Strep throat scarlet fever

Does your child have a bright red rash that looks and feels like sandpaper? It could be scarlet fever.

Scarlet fever — also called scarlatina — is an infection that’s easily spread from person to person. It gets its name from the red, bumpy rash that typically covers the body. It starts out looking like a sunburn. Most often, the rash begins on the face and neck and then spreads to the rest of the body.

If your child has strep throat, there’s a chance he will also develop scarlet fever. The same bacteria that causes scarlet fever causes strep throat. It’s called “group A strep.”

Scarlet fever can also be linked to burns or wounds that become infected — your own or the infected wounds of another person.

Anyone can get scarlet fever, but it’s most common in kids from 5 to 15 years old. The infection is often passed between classmates at school or family members who are in close contact with each other. It’s most often spread by contact with the droplets emitted when an infected person coughs or sneezes. It can even be spread if you touch something — like a plate or glass – on which these droplets have landed.

Scarlet Fever

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What Is Scarlet Fever?

Scarlet fever (also known as scarlatina) is an illness that can happen in kids who also have strep throat or strep skin infections. The strep bacteria make a toxin (poison) that causes a bright red, bumpy rash.

The rash spreads over most of the body and is what gives scarlet fever its name. It often looks like a bad sunburn with fine bumps that may feel rough like sandpaper, and it can itch. It usually starts to go away after about 6 days, but might peel for several weeks as the skin heals.

If your child has a rash like this, it’s important to call your doctor. Kids with scarlet fever can be treated with antibiotics.

What Are the Symptoms of Scarlet Fever?

The telltale rash is the main sign of scarlet fever. It usually starts on the neck and face, often leaving a clear 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, elbows, and groin, the rash forms red streaks.

Other symptoms of scarlet fever include:

  • a red, sore throat
  • a fever above 101°F (38.3°C)
  • swollen glands in the neck

Also, the tonsils and back of the throat might be covered with a whitish coating, or look 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 child with scarlet fever also may have chills, body aches, nausea, vomiting, and loss of appetite.

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.

How Is Scarlet Fever Diagnosed?

To confirm whether a child has scarlet fever, doctors usually order a rapid strep test or throat culture (a painless swab of the throat) to check for the strep bacteria.

How Is Scarlet Fever Treated?

If a strep infection is confirmed, the doctor will prescribe an antibiotic for a child to take for about 10 days. That usually will cure the infection itself, but it may take a few weeks for the tonsils and swollen glands to return to normal.

How Can I Help My Child?

Eating can be painful for kids with severe strep throat, so serving soft foods or a liquid diet may be best. Include soothing teas and warm nutritious soups, or cool drinks, popsicles, or slushies. Make sure that your child drinks plenty of fluids. You can give over-the-counter acetaminophen or ibuprofen for fever or throat pain.

If the rash itches, make sure that your child’s fingernails are trimmed short so skin isn’t damaged through scratching. Try an over-the-counter anti-itch medicine to help relieve the itching.

Can Scarlet Fever Be Prevented?

The bacterial infection that causes scarlet fever is contagious. Kids with scarlet fever can spread the bacteria to others through sneezing and coughing. A skin infection caused by strep bacteria, like impetigo, can be passed through contact with the skin.

When a child is sick at home, it’s always safest to keep his or her toothbrush, drinking glasses, and eating utensils separate from those of other family members, and to wash these items well in hot soapy water. Wash your own hands often as you care for a child with a strep infection.

When Should I Call the Doctor?

Call the doctor whenever your child suddenly develops a rash, especially if he or she also has a fever, sore throat, or swollen glands. This is especially important if your child has any of the symptoms of strep throat, or if someone in your family or at your child’s daycare or school recently had a strep infection.

Reviewed by: Joanne Murren-Boezem, MD Date reviewed: February 2017

Scarlet fever, also known as scarlatina, is a bacterial infection caused by group A Streptococcus or “group A strep.” This condition generally affects some people who have strep throat or skin infections caused by group A strep. Pharmacists can play an important role in counseling parents on prevention and treatment strategies for scarlet fever. Check out these 3 facts about scarlet fever.

