet fever is an exotoxin -mediated disease that occurs most often in association with a sore throat and rarely with impetigo or other streptococcal infections. Ordinarily, scarlet fever evolves from a tonsillar/pharyngeal focus, although the rash develops in fewer than 10% of cases of "strep throat." The site of bacterial replication tends to be inconspicuous compared to the possible dramatic effects of released toxins. Exotoxin-mediated streptococcal infections range from localized skin disorders (eg, bullous impetigo) to the systemic rash of scarlet fever to the uncommon but highly lethal streptococcal toxic shock syndrome. Streptococcus pyogenes (group A strep) is responsible for scarlet fever. It can also cause simple angina, erysipelas and serious toxin mediated syndromes like necrotizing fasciitis and the so called streptococal toxic shock like syndrome. The virulence of group A strep seems to be increasing lately. The exanthem of scarlatina is thought to be due to erythrogenic toxin production by specific streptococcal strains in a nonimmune patient. Alongside with erythrogenic toxins, the Group A strep produces several toxins and enzymes. Two of the most important are the streptolysins O and S. Streptolysin O, an hemolytic, thermolabile and immunogenic toxin is the base of an assay for scarlatina and erysipelas - the anti-streptolysin O titer. Scarlet fever once was common among children ages 2 to 10, but now it is relatively rare. The reason for this remains a mystery, especially because there has been no decrease in the number of cases of strep throat or strep skin infections

The main symptoms of scarlet fever is sore throat and headache, fever, vomiting and swollen neck glands Rash is the most striking sign of scarlet fever. It usually begins looking like a bad sunburn with tiny bumps and it may itch. The rash begins to fade three to four days after onset and desquamation (peeling) begins. The rash usually appears first on the neck and face, often leaving a clear unaffected area around the mouth. It spreads to the chest and back, then to the rest of the body. In body creases, especially around the underarms and elbows, the rash forms classic red streaks. Areas of rash usually turn white when you press on them. By the sixth day of the infection the rash usually fades, but the affected skin may begin to peel. Scarlet spots or blotches, giving a boiled lobster appearance, are often the first sign of rash. As skin lesions progress and become more widespread, they start to look like sunburn with goose pimples. The skin may have a rough sandpaper-like feel. In body folds, especially the armpits and elbows, fragile blood vessels (capillaries) can rupture and cause classic red streaks called Pastia lines. These may persist for 1-2 days after the generalised rash has gone. In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo . In these cases, the child may not get a sore throat. Penicillin remains the drug of choice (there are still no documented cases of penicillin-resistant group A streptococci infections).

Causes of Scarlet Fever

Common Causes and Risk factors of Scarlet Fever

• Group A beta-hemolytic streptococci.
• Toxin mediated syndromes.
• Necrotizing fasciitis.

Sign and Symptoms of Scarlet Fever

Common Sign and Symptoms of Scarlet Fever

• Fever.
• Fatigue.
• Sore throat.
• Headache.
• Nausea.
• Vomiting
• Abdominal pain.

Treatment for Scarlet Fever

Common Treatment for Scarlet Fever

• The treatment of scarlet fever is antibiotic therapy to eliminate the bacteria that causes this infection from the throat.
• Penicillin or amoxicillin for up to 10 days. It is very important that the full antibiotic course is taken to ensure all the infection is cleared, thus preventing complications from occurring. In some situations penicillin given by intramuscular injection.
• Patients allergic to penicillin may be treated with an alternative antibiotic such as erythromycin .
• 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 or calamine lotion to relieve the itch of rash.
• Keep fingernails short on young children to prevent them from damaging the skin.