Pediatrics

Scarlet fever

Synonyms in a broader sense

Medical: Scarlatina

English: scarlet fever

Definition of scarlet fever

Scarlet fever is an infectious disease caused by bacteria, typically associated with febrile tonsillitis (Tonsillar angina) and a red rash (Rash) goes hand in hand.

Forms of scarlet fever

As a rule, scarlet fever in children runs smoothly. In rare cases, however, the disease can develop into a serious course with complications.

Purulent tonsillitis (angina tonsillaris) can spread to the sinuses or the middle ear and lead to inflammation (sinusitis or otitis media) there. Inflammation of the heart muscle (myocarditis) can also occur in seriously ill children.

In 1% of the cases, a massive suppuration of the pharynx (angina necroticans) leads to a Blood poisoning (sepsis) who have meningitis (meningitis) or in the most severe case with a blockage of the draining cerebral vessels (cerebral sinus thrombosis).

It is even rarer that the high concentration of bacterial toxins in the blood leads to circulatory shock (toxic shock) with vomiting, circulatory failure, cramps and drowsiness, which can lead to death (Scarlatina fulminans).

After a streptococcal infection such as scarlet fever, the child can develop a secondary disease, which is caused by the fact that the immune system has formed defensive substances (antibodies) against the bacteria, which now attach to the body's own structures and lead to inflammation.

This can manifest as so-called streptococcal rheumatism (rheumatic fever) with inflammation of the heart (carditis) or inflammation of the joints (polyarthritis).
Please also read our article on this Rash and joint pain
Kidney disease (Glomerulonephritis) can be caused by this.

If the child feels sick again 1-2 weeks after the scarlet fever, the pediatrician must rule out such a secondary disease.

Epidemiology

At the Scarlet fever the frequency peak of the disease is between the ages of 3 and 10. In the main season from October to March, scarlet fever occurs in community facilities such as Schools or kindergartens permanently before (Endemic).

This is due not least to the fact that in the winter months 20% of the population are healthy carriers of the scarlet fever bacterium (Streptococcus Pyogenes) and the infection can thus occur undetected.

Symptoms of scarlet fever

After the scarlet pathogens are absorbed into the body via droplet infection, it takes about 2-8 days for the disease to break out in the child (incubation period). Scarlet fever usually starts with a sudden high fever above 38.5 ° C, which can cause the child to have chills, headaches and feel very sick. Nausea, vomiting and loss of appetite are common accompanying symptoms. Furthermore, a child with scarlet fever has a fiery red (scarlet) throat and pain when swallowing (Tonsillopharyngitis), as well as a reddened soft palate (Enanthem). The almonds (Tonsils) are swollen, reddened and have white-yellowish pus spots (Stipple).
Read more about the topic here: Swollen tonsils

If you palpate the neck region and neck of a child with scarlet fever, you will usually find swollen lymph nodes, which are a sign that the body's own defenses are highly active. From the 2nd day of illness, a red skin rash (rash after fever) typically appears with pin-head-sized, dense, non-overlapping (non-confluent) spots that are slightly raised and therefore feel like sandpaper. As a rule, the rash does not itch and spreads from the groin area upwards over the entire trunk of the child towards the neck.

After about 4 days (2-6 days) the rash will fade and flaking of the skin may occur afterwards. The child's palms and soles are particularly affected. This peeling of the skin happens in coarser skin platelets (Slats) and occurs about 1 to 6 weeks after the onset of the disease, but not in every child with scarlet fever. Another characteristic of scarlet fever is that the child may have intensely reddened cheeks, but the area around the mouth is pale (perioral pallor, facies scarlatinosa).

On the 4th day of illness, another characteristic of scarlet fever appears: the strawberry or raspberry tongue. If the child's tongue is still white at the beginning of the scarlet fever, the red inflamed tongue buds (papillae) now appear and give the tongue its strawberry or raspberry-like appearance.

Further information on the topic can be found here: The scarlet tongue

The rash in scarlet fever is usually not itchy. This is what sets it apart from other rashes, such as rubella, chickenpox or an allergic rash.

Find out more about the Symptoms of scarlet fever.