  1. Scarlet fever is contagious.

Group A strep bacteria can spread from the droplets of an infected person through coughing and sneezing, drinking and eating from a contaminated glass or plate, or coming in contact with sores from skin infections. Anyone can develop scarlet fever, but it usually affects children 5 to 15 years of age.1 Unfortunately, there is no vaccine to prevent scarlet fever. Counsel patients that prevention is key so they should wash their hands often with soap and water for at least 20 seconds and avoid sharing eating utensils, linens, towels, or other personal items. If soap and water are not available, then an alcohol-based hand sanitizer containing at least 60% alcohol should be used. Children with scarlet fever should stay home from school or daycare for at least 24 hours after starting antibiotics. Let patients know that they can become infected with scarlet fever more than once.

2. Red rash is a classic symptom. The classic symptom of scarlet fever is a red rash that feels like sandpaper which appears 1-2 days after the illness begins and generally lasts for 3-5 days.1,2 The rash may first emerge on the neck, underarm, and groin regions and then spread over the body. Other symptoms also include a headache, fever, sore throat, swollen tonsils, chills, vomiting, and abdominal pain. The tongue may also have a “strawberry”-like appearance.1,3 Let parents know to contact their pediatrician if their child has a fever, sore throat, and rash.
3. Treatment with antibiotics is important to prevent complications. Strep tests should be performed to determine whether group A strep is causing the illness. Penicillin or amoxicillin are the drugs of choice for treating group A streptococcal infections. Antibiotic therapy is recommended for 10 to 14 days. First-generation cephalosporins can be used as an alternative therapy as long as patients did not have an anaphylactic reaction to penicillin. Clindamycin or erythromycin are alternative treatments for patients unable to take penicillin or cephalosporins. Educate patients to complete the full antibiotic treatment to prevent resistance and the following long-term health problems:

  • Rheumatic fever
  • Kidney disease
  • Otitis media
  • Skin infections
  • Throat abscesses
  • Pneumonia
  • Arthritis

Ibuprofen or acetaminophen can be used to treat fever and pain. Ibuprofen should only be used for children older than 6 months of age. Patients should drink plenty of fluids to keep the throat moist and prevent dehydration. Parents can prepare a saltwater gargle to help ameliorate throat pain. Cool mist humidifiers can help to eliminate dry air that may cause throat irritation.

Scarlet Fever: All You Need to Know

Bacteria Cause Scarlet Fever

Bacteria called group A Streptococcus or group A strep cause scarlet fever. The bacteria sometimes make a poison (toxin), which causes a rash — the “scarlet” of scarlet fever.

How You Get Scarlet Fever

Group A strep live in the nose and throat and can easily spread to other people. It is important to know that all infected people do not have symptoms or seem sick. People who are infected spread the bacteria by coughing or sneezing, which creates small respiratory droplets that contain the bacteria.

People can get sick if they:

  • Breathe in those droplets
  • Touch something with droplets on it and then touch their mouth or nose
  • Drink from the same glass or eat from the same plate as a sick person
  • Touch sores on the skin caused by group A strep (impetigo)

Rarely, people can spread group A strep through food that is not handled properly (visit CDC’s food safety page). Experts do not believe pets or household items, like toys, spread these bacteria.

Common Signs, Symptoms of Scarlet Fever

  • Very red, sore throat
  • Fever (101 °F or higher)
  • Whitish coating on the tongue early in the illness
  • “Strawberry” (red and bumpy) tongue
  • Red skin rash that has a sandpaper feel
  • Bright red skin in the creases of the underarm, elbow, and groin (the area where your stomach meets your thighs)
  • Swollen glands in the neck

Other general symptoms:

  • Headache or body aches
  • Nausea, vomiting, or abdominal pain

Scarlet Fever: What to Expect

In general, scarlet fever is a mild infection. It usually takes two to five days for someone exposed to group A strep to become sick. Illness usually begins with a fever and sore throat. There may also be chills, vomiting, or abdominal pain. The tongue may have a whitish coating and appear swollen. It may also have a “strawberry”-like (red and bumpy) appearance. The throat and tonsils may be very red and sore, and swallowing may be painful.

One or two days after the illness begins, a red rash usually appears. However, the rash can appear before illness or up to 7 days later. The rash may first appear on the neck, underarm, and groin (the area where your stomach meets your thighs). Over time, the rash spreads over the body. The rash usually begins as small, flat blotches that slowly become fine bumps that feel like sandpaper.

Although the cheeks might look flushed (rosy), there may be a pale area around the mouth. Underarm, elbow, and groin skin creases may become brighter red than the rest of the rash. The rash from scarlet fever fades in about 7 days. As the rash fades, the skin may peel around the fingertips, toes, and groin area. This peeling can last up to several weeks.

