Scarlet fever and its typical symptoms: how to recognize it in time?

Scarlet fever and its typical symptoms: how to recognize it in time?
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Scarlet fever is one of the most common bacterial diseases. It mainly affects children between the ages of 3 and 10 years. It manifests itself mainly with exanthema (skin rash), but also with fever, chills or lack of appetite. If treated early with antibiotics, it has a mild course and does not require hospitalisation.

scarlet fever is one of the most common childhood infectious diseases occurring between the ages of 3-10 years.

It is a bacterial disease, manifested by exanthema (seeding on the skin). It is caused by ß-haemolytic group A streptococcus (Streptococcus pyogenes). It is an erythrogenic toxin-producing strain (SPE-A) with several antigenic types.

In the past, scarlet fever has had a severe course and serious complications.

Epidemiology or how can a child become infected?

The incidence is higher in spring and is mainly transmitted in groups. The source of infection is a sick person or a bacillary carrier (a person who carries the disease but is currently asymptomatic).

The most common form of transmission is by airborne droplet infection via the nasopharynx. Less commonly, it is transmitted by direct contact or contaminated objects.

Rarely, scarlet fever is transmitted through a skin wound. In this form of the disease, tonsillitis is absent or develops later.

Streptococcus produces several types of toxins. The child's body develops antibodies to these toxins, and immunity develops.

If, however, the child becomes infected with other types of streptococcus and the body does not recognise the other toxins, the disease comes back with tonsillitis or a rash. Therefore, scarlet fever can easily recur several times a year.

The incubation period is usually 3 days, ranging from 1 to 6 days.

The disease is notifiable.

Scarlet fever has unmistakable symptoms!

Scarlet fever manifests itself as streptococcal tonsillitis (pharyngitis, tonsillitis). It is accompanied by fever and is soon accompanied by a small light red maculopapular rash, which appears within 1-6 days.

If scarlet fever is suspected, the doctor checks the child's throat and nodes. Using the history (interview), he asks the accompanying person about the child's body temperature, whether he has had chills, nausea (feeling like vomiting), whether he likes to eat (loss of appetite appears).

He/she then concentrates on the skin examination.

The fine macular seeding on the upper chest is accentuated in the folds (neck, axillae - arms, inguinae - groin, lower abdomen, elbow sockets). In these locations there may be linear petechiae - Pastio's sign. The erythema (redness) disappears, resolves within 4-5 days.

Interestingly, the palms of the hands and the soles of the feet are free of exanthema, but the skin on them peels off. The peeling is sometimes the only sign of an ongoing infection.

The face tends to be red with a perioral appearance (blanching around the mouth).

In the oral cavity, typical manifestations are present.

  • red pharynx
  • Forschheimer's spots (small red petechiae on the hard and soft palate and uvula)
  • and manifestations on the tongue:
    • white tongue with red papules at the beginning
      • white strawberry tongue
    • On day 4, the hyperkeratotic membrane peels off and is red
      • raspberry red tongue

The skin is rough (cutis anserina), manifesting as "goose bumps".

Shramek's sign appears, i.e. tiny whitish papules on the skin around the nail bed and the pinnae.

The skin gently peels off after the sowing is complete.

The symptoms can be divided into:

  • General
  • In the oral cavity
  • Cutaneous

The symptoms are summarised in the following table

General symptoms Symptoms in the oral cavity Cutaneous symptoms
High temperature The finding in the mouth is typical of tonsillitis Typical rash
Headache Dark red mucous membranes Skin seeding appears 1-2 days after infection
Abdominal pain Swelling of tonsils It's a small red spot at the beginning that starts to lift. The result is a tiny pink or light red crust or just rough skin
Nausea Purulent deposits on the tonsils The most common sites of occurrence are the lower abdomen, inner thighs, sides of the trunk
Malaise Presence of red dots on the upper palate When pressure is applied to the skin, the seeding disappears
Significant pain in the throat The tongue is covered with tiny red pimples called raspberry tongue Seeding disappears within 5 days

+ about symptoms:

  • Fever - Usually appears unexpectedly. It is accompanied by chills and nausea. When the rash subsides, the temperature usually drops.
  • Vomiting and nausea - These are common in children and come immediately after the body temperature rises.
  • Angina - Occurs shortly after a rise in temperature. Pins and needles and purulent plaques appear on the tonsils. At the beginning of the illness, the tongue is covered with a white coating. In two to three days, the coating peels off and a typical raspberry tongue develops.
  • Lymphadenopathy - The lymph nodes in the neck are enlarged and painful to the touch.
  • Rash - Appears 12 to 24 hours after the onset of the disease. It first appears in the lower abdomen, later on the trunk and quickly spreads to other parts of the body.
  • Peeling of the skin - After 3-4 days, the rash begins to subside. The skin begins to peel due to increased cornification of the skin.

How is scarlet fever diagnosed?

Diagnostically, the clinical picture of tonsillitis with exanthema, leukocytosis (increased leukocyte count) with leftward shift and eosinophilia is decisive.

CRP (C-reactive protein) is usually elevated. Streptococcal tonsillitis may also be detected (but may not always be detected) and antistreptolysin serology (ASLO) positivity. These are antibodies that the body makes against the product of streptococcal tonsillitis (streptolysin O).

ASLO levels increase at the end of the first week of illness. They peak between weeks 3 and 5. They gradually decrease.

Is scarlet fever treatable?

Currently, with early treatment with antibiotics, the course of scarlet fever is mild. Angina is catarrhal in nature, rashes are few and easily escape attention.

A throat culture (swab) is recommended before antibiotics are given.

Antibiotics are used in the treatment: penicillins, cephalosporins or azithromycin or clarithromycin. Mild course does not require hospitalization.

Can scarlet fever be mistaken for another disease?

Before making a diagnosis, the doctor will test the blood for streptococcus and take a throat swab. The disease may resemble other commonly occurring diseases:

  • Rubella and measles - The rash progresses from the head to the torso and, thanks to vaccinations, their occurrence in children is very rare.
  • Viral eczanthema - A rash that accompanies a viral illness.
  • Toxoallergic eczanthema - A rash caused by external exposure to allergens.

What are the complications of scarlet fever?

Early detection and treatment of scarlet fever carries almost no risks. However, the opposite can occur if the disease is caught at a late stage.

Table with complications

Serious complications Minor complications
Inflammation of the heart muscle Otitis media
Kidney inflammation Sinusitis
Inflammation of the joints Abscess on tonsils

A common complication, although very rare after the discovery of penicillin, is rheumatic fever.

It manifests itself by affecting the joints, heart and brain.

It occurs 2-3 weeks after overcoming the disease.

What is the prevention of scarlet fever?

An infected person, most often a child, should be excluded from the collective and isolated in the home environment for at least a few days. All persons who have been in contact with an infected person should have a throat swab taken to check for the presence of streptococcus. If positive, they should be treated with antibiotics.

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Interesting resources

  • - Infectious diseases accompanied by exanthema, MUDr. Klára Martinásková, PhD.1, MUDr. Karolína Vorčáková, PhD.2, 1DermatovenerologyDepartment ofJ. E. Purkyně University Hospital in Ústí nad Labem. A. Reiman, Prešov, 2DDermatovenerologyclinic ofUNM and JLF UK, Martin
  • - Exanthemas in infectious diseases, MUDr. Barbora GulánováDermatovenerology Clinic of the Faculty of Medicine and the Faculty of Medicine of the Charles University in Bratislava.
  • - Scarlet fever: everything you need to know
  • - Spála
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