Rash on the face

Scarlet fever is one of the well-known childhood diseases. It is characterized by a high fever, sore throat, headache and vomiting. The so-called is also typical of scarlet fever "Scarlatiform rash". This is a rash that is typical of scarlet fever, which begins on the face and shows a very characteristic expression there. The rash appears on the face about 48 hours after the onset of the disease.Reddened cheeks with a cutout of the area around the mouth, which is known as perioral pallor, are typical. This rash on the face is also called "Facies scarlatinosa" designated. The rash is finely spotted, pale red in appearance. After a day or two, the fine spots flow together to larger areas in some places and turn scarlet. If you put pressure on the affected areas, the rash will fade a little for a few seconds. In the 2nd to 4th week of the disease, the skin on the face flakes off.

Rash in the groin

The severity of the rash in scarlet fever is usually most pronounced in the groin. It typically begins on the face and spreads over the trunk of the body to the groin and other joints. At the beginning, the fine-spotted rash is pale red. After about two days, it turns a dark red color, also known as scarlet red. The rash is slightly raised above the skin level, also known as papular. As a simple comparison, you can imagine the rash as kind of goosebumps. In principle, the rash can spread to the whole body. In contrast to other childhood diseases such as rubella, measles or chickenpox, you can see a strong emphasis on the rash in the groin, armpits and face.

Read more about the topic here: Scarlet fever rash

Red spots on the palate - an indication of scarlet fever?

Especially when adults are sick with a scarlet fever infection, it can happen that not all symptoms occur as in children.
Sometimes only reddish spots are visible in the area of the palate and cheek mucosa. Here it may be necessary to have a smear taken to check whether there is actually a scarlet fever disease.
In general, however, scarlet fever is only rarely associated with reddening of the palate. As a rule, the reddish spots in the area of the palate become visible after the first rise in fever. Shortly afterwards these disappear again.

Please also read: Red spots in the throat

Scarlet fever on the tongue

About two days after the onset of the disease, which is characterized by an abrupt high fever, the scarlet fever enters the so-called "rash stage". This is the stage of the disease in which the typical rash of scarlet fever develops. As part of this, the scarlet fever is also expressed on the tongue. The tongue is inflamed and therefore swollen and red. The fine papillae of the tongue protrude, so that, because of the resemblance to a strawberry, one can see a "Strawberry tongue" speaks. The term “raspberry tongue” is also often found. At the beginning you can still see whitish coatings on the tongue, which gradually disappear under the reddened skin.

causes

Scarlet fever is caused by a bacterium that Streptococcus pyogenes is called and belongs to the group of A streptococci (GAS) is counted. This pathogen usually leads to a Tonsillitis (Tonsillar angina), as group A streptococci secrete substances (Toxins) that affect the tissue in the throat and tonsils (Tonsils) damage. This is accompanied by severe redness, pain and fever. The rash that typically occurs in scarlet fever (Rash) comes about when a virus (Bacteriophage) nests in the bacterium and a poison (erythrogenic toxin) is formed. This poison activates the body's own defense cells, which substances (Cytokines) that reduce the permeability of blood vessels (Vascular permeability) increase. The red blood cells (Erythrocytes) emerge from the veins into the skin and lead to the reddening of the skin that is typical of scarlet fever. Not all children are sensitive to this poison, so it is also possible for the disease to progress without a scarlet rash.

Since there are many different variants of the poison (erythrogenic toxin) and also the bacterium (Streptococcus pyogenes) occurs in several forms, it is possible to select several times Scarlet fever to get sick.

Pathogen

Scarlet fever is caused by bacteria known as streptococci. Strictly speaking, it is the so-called group A streptococci that also cause scarlet fever, among other things. These bacteria produce special toxins, bacterial poisons, that lead to the disease. In the course of a systemic reaction caused by the bacterial poison, the various symptoms of scarlet fever occur. A systemic reaction has to be imagined in such a way that the whole immune system reacts to the bacterium and its toxin. Group A streptococcal infection can be treated well with the antibiotic penicillin.

diagnosis

The pediatrician recognizes the disease Scarlet fever easily by their typical symptoms: the child has febrile tonsillitis in combination with a red-spotted rash and strawberry / raspberry tongue. If these features are recognizable, no further diagnostic measures are normally necessary. However, if the examination results are not so clear, various tests can be carried out to confirm the diagnosis of scarlet fever.