Children and Certain Adults Are at Increased Risk

Anyone can get scarlet fever, but there are some factors that can increase the risk of getting this infection.

Scarlet fever, like strep throat, is more common in children than adults. It is most common in children 5 through 15 years old. It is rare in children younger than 3 years old. Adults who are at increased risk for scarlet fever include:

  • Parents of school-aged children
  • Adults who are often in contact with children

Close contact with another person with scarlet fever is the most common risk factor for illness. For example, if someone has scarlet fever, it often spreads to other people in their household.

Infectious illnesses tend to spread wherever large groups of people gather together. Crowded conditions can increase the risk of getting a group A strep infection. These settings include :

  • Schools
  • Daycare centers
  • Military training facilities

Doctors Can Test for and Treat Scarlet Fever

Many viruses and bacteria can cause an illness that includes a red rash and sore throat. Only a rapid strep test or a throat culture can determine if group A strep are the cause.

A rapid strep test involves swabbing the throat and testing the swab. The test quickly shows if group A strep are causing the illness. If the test is positive, doctors can prescribe antibiotics. If the test is negative, but a doctor still suspects scarlet fever, then the doctor can take a throat culture swab. A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses. Culture is important to use in children and teens since they can get rheumatic fever from an untreated scarlet fever infection. For adults, it is usually not necessary to do a throat culture following a negative rapid strep test. Adults are generally not at risk of getting rheumatic fever following scarlet fever.

Antibiotics Get You Well Fast

Doctors treat scarlet fever with antibiotics. Either penicillin or amoxicillin are recommended as a first choice for people who are not allergic to penicillin. Doctors can use other antibiotics to treat scarlet fever in people who are allergic to penicillin.

Benefits of antibiotics include:

  • Decreasing how long someone is sick
  • Decreasing symptoms (feeling better)
  • Preventing the bacteria from spreading to others
  • Preventing serious complications like rheumatic fever

Long-term Health Problems Are Not Common but Can Happen

Complications are rare but can occur after having scarlet fever. This can happen if the bacteria spread to other parts of the body. Complications can include:

  • Abscesses (pockets of pus) around the tonsils
  • Swollen lymph nodes in the neck
  • Ear, sinus, and skin infections
  • Pneumonia (lung infection)
  • Rheumatic fever (a heart disease)
  • Post-streptococcal glomerulonephritis (a kidney disease)
  • Arthritis (joint inflammation)

Treatment with antibiotics can prevent most of these health problems.

Protect Yourself and Others

People can get scarlet fever more than once. Having scarlet fever does not protect someone from getting it again in the future. While there is no vaccine to prevent scarlet fever, there are things people can do to protect themselves and others.

Good Hygiene Helps Prevent Group A Strep Infections

The best way to keep from getting or spreading group A strep is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating. To practice good hygiene you should:

  • Cover your mouth and nose with a tissue when you cough or sneeze
  • Put your used tissue in the waste basket
  • Cough or sneeze into your upper sleeve or elbow, not your hands, if you don’t have a tissue
  • Wash your hands often with soap and water for at least 20 seconds
  • Use an alcohol-based hand rub if soap and water are not available

You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are safe for others to use once washed.

Antibiotics Help Prevent Spreading the Infection to Others

People with scarlet fever should stay home from work, school, or daycare until they:

  • No longer have a fever
  • Have taken antibiotics for at least 24 hours

Take the prescription exactly as the doctor says to. Don’t stop taking the medicine, even if you or your child feel better, unless the doctor says to stop.

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What Is It?

Published: December, 2018

Scarlet fever is an infection caused by Group A Streptococcus (“strep”) bacteria. It causes a finely textured rash that can appear like sandpaper along with other symptoms. It usually occurs after a strep infection of the throat (strep pharyngitis, or strep throat), but occasionally after a strep skin infection. The rash of scarlet fever is caused by a toxin that the strep bacteria produce.

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.

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Strep Throat and Scarlet Fever: What’s the Connection?

With recent news of scarlet fever outbreaks in the United Kingdom, it’s a good time to take a look at what scarlet fever is and how to treat, so you’re prepared.

For starters, it’s not the reason Mary Ingalls from Little House on The Prairie went blind, according to research published in March 2013 in the journal Pediatrics.

Scarlet fever, also referred to as scarlatina, is a relatively mild illness that can be brought on by a streptococcal (strep) A infection.

