Scarlet Fever (Scarlatina)

Scarlet fever, a contagious childhood disease, usually begins with an acutely sore throat that is caused by a particular strain of streptococci bacteria. If allowed to progress, the bacteria produce a toxin that quickly spreads throughout the body and causes the symptoms that give scarlet fever its name: a high temperature accompanied by a red speckled rash and strawberry colored tongue.

In typical cases, the rash extends from the chest and arms to the lower abdomen and the legs, increasing in redness in the skin folds of the groin, armpits, and inner elbow. The reddened area turns pale when pressure is applied, and the skin itself, which has the rough texture of sandpaper, peels. The skin may continue to flake or peel for several weeks after the infection has been controlled.

At one time, scarlet fever was quite common, but today it is relatively rare because of the widespread use of antibiotics to treat strep infections. The disease is contagious from about 24 hours before any symptoms appear until two weeks after the rash disappears, especially if there are lingering complications, such as a middle ear infection or a sinus infection.

Diagnostic Studies and Procedures

A doctor can diagnose scarlet fever on the basis of the characteristic rash and strawberry colored tongue and by inspecting the inflamed throat and tonsils. It may be necessary to have a throat culture done to verify the presence of streptococcal infection. When a child is known to have been exposed to a strep infection from other family members or close associates, a throat culture is considered advisable, even if symptoms have not yet developed. If the result is positive, prompt antibiotic treatment at this point can prevent the onset of scarlet fever.

Medical Treatments

Penicillin is the antibiotic of first choice for treating scarlet fever, but if the patient is allergic to it, erythromycin or a similar broad-spectrum antibiotic is an effective alternative. To prevent ear infections and other potentially serious complications, the full course of medication -- usually 10 days -- must be completed. Sometimes, a single large dose of the antibiotic is given by injection instead of having the patient take daily pills. If severe complications such as pneumonia or meningitis develop, hospitalization and intravenous antibiotics are usually necessary.

Alternative Therapies

Alternative therapies cannot substitute for antibiotic treatment of a strep infection, but they are useful for reinforcing medical treatment or reducing the risk of its side effects.

Herbal Medicine. To ease the discomfort of a sore throat, herbalists often recommend gargles and teas made of eucalyptus, red sage, fenugreek, or horehound. Fervain or feverfew tea is said to reduce fever. Garlic and goldenseal have mild antibacterial properties, and may be advised to augment therapy with antibiotics. Both are available either as capsules or powders, but some herbalists recommend chewing a fresh clove of garlic.

Naturopathy and Nutrition Therapy. Sucking on zinc lozenges alleviates a sore throat. Some nutritionists advocate supplements of vitamin C and beta carotene, a precursor of vitamin A, to build resistance against further infection. Others feel that including ample foods in the diet that are high in these nutrients, especially fresh fruits and vegetables, is preferable to supplements.

Self-Treatment

The child should be kept in bed until the rash and sore throat abate. Ask your doctor about giving acetaminophen to lower the fever and reduce the pain of swallowing. Aspirin is a safe medication when a child has a bacterial infection, but when given for a viral infection, it has been associated with Reye's syndrome, a life-threatening condition affecting the brain and liver. Many doctors advise not giving aspirin to anyone under age 18 unless there is a compelling reason, such as the presence of juvenile rheumatoid arthritis, to use it.

Sponge baths with lukewarm water also help lower a high temperature. Do not use rubbing alcohol, however, because its fumes are potentially harmful and some of the substance can be absorbed through the skin.
Gargling with warm salt water is a time-honored home remedy for a sore throat. Chicken soup and other broths can ease a sore throat and help prevent dehydration from a high fever as well. Sorbet, gelatin, and similar smooth, cold foods are also soothing to a sore, inflamed throat. In general, bland, soft foods are recommended.

When a child's temperature returns to normal, bed rest is not necessary, but quiet activities should be encouraged until she recovers completely. A doctor should be consulted about when the child can return to school without spreading the infection to others.

It is possible to contract scarlet fever and other strep infections more than once, so children should always be monitored for sore throat, rash, and other signs of illness after contact with someone who has the infection.

Other Causes of Scarlet Fever Symptoms

Rheumatic fever, also a complication of strep throat, can cause inflammation of the joints, nerves, and heart. Measles and rubella produce red rashes and perhaps a sore throat, but these are viral infections that a doctor can easily distinguish from scarlet fever, juvenile rheumatoid arthritis sometimes starts with a rash, sore throat, and fever, but the tongue is not bright red.