All about Scarlet fever

Rheumatic fever can occur as a Complication of Scarlet fever


What causes scarlet fever?

Scarlet fever is due to a throat infection caused by a bacterium (germ) called streptococcus. There are various strains (types) of streptococcus. They cause various infections, and one strain causes scarlet fever.

What are the symptoms of scarlet fever?
  • Sore throat and fever (high temperature) are the typical first symptoms.
  • A bright red (scarlet) rash soon develops. This is caused by a toxin (poison) that is made by the streptococcal bacteria. The toxin gets into the blood from the infected throat. The rash starts as small red spots, usually on the neck and upper chest. It soon spreads to many other parts of the body. The face may become quite flushed. The rash blanches (goes white) if you press on it.
  • The tongue may become pale but coated with red spots ('strawberry tongue'). After a few days the whole tongue may look red.
  • Other common symptoms include: headaches, vomiting, being off food, and feeling generally unwell.

Most children will recover fully within a week or so, even without treatment. (However, it is best to have treatment - see below.) The sore throat and fever last a few days, and then usually ease. The rash lasts about six days, and then usually fades away. As the rash fades, some of the skin may peel, mainly on the hands and feet (a bit like after being sunburnt).

What is the treatment for scarlet fever?

Treatment is to speed recovery and to prevent possible complications.

  • Antibiotics. A 10 day course of penicillin is usually advised. Other antibiotics are advised if you are allergic to penicillin. Symptoms usually go in a few days, but it is important to finish the course of antibiotics. This makes sure all the bacteria are killed and reduces the chance of complications.
  • Other treatments aim to keep the child comfortable until the illness goes.
    • Paracetamol (Calpol, Disprol, etc) reduces fever and eases aches and pains. Ibuprofen is an alternative.
    • Keep the child cool. If the room is warm then take all their clothes off.
    • Give lots of cool drinks. This helps lower the fever and prevent dehydration.
What are the possible complications of scarlet fever?

Complications are uncommon, but can be serious. They include the following.

  • Serious infection such as throat abscess, sinusitis, and spread of infection to the lungs which can cause pneumonia.
  • Late complications sometimes develop 2-3 weeks after the infection has gone. These are rheumatic fever (which can damage the heart) and kidney damage (glomerulonephritis). These are due to immune reactions in the kidneys, heart, joints and other organs following infection with streptococcal bacteria.
Treatment with antibiotics reduces the chance of complications. Complications now rarely occur.

Is scarlet fever infectious?

Yes. Coughing, sneezing, and breathing out the bacteria can pass it on to others. It takes 2-4 days to develop symptoms after being infected. Keep children with scarlet fever off school, and away from others, for five days after starting antibiotics.

In summary
  • Scarlet fever is an infectious illness.
  • Full recovery is usual.
  • Serious complications are now rare, probably due to antibiotic treatment.
  • Finish the full course of antibiotics, even if symptoms soon go.

What other Conditions or Diseases can Mimic Rheumatic Fever ?

Differential Diagnosis of Rheumatic fever 

  • Arthritis consider:
    • Rheumatoid arthritis (including Still's disease in children)
    • Henoch-Schonlein purpura
    • Reactive arthritis
    • Erythema nodosum
  • Heart disease consider:
    • Cardiomyopathy
    • Kawasaki disease
    • Infective endocarditis
  • Rash (erythema marginatum) consider:
    • Drug reactions
    • Lyme disease
  • Chorea consider:
    • Drug reactions (especially in young people) to:
      metoclopramide, oral contraceptives, phenytoin, haloperidol or amitriptyline.
    • Huntington's chorea. This does not usually present until at least 30 (peak age 35-45).
    • Chorea gravidarum may occur in pregnancy.
    • Wilson disease

Can my child develop rheumatic fever again after the first attack? ?


Yes, although the chances are reduced because of the use of prophylactic antibiotics after the initial disease process. The greatest chance of recurrence is during the first three years. The chance of developing the disease again decreases with age and time since the first attack.

After having rheumatic fever, your child will need prophylactic medications  to help decrease the chance of developing rheumatic fever again.(Daily Oral penicillin or Long acting Penicillin injections every 3 weeks). The duration of prophylactic medications depend on the severity of initial attack and will be decided by your doctor.