Complications of scarlet fever


Scarlet fever is an infection caused by a certain type of bacteria called streptococci.
The infection usually leads to symptoms such as fever and sore throat, as well as swelling and reddening of the tonsils. The tongue can also appear red after a while; this symptom is called raspberry tongue (scarlet tongue). After a few days, a rash also appears, which characteristically omits the mouth.
Dangerous complications of scarlet fever arise when the pathogen can lodge in the entire body.

These complications can occur with scarlet fever

Here is an overview of the main complications of scarlet fever infection. These are then discussed in detail.

  • Rheumatic fever

    • Rheumatic endocarditis

  • Post-streptococcal glomerulonephritis

  • Tourette syndrome


  • Chorea minor

Also interesting: Scarlet fever rash

Acute rheumatic fever (ARF)

Acute rheumatic fever is the body's response to a strep infection that occurs about three weeks after the actual illness.

The most feared complications are rheumatic endocarditis, myocarditis and pericarditis. As a consequence, without adequate antibiotic therapy, heart failure usually occurs, which is usually fatal. The heart can also be permanently damaged with antibiotics; diseases of the heart valves are often due to a reaction after the streptococcal infection.

In addition, there is an acute inflammation of individual joints, known as polyarthritis. This complication is most common in children.

The brain can also be affected by acute rheumatic fever, which manifests itself in neurological abnormalities. As the name suggests, symptoms such as fever and muscle pain also appear rather unspecific.

Treatment of ARF ideally takes place before this complication occurs. To do this, a streptococcal infection must be detected in good time and treated with antibiotics such as penicillin. If the acute rheumatic fever has actually set in, anti-inflammatory drugs should be given. Since ARF is a reaction of the immune system to the streptococcal infection, it can also be treated with cortisone, which leads to a changed reaction of the immune system.

Also read:

  • Rheumatic fever
  • Endocarditis

Acute glomerulonephritis

Glomerulonephritis is an inflammation of the kidneys. This can occur as a complication of a strep infection. Acute glomerulonephritis also occurs a few weeks after the actual infection of the streptococci and manifests itself primarily through blood in the urine. In addition, it can lead to the excretion of proteins as well as increased blood pressure and water retention.

Acute glomerulonephritis is usually diagnosed by examining the blood and urine. Usually, based on the anamnesis, i.e. the questioning of the person concerned, it is possible to find out whether a streptococcal infection has occurred. Then blood and proteins are detected in the urine test. Since the kidney is inflamed in glomerulonephritis, a so-called pounding pain in the kidneys can also occur. To examine this, the doctor taps the person on the back at kidney level. In order to be able to make the diagnosis with absolute certainty, it is often necessary to take a sample from the kidney. This can be examined under the microscope and thus provide the last decisive clue so that the correct therapy can be initiated.

Treatment usually consists of antibiotics. Dialysis may also be temporarily necessary as renal replacement therapy.

You can find important information here: Gomerulonephritis: symptoms and diagnosis

Neurological abnormalities

The neurological abnormalities after a streptococcal infection can essentially be summarized in three clinical pictures. Observations have been made that although these diseases occur more frequently after a streptococcal infection, the relationship has not been finally clarified.

Tourette's syndrome is a disease that causes so-called tics. These usually take the form of very sudden movements. The disease is also characterized by aggressive expressions that suddenly gush out of the affected person.

PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) is a disease that usually only occurs in children. It can only be triggered by a strep infection such as scarlet fever and manifests itself in psychological symptoms such as sleep disorders, depression, irritability, and anxiety. The disease has not yet been adequately researched, which is why the therapy has so far consisted of antibiotics. Since PANDAS occurs as a reaction of the immune system to the strep infection, immunosuppressive therapy, i.e. a treatment that shuts down the immune system, can also be considered.

Chorea minor also occurs a few weeks after the scarlet fever and manifests itself as grimacing as well as swallowing disorders and difficulties in controlling the tongue muscles. The treatment consists of a high dose of antibiotics.

Also read: Tourette syndrome

Joint pain

Joint pain can already occur during the scarlet fever infection.
Similar to the flu, these occur in the form of muscle pain during attacks of the fever. But polyarthritis can also occur after the actual illness. This arises in the context of acute rheumatic fever. This usually affects individual large joints such as knees, hips, shoulders and elbows. The pain usually travels from one joint to another.

The therapy in this case consists of antibiotics, pain relievers and possibly cortisone.

You might also be interested in: Rheumatoid arthritis

Toxic Shock-like Syndrome

Streptococcal Toxic Shock Syndrome, STSS for short, or Toxic Shock-like Syndrome, is an infection with the bacteria streptococci that has spread throughout the body. This is often confused with the toxic shock syndrome caused by staphylococci.

Such a shock syndrome usually does not occur with scarlet fever.The streptococci, the pathogens causing scarlet fever, can easily get into the bloodstream and cause blood poisoning (sepsis). The shock syndrome mentioned is primarily triggered by the toxins produced.

The cause of the toxic shock syndrome are very absorbent tampons, especially without a return filter. The staphylococci can multiply quickly in the warm and humid environment and produce toxins. Symptoms include fever, rash, and cardiovascular shock, which is defined by low blood pressure and a high pulse. Flu-like symptoms can also occur. The infection can also damage the liver and kidneys. In addition, clouding of consciousness occurs when the brain is also affected. The result is the failure of many organs, which can even be fatal.

The symptomatically very similar Toxic Shock-like Syndrome is triggered by the same pathogen as that of scarlet fever, but often has an unknown source of infection.

For more information on the exposure to strep toxin, see Superantigens.