To rule out the possibility of a condition other than scarlet fever (e.g. rubella, measles) the cause of the rash (Exanthema), the doctor presses the spots with a transparent spatula (glass spatula): with scarlet fever, the reddening disappears under the slight pressure and the skin below appears yellowish (Subicterus). The doctor can also take a throat swab through which the typical streptococci (GAS) can grow and thus prove. It may be necessary for the pediatrician to draw blood from the sick child because a blood test will show signs of bacterial inflammation. It can also be checked whether the defense system (immune system) the child actively takes action against the streptococci: the so-called. A.nti-S.treptolysinTiter (ASLAntibodies). A typical component of the streptococcus bacteria (Streptolysin) is recognized by the body's own defense cells and defense substances (antibodies) are formed against them in order to destroy the bacterium. These substances can be measured in the child's blood and, depending on how much they are in the blood, one can assess whether the child's immune system is currently active against these bacteria and whether there is a streptococcal infection. The direct detection of streptococcal components (antigens) in the blood is also possible, but normally not necessary.

Scarlet fever rapid test

The so-called streptococcal A rapid test is used to reliably detect the causative agent of scarlet fever. To carry out the test, throat secretions are applied to a ready-made rapid test. The result can be read after a few minutes. A positive result makes the presence in combination with the typical symptoms very likely. A negative result, on the other hand, does not definitely rule out scarlet fever. The streptococcal A rapid test is particularly well suited to confirm the diagnosis of special forms of scarlet fever.

Also read: Scarlet fever test

infection

Scarlet fever is one Infectious disease which primarily affects children between the ages of four and seven. However, it can also occur in adulthood. There are no vaccination against scarlet fever, the disease can occur more than once in a lifetime.

The contagion occurs about bacteria the one Beta-hemolytic streptococci names, they belong to Lancefield group A. If these bacteria have specialized viruses, so-called bacteriophages, the full clinical picture occurs because the bacteriophages produce a scarlet fever toxin. If the bacteria have no specialized viruses, the full clinical picture does not occur, but "only" a purulent one Tonsillitis.

Those who specialize alone have it Viruses no disease value.

The infection takes place via Droplet infection, Smear infection, Mouth and throat contact. So the bacteria can be transmitted through sneezing, coughing and speaking. But they can also enter the body through open wounds and Scarlet fever trigger. There are also disease carriers who do not fall ill themselves, but can transmit the disease.

The disease can occur several times in life as there are different types of specialized viruses.

Therapy of scarlet fever

Since scarlet fever is a disease caused by bacteria (streptococci), a sick child is treated with an antibiotic.

The antibiotic penicillin works best against streptococci. This antibiotic damages the cell wall of the streptococci and thus destroys them.

Is there e.g. If there is an intolerance to penicillin, there are other effective antibiotics (cephalosporins, macrolides).

The treatment of scarlet fever with penicillin lasts 10 days and should not be stopped earlier, as otherwise the risk of the child developing a secondary disease (rheumatic fever, glomerulonephritis) is increased.

After 1-2 days of medication, the fever should have subsided and the child should feel much better.

If this is the case, the child can return to public facilities such as kindergarten or school 48 hours after the start of therapy, as it is no longer contagious.

Read more on the topic: Treatment of scarlet fever

incubation period

Scarlet fever is a highly contagious but not dangerous disease. It is hardly possible to protect siblings from the disease, as the incubation period is a few days. The incubation period is the time between infection and the onset of a disease. The incubation period for scarlet fever is around two to four days, depending on the literature. Then the first symptoms appear. These include fever, chills, sore throat, and rashes. Children of kindergarten and school age are most frequently affected, i.e. around the age of four to seven years.

Without treatment, children and adults are contagious for up to three weeks. In the case of severe scarlet fever, the risk of infection can increase or last longer. If antibiotic therapy begins shortly after the onset of the disease, the risk of infection is reduced to about one to two days.

You can also find out more at: This is how long scarlet fever usually lasts

prophylaxis

There is no vaccination against scarlet fever because the causative bacterium (Streptococcus pyogenes) occurs in too many different variants.

Long-term medical care to prevent a new illness (Reinfection prophylaxis) is only necessary if the child has the secondary disease rheumatic fever.

The affected child must then penicillin take in low doses over a period of at least 5 years. To avoid a late pathological change in the kidneys (Glomerulonephritis) not to be overlooked, the urine of a child with scarlet fever should be checked by the pediatrician 2 weeks after the onset of the disease.