Most cases of strep begin in the throat and sometimes can develop into scarlet fever. Certain strains of strep can produce a toxin that causes the rash associated with scarlet fever, explains Camille Sabella, MD, director of the Center for Pediatric Infectious Diseases at the Cleveland Clinic in Ohio.

In other words, if someone is sick with strep throat, there is a chance they can also get scarlet fever and should know the signs.

Scarlet fever is characterized by:

  • a very red, sore throat
  • a bright red rash on the body that has a sandpaper feel
  • a “strawberry,” or red and bumpy, tongue

Other symptoms can include fever, swollen glands in the neck, a whitish coating on the tongue, and bright red skin in the underarm, elbow, or groin.

Scarlet Fever Spreads in Droplets Through the Air

Scarlet fever, like strep throat, is highly contagious and is more common in children than adults, particularly those between the ages of 5 and 15.

It’s spread from person to person when someone who is infected coughs or sneezes, through small droplets in the air. You can get sick by breathing in those droplets or by touching something that the droplets have landed on and then touching your nose or mouth. Drinking from the same glass or eating off the same plate as someone who has scarlet fever can also spread the illness.

It’s also possible to get scarlet fever sores on the skin caused by a strep infection.

Close contact with someone who has the infection is the biggest risk factor for getting the illness.

“Certainly among family members and in schools it’s usually very contagious because of close contact among children,” Dr. Sabella says. “There are lots of outbreaks usually in the winter and springtime.”

How Common Is Scarlet Fever in the United States?

A study published November 2017 in the journal The Lancet Infectious Diseases found dramatic increases in scarlet fever in certain parts of the world. The research found that England in particular has seen a sharp rise in cases since 2014, with a 50-year high of 620 outbreaks totalling more than 19,000 cases in 2016.

Countries in East Asia, including China, Vietnam, and South Korea, have also reported recent surges.

In the United States, the Centers for Disease Control and Prevention (CDC) does not track the number of scarlet fever cases, so the exact number and whether cases are increasing or decreasing is not known. But Sabella says scarlet fever is more common than most people probably think.

“Think of all the strep throat infections kids get each year. Pediatricians see lots of cases of scarlet fever, too,” he says.

Doctors Can Easily Diagnose and Treat Scarlet Fever

Scarlet fever typically begins with a fever and sore throat followed by a rash, which usually appears a day or two later. But the rash can also begin before the other symptoms begin to manifest, or even up to seven days after the onset of symptoms.

Doctors diagnose scarlet fever based on the appearance of symptoms, most notably the sandpaper-like rash and strawberry tongue in addition to sore throat.

“It’s pretty easy to recognize clinically,” Sabella says. “It’s usually not a mystery.”

Scarlet fever is easily treated with antibiotics. But it’s important to complete the entire course of the medication prescribed by your healthcare provider to reduce the spread of infection as well as your risk for developing complications.

Over-the-counter medicines, including Advil (ibuprofen) and Tylenol (acetaminophen), can be used to help reduce fever and relieve pain associated with the illness.

RELATED: How To Keep Antibiotics From Causing Diarrhea

Complications Are Rare but Can Occur

Complications from scarlet fever are very rare but sometimes happen. They include:

  • Abscesses around the tonsils
  • Swollen lymph nodes in the neck
  • Pneumonia
  • Skin infection
  • Arthritis
  • Sinus and ear infections

Other, more serious complications are even rarer and can include include rheumatic fever, which causes inflammation, especially of the heart, blood vessels, and joints.

“Some people confuse scarlet fever with rheumatic fever but they are totally different entities,” Sabella says.

Scarlet fever may also lead to long-term problems with the kidneys, including kidney disease.

Still, “the overwhelming majority of scarlet fever cases are fully treated and have no complications,” Sabella says.

RELATED: Pneumonia Treatment and Prevention

How to Prevent Scarlet Fever

There is no vaccine for scarlet fever, but people can protect themselves by practicing good hygiene. This includes using a tissue to cover your mouth when sneezing or coughing, frequent hand washing, using alcohol-based hand sanitizer if soap and water are unavailable, and coughing or sneezing into your upper sleeve or elbow rather than your hands if a tissue isn’t available.

Additionally, Sabella says that “probably the best way to avoid scarlet fever is if you treat strep throat quickly and adequately. A lot of times you can prevent scarlet fever this way.”

If your child develops any of the symptoms of scarlet fever — especially if they have been around someone else who is sick — get them to a pediatrician right away for treatment.

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