Scarlet Fever – Symptoms and Causes

Overview

Scarlatina, also known as scarlet fever, is a bacterial condition that may develop in individuals with strep throat. This illness is marked by a distinctive bright red rash that spreads across most of the body.

People with scarlet fever typically experience a sore throat and a high fever.

The red rash usually starts on the face or neck before spreading to the chest, trunk, arms, and legs. Children between 5 and 15 years old are most commonly affected by this condition.

While scarlet fever was once considered dangerous, modern antibiotic treatments have made it much less threatening. However, without proper treatment, it can lead to more serious complications affecting the heart, kidneys, and other body systems.

Signs and Symptoms

Scarlet fever has several distinct signs that make it recognizable. The most noticeable symptom is a red, sunburn-like rash that feels rough, like sandpaper, when touched.

This rash typically starts on the face or neck before spreading to the chest, arms, and legs. When pressed, the reddened skin turns pale.

Some body areas develop deeper red lines, especially in skin folds around the groin, armpits, elbows, knees, and neck. The face often looks flushed, with a pale ring around the mouth.

Another sign is “strawberry tongue,” which appears red, bumpy, and sometimes has a white coating in the early stages of the illness.

Other symptoms include:

• Fever of 100.4°F (38.0°C) or higher, often accompanied by chills
• Very sore, red throat, sometimes with white or yellowish patches
• Trouble swallowing
• Swollen, tender neck glands
• Nausea or vomiting
• Stomach pain
• Headache and body aches

The rash and redness on the face and tongue usually last about a week. After these symptoms go away, the affected skin often peels.

When to Contact a Healthcare Provider

It’s important to seek medical help if your child has a sore throat along with:

• Fever of 100.4°F (38.0°C) or higher
• Swollen or tender neck glands
• Red rash

Warning Signs Requiring Immediate Medical Attention

Some symptoms indicate a need for emergency care. Get help right away if your child shows:

• New breathing problems while resting
• Struggling to breathe (pulling in chest muscles, flaring nostrils)
• Wheezy or raspy breathing that doesn’t improve with coughing
• Fast breathing
• Chest pain
• Problems swallowing liquids or saliva
• Muffled voice or inability to fully open mouth
• Confusion or unusual tiredness
• Dizziness when sitting or standing
• Drooling (in children 3 years or older)
• Severe or continuous vomiting or diarrhea
• Signs of dehydration

For babies under 2 months old, also seek emergency care if they:

• Cannot be comforted
• Have breathing that stops and starts
• Have a temperature below 96.0°F (35.5°C) or above 100.4°F (38°C)

Early medical attention can prevent serious complications and help your child recover faster.

Causes

Scarlet fever develops from an infection with group A streptococcus bacteria—the same bacteria responsible for strep throat.

These bacteria can release toxins when they infect someone, leading to the red rash and “strawberry tongue” associated with the illness.

The infection spreads through respiratory droplets. When someone with the infection coughs or sneezes, they release tiny droplets containing bacteria into the air.

People can get sick by inhaling droplets or touching surfaces where they land, then touching their mouths or noses. After exposure to the bacteria, it typically takes 2 to 4 days for symptoms to appear.

Risk Factors

Children ages 5 to 15 face a higher risk of getting scarlet fever compared to other age groups. The disease spreads more easily in settings where people have close contact with each other, such as:

• Family homes
• Child-care centers
• School classrooms

Scarlet fever typically follows a strep throat infection, though it can sometimes develop after skin infections like impetigo. Having scarlet fever once does not prevent future infections; it can occur multiple times in a person’s life.

Possible Problems

Untreated scarlet fever can cause the bacteria to spread throughout the body. The infection may reach several important areas, including:

• Tonsils
• Blood
• Skin
• Middle ear
• Sinuses
• Lungs
• Heart
• Kidneys
• Joints
• Muscles

Scarlet fever can sometimes lead to rheumatic fever, a serious inflammatory condition that affects the heart, joints, nervous system, and skin.

Researchers have proposed a link between strep infections and PANDAS (pediatric autoimmune neuropsychiatric disorders associated to group A streptococci).

Children with this condition may have intensified symptoms of neuropsychiatric issues, such as obsessive-compulsive disorder or tic disorders, following a streptococcal infection.

This connection remains unproven and is still debated among medical experts.

Prevention

No vaccine exists for scarlet fever prevention. The best approach involves following standard infection prevention practices.

Proper hand hygiene is essential. Teach children to wash their hands thoroughly with warm, soapy water for at least 20 seconds. When soap and water aren’t available, alcohol-based hand sanitizers can be effective alternatives.

Refrain from exchanging personal belongings. Children should not share drinking glasses, eating utensils, or food with friends or classmates.

Practicing proper respiratory etiquette significantly reduces the spread of germs. Instruct children to cover their mouths and noses when coughing or sneezing to prevent germs from spreading to others.

If a child has scarlet fever, take extra cleaning precautions. Wash all drinking glasses and utensils in hot, soapy water, or use a dishwasher after each use to prevent the spread of infection.