Also read our topic: How often can you get scarlet fever?

vaccination

Scarlet fever is caused by bacteria known as group A streptococci. Unlike other childhood diseases such as measles, mumps or rubella, against which one can successfully vaccinate nowadays, this is unfortunately not possible with scarlet fever. There is therefore no immunity. You can get scarlet fever several times in the course of your life, as even having passed through an infection does not make you immune to the disease.

Read more about the topic here: Vaccination against scarlet fever

forecast

Scarlet fever is a common contagious disease that occurs especially in childhood. Since the course of the disease is usually uncomplicated, complications rarely occur, and antibiotic treatment is simple and effective, the prognosis is very good. The majority of children suffering from scarlet fever are healthy again within a short time and do not develop any secondary diseases. However, it forms as a result of infection with the scarlet fever bacterium (Streptococcus pyogenes) kidney disease (Glomerulonephritis) or rheumatic fever, the prognosis is correspondingly worse and a longer and more severe course of the disease must be expected. It is therefore all the more important to take the antibiotic prescribed by the pediatrician strictly according to the guidelines, because continuous penicillin therapy over 10 days can largely prevent the occurrence of secondary diseases.

In contrast to childhood illnesses caused by viruses, such as Chickenpox (Varicella), a person can get scarlet fever several times in a lifetime.

A scarlet fever illness does not offer permanent protection against infection (immunity). In 1-4% of the cases there is a second disease of scarlet fever.

You might also be interested in: Complications of scarlet fever

Duration of the rash

The scarlet fever rash will fade after about three to four days. However, it can take up to a week for the rash to go away. After about two to four weeks, the skin flakes off.

Scarlet Fever in Pregnancy

Most people get scarlet fever at least once during their childhood. Scarlet fever is one of the typical teething problems. However, an infection that has passed through does not lead to immunity, as is the case with some other diseases. Therefore, even if you have had scarlet fever in your lifetime, there is still a risk of a new infection during pregnancy. The risk is particularly high in community facilities such as kindergartens, schools or the like. However, unlike other diseases, scarlet fever is not directly dangerous to pregnancy. It does not lead to malformations in the child or to pregnancy complications. Nevertheless, pregnant women should always be examined by a doctor if they feel sick or have symptoms in order to ensure good care. It is important that scarlet fever is treated with an antibiotic, namely penicillin, in order to prevent secondary diseases. Unlike scarlet fever, these could be dangerous for pregnancy. Basically, however, scarlet fever is not a cause for concern and secondary diseases hardly occur at all in industrialized nations thanks to the highly effective drugs.

Special features of the baby

Scarlet fever primarily affects children between the ages of four and ten years. Scarlet fever in babies is extremely rare. However, babies can also develop scarlet fever. The risk of infection from siblings in toddler age who are sick with scarlet fever is therefore definitely present. Basically, scarlet fever expresses itself in babies in the same way as it does in toddlers or adults. As babies are unable to communicate their complaints, parents should be particularly careful. In addition to the typical symptoms of scarlet fever, such as the rash, thick tonsils, fever and chills, babies can show other signs. These include general restlessness and reluctance to drink. If there are signs of illness, you should take your child to the pediatrician. They can diagnose the scarlet fever and treat it with the appropriate antibiotic, penicillin. Penicillin is also well tolerated by babies and can therefore be used to treat scarlet fever.

Read more about the topic here: Scarlet fever in the baby

Summary

A child becomes infected with scarlet fever by passing small droplets of Body fluids (e.g. saliva) from a sick person (droplet infection). After the pathogen has been absorbed, it takes about a week (2-8 days) for the disease to break out (incubation period). At the Scarlet fever are typical disease characteristics that the child suddenly has high fever Has, Sore throat and a headache expresses himself and feels very sick. Soon after, a rash with small red spots that may be itchy will develop from the lower trunk. The doctor shows a pronounced purulent Inflammation of the tonsils and a strong reddening of the Throat.

After taking one Antibiotic the child soon feels better, is usually no longer contagious 24 hours after the start of therapy and it is after about a week Scarlet fever completely healed.

With this very common childhood disease, complications such as a Myocarditis (Myocarditis), one Otitis media (Otitis media) or a collection of pus behind the tonsils (Pertonsillar abscess). Secondary diseases such as acute rheumatic fever or Kidney disease (Glomerulonephritis) occur, but are not common either.