What is Scarlet Fever?

Scarlatina is the scientific name of scarlet fever.  Today, Scarlatina is commonly used to refer to the less acute forms of the disease, which is an illness caused by the exotoxin produced by streptococcus pyogenes.  It used to be a major cause of death worldwide but can now be easily controlled through effective treatment with antibiotics.  Since the beginning of the twentieth century, only minor outbreaks of the disease have been documented.

Scarlet fever is typically accompanied by sore throat, high fever, bright red tongue with strawberry-like manifestation and a characteristic rash.  The rash possesses the following distinct characteristics:

• It is fine, red in color and has a rough sandpaper-like texture; it also blanches when put under pressure.
• It usually appears around 12 to 48 hours after contacting fever. It is more common to children below mid-teens.
• The rash usually starts on the chest, underarms, and behind the ears, but no appearances on the face.
• The rash is worse in skin folds and may run together in the groin and armpit areas.  When this happens, the Pastia lines may appear and can linger even after the rash is gone. It may also spread to infect the uvula.
• Typically, the rash starts to fade 3 to 4 days after the onset and this marks the start of desquamation (peeling process).  The phase starts with peeling from the face followed by peeling from the palms and the fingers about a week later.  Desquamation may also occur in the axilla, the groin area and on the finger and toe tips.

Diagnosis for the disease is clinical where the blood test will show significant leukocytosis with neutrophilia and increased eosinophils. There is also a high erythrocyte sedimentation rate (ESR) and Creative protein (CRP), and an increase in antistreptolysin O titer.  Although blood culture is very seldom positive, streptococci may appear in throat culture.

Complications of the disease may include septic complications that happen because of the spread of streptococcus in the blood, and immune-induced complications because of an immune response aberration.  Very rare today, septic complications that appear in malignant cases of the disease include ear and sinus infections, streptococcal pneumonia, empyema throracis, full blown sepsis, and meningitis.  Immune complications, on the other hand, include acute cases of glomerulonephritis, rheumatic fever and also erythema nodosum.

The secondary malignant syndrome of the illness (scarlatinous disease) is accompanied by heightened fever, renewed angina, septic ear, nose and throat complications, and rheumatic fever.  These are seen around the eighteenth day of an uncured and unattended scarlet fever.

Treatment

Except for the diarrhea symptom, the course of scarlet fever is similar to that of any strep throat case.  The treatment is the same.  Penicillin is more commonly prescribed.  However, for people with penicillin allergies, clindamycin or erythromycin may be used to achieve the same results.  Within 24 hours after taking antibiotics, a patient is no longer infectious.

For people who are exposed to the disease, they must be observed for a full week for symptoms.  This is especially important for children aged 3 to 15.  Testing (throat culture) must be done and if found positive, proper treatment must be applied.

History

In 1924, the husband and wife tandem of Gladys Henry Dick and George Frederick Dick developed a vaccine for the then dreaded infectious disease.  The vaccine was used for treatment until the 1940’s when penicillin was discovered.  To this day, penicillin is still used for the management and treatment of scarlet fever.

Statistics

Mortality – Around 5 deaths are reported every year.

Hospitalization Statistics

• 0.0021% of consultations for symptoms turn out positive.
• 97% of positive results require hospital admission.  96% are emergency cases.
• Around 47% of all consultations recorded are for men and 53% for women.
• The mean days for hospital stay is 1.3 days.  Median length is 1 day.
• Median age of patients is 6 years.
• 6% of consultations are for people aged 15 – 59 years.  No episodes occur for people over 75 years old.