Scarlet fever

Scarlet fever
Specialty	Infectious diseases, pediatrics

Scarlet fever is a disease caused by an exotoxin released by Streptococcus pyogenes. It is characterized by sore throat, fever, a 'strawberry tongue', and a fine sandpaper rash over the upper body that may spread to cover the uvula (Forchheimer spots).

• Bright red tongue with a "strawberry" appearance

• Characteristic rash, which:

• is fine, red, and rough-textured; it blanches upon pressure
• appears 12–48 hours after the fever
• generally starts on the chest, armpits, and behind the ears
• is worse in the skin folds
• Pastia lines (where the rash becomes confluent in the arm pits and groins) appear and persist after the rash is gone

• The rash begins to fade three to four days after onset and desquamation (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later ." Peeling also occurs in axilla, groin, and tips of the fingers and toes.

Diagnosis of scarlet fever is clinical. The blood tests shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), and elevation of antistreptolysin O titer. Blood culture is rarely positive, but the streptococci can usually be demonstrated in throat culture. The complications of scarlet fever include septic complications due to spread of streptococcus in blood and immune-mediated complications due to an aberrant immune response. Septic complications, today rare, include ear and sinus infection, streptococcal pneumonia, empyema thoracis, meningitis and full-blown sepsis, upon which the condition may be called malignant scarlet fever.

Immune complications include acute glomerulonephritis, rheumatic fever and erythema nodosum. The secondary scarlatinous disease, or secondary malignant syndrome of scarlet fever, includes renewed fever, renewed angina, septic ear, nose, and throat complications and kidney infection or rheumatic fever and is seen around the eighteenth day of untreated scarlet fever.

Red cheeks giving the appearance of a white mustache typical of Scarlet Fever.

Scarlet Fever's pebbly, dry rash.

Symptoms

The 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 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 (on very dark skin, the streaks may appear darker than the rest of the skin). Areas of rash usually turn white (or paler brown, with dark complected skin) when you press on them. By the sixth day of the infection the rash usually fades, but the affected skin may begin to peel.

Aside from the rash, there are usually other symptoms that help to confirm a diagnosis of scarlet fever, including a reddened sore throat, a fever at or above 101° Fahrenheit (38.3° Celsius), and swollen glands in the neck. Scarlet fever can also occur with a low fever. The tonsils and back of the throat may be covered with a whitish coating, or appear red, swollen, and dotted with whitish or yellowish specks of pus. Early in the infection, the tongue may have a whitish or yellowish coating. A person with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.

When scarlet fever occurs because of a throat infection, the fever typically stops within 3 to 5 days, and the sore throat passes soon afterward. The scarlet fever rash usually fades on the sixth day after sore throat symptoms began, but skin that was covered by rash may begin to peel. This peeling may last 10 days. With antibiotic treatment, the infection itself is usually cured with a 10-day course of antibiotics, but it may take a few weeks for tonsils and swollen glands to return to normal.

In rare cases, scarlet fever may develop from a streptococcal skin infection like impetigo. In these cases, the person may not get a sore throat.

Treatment

Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any strep throat. In case of penicillin allergy, clindamycin or erythromycin can be used with success. Patients should no longer be infectious after taking antibiotics for 24 hours. If you have been exposed to scarlet fever, watch carefully for a full week for symptoms, especially if you are aged 3 to young adult. It's very important to be tested (throat culture) and if positive, seek treatment. For whatever reason, toddlers rarely contract scarlet fever.

Popular culture references

Five go adventuring by enid blyton - Anne, Dick and Julians mother has scarlet fever at the begining of the book causing them to go to Kirrin Cottage for the school holidays

• Little Women by Louisa May Alcott (1868) - Beth contracts scarlet fever, seems to recover, but progresses to rheumatic fever and ultimately succumbs to congestive heart failure.
• By the Shores of Silver Lake by Laura Ingalls Wilder - Laura's sisters Mary, Carrie, and Grace and their mother contract scarlet fever, the family recovers, but Mary is left blind as a result.
• The Velveteen Rabbit by Margery Williams (1922) - The main protagonist, a small boy, contracts scarlet fever and his toys are all burned. Indeed, the velveteen rabbit itself, the boy's favorite toy, was going to be burned by a nurse, but at the book's climax, the toy rabbit comes alive and joins the "real" rabbits outside in the garden.
• All-of-a-Kind Family by Sydney Taylor - Four of the five sisters come down with it, and the house goes under quarantine; no lasting harm to any of the patients.
• Frankenstein; or, The Modern Prometheus by Mary Wollstonecraft Shelley (1818) - Victor Frankenstein's adoptive sister Elizabeth contracts scarlet fever and recovers. But Victor's mother, who contracts the scarlet fever from Elizabeth, dies.
• Anna Karenina; By Leo Tolstoy - All six of the Oblonsky children contract scarlet fever but are nursed through it succesfully by their mother Dolly and aunt Kitty.
• The Witch of Blackbird Pond (1958) by Elizabeth George Spears - A young girl from Barbados is accused of giving scarlet fever to her cousins by using witchcraft.
• Fever Dream by Ray Bradbury - the young protagonist is diagnosed with scarlet fever, though it appears to mutate into something much more sinister.
• Private Peaceful by Michael Morpurgo - Molly gets scarlet fever and survives.
• The first episode of the television show Ozzy & Drix featured a villain named Scarlet Fever, who died after getting sucked into the spleen and shredded.
• In the 1989 film See No Evil, Hear No Evil, David Lyons, a deaf man played by Gene Wilder explains to Wally Karue, a blind man played by Richard Pryor that he became deaf as a result of getting scarlet fever in high school.
• In the 2001 film Osmosis Jones, the main antagonist is a strain of scarlet fever known as "Thrax," whose goal is to "get his own chapter in the medical book" after taking out his host, Frank, in 48 hours. He had the ability to light fire to anything he touched, but was killed when he fell into a jar of rubbing alcohol. Thrax is voiced by Laurence Fishburne.
• An American soldier in The Steel Helmet lost all of his hair as a child due to Scarlet Fever.
• Anna Jones, mother of the young Henry 'Indiana' Jones died of Scarlet Fever during the year of 1912.
• In his memoir Survival in Auschwitz, Primo Levi describes his stay at the Auschwitz concentration camp. In the later part of the book, he mentions that he has developed Scarlet fever.
• Scarlet Fever is also the title of a 1983 hit single by Kenny Rogers.
• "Casualty 1907" Episode 3 (BBC) Probationer Bennett contracts Scarlet Fever after caring for an infected patient. She ended up having to sweat it out along with Saline solution injections.
• The Moffats by Eleanor Estes (1945) - The youngest son, Rufus Moffat, gets scarlet fever. The whole Moffat family is under quarantine for several weeks while Rufus recovers. Mama, Sylvie, Jane, and Joe go through one night when they worry that Rufus might die.
• Goodnight Mister Tom by Michelle Magorian (1981) - Toms wife dies of Scarlet fever shortly after giving birth. The baby later dies of scarlatine also.
• Thomas "Stonewall" Jackson's friend Jane, who was a little southern girl, died of Scarlet fever as was portrayed in the 2002 movie Gods and Generals
• In The Hardy Boys book series, Frank missed a year of school due to being sick with scarlet fever and thus is now in the same grade as his younger brother Joe.
• Buffalo Bill's son, Kit Carson Cody, was 5 in 1876, when he died of scarlet fever.