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Scarlet fever: symptoms and therapy

by Josephine Andrews
Published: Last Updated on 179 views

Scarlet fever (Scarlatina) is a very contagious infectious disease. The causative bacteria are transmitted via the smallest droplets of saliva and can cause a sore throat, skin rash and fever. Here you can read more about the topic: What exactly is scarlet fever? How does the infection occur? How long is the scarlet fever incubation period? What are the symptoms? How is scarlet fever treated?

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.


quick overview

  • Important symptoms : sore throat, tonsillitis with redness, swelling, pain; Pallor around the mouth (perioral) and “raspberry tongue” (bright red colored tongue), characteristic rash (small-spotted papules, starting on the upper body, then all over the body except the palms and soles)
  • Infection : mostly via droplet infection (via sneezing, coughing , speaking) or smear infection (use/touch of contaminated objects and surfaces)
  • Checks : Throat exam , rapid scarlet fever test, blood tests for bacteria and antibodies
  • Treatment : bed rest, gargling , painkillers and antipyretics ( paracetamol , ibuprofen ), antibiotics
  • Complications and long-term effects : abscess of the tonsils, pneumonia, otitis media , sinusitis, acute nephritis , rheumatic fever , inflammation of the inner lining of the heart ( endocarditis ) and inflammation of the heart muscle (myocarditis)

Scarlet fever: symptoms

Scarlet fever symptoms first appear about one to three days after infection with the causative bacteria (scarlet fever incubation period). The disease almost always begins suddenly out of the blue. Common symptoms of scarlet fever include:

  • Sore Throat
  • difficulties swallowing
  • often high fever
  • chill
  • flushed cheeks
  • exhaustion
  • Vomit
  • abdominal pain (especially in younger children)
  • headache and body aches

However, signs like these are not clear and can also occur with many other diseases. Only typical scarlet fever symptoms bring certainty: In addition to raspberry tongue and a characteristic rash , this includes scarlet fever angina, an inflammation of the tonsils .

There are also people who get scarlet fever without a fever or rash. Elderly patients in particular often do not show all the typical scarlet fever symptoms. In general, the disease is easily overlooked in adults.

Three characteristic scarlet fever symptoms
A raspberry-red tongue, the typical scarlet fever rash, and inflammation of the throat and tonsils are the three main symptoms of scarlet fever.

scarlet angina

Almost everyone with scarlet fever develops tonsillitis (angina tonsillaris). None of the other scarlet fever symptoms occur as regularly as this one. The reason for this is that the scarlet fever pathogens colonