Scarlet Fever

This illness, characterized by high fever and a bright, red rash covering the entire body, occurs in conjunction with about 10 percent of cases of streptococcal respiratory infection, or strep throat. In general, the widespread use of antibiotics to treat strep throat has made scarlet fever less common than it was in the past, but occasional outbreaks still occur.

Like strep throat, scarlet fever is most common among children over the age of four. It generally spreads in school and household settings.

WHAT CAUSES SCARLET FEVER?
Scarlet fever is caused by a toxin that certain strains of streptococcal bacteria release when they infect the upper respiratory tract. It passes from person to person the same way strep throat does—through close contact between an infected and a noninfected person. When a child with the infection coughs or sneezes, bacteria-laden droplets are expelled. Children playing face to face, eating together, and sharing toys and eating utensils can easily pass strep infections back and forth.

WHEN SHOULD I SUSPECT THAT MY CHILD HAS SCARLET FEVER?
The first symptoms, which may develop suddenly, include a high fever, headache, abdominal pain, nausea and vomiting. Occasionally, abdominal pain and vomiting develop one or two days before the rash appears.

The rash, which consists of tiny, red bumps, begins on the trunk and spreads outward, covering the body in a matter of hours or days, giving the skin a rough sandpaper-like texture. Application of pressure makes the bumps disappear momentarily.

The rash generally spares the area around the mouth, although the lips (as well as the palms and the soles) frequently turn bright red. The tongue, too, undergoes characteristic changes, turning white (with small flecks of red) early in the course of the illness, then becoming swollen and red (strawberry tongue). In addition, deep, red streaks may appear in creases formed by joints—in the armpits and elbow crooks, as well as in the groin and behind the knees. Evidence of strep throat (sore, swollen tonsils covered by whitish-yellow material) is usually part of the picture.

IS MEDICAL ATTENTION NECESSARY?
Yes. It is important to get an accurate diagnosis of strep infections and scarlet fever, since many other conditions can cause similar symptoms. If a strep infection is present, antibiotic therapy is necessary to prevent complications, such as rheumatic fever.

HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS SCARLET FEVER?
The pediatricians may suspect a strep infection if other cases of strep throat or scarlet fever recently have occurred in the community. To be sure of the diagnosis, she will take a throat culture. In this test, a cotton swab is rubbed against the back of the child's throat to remove secretions, which are then placed on growth medium and, after 24 hours, examined under a microscope for the presence of strep bacteria.

WHAT TREATMENTS ARE AVAILABLE?
Penicillin is the drug of choice for children with scarlet fever. Once the bacteria are wiped out, the toxin that causes scarlet fever will be eliminated as well. Children who are allergic to penicillin may be given erythromycin instead. Treatment is continued for 10 to 14 days even if the symptoms disappear earlier.

GETTING HELP
Call your doctor if your child:

• Suddenly develops nausea, vomiting, and a red rash on the trunk

• Complains of a sore throat after exposure to strep in school or day care

Excerpt from THE DISNEY ENCYCLOPEDIA OF BABY & CHILD CARE, © 1995 DSH Communications, Inc. This material is based on current medical research and, to the best of the editors' knowledge and understanding, is accurate and valid. However the reader should not use information contained in this material to alter a medically prescribed regimen or as a form of self-treatment, without seeking the advice of a licensed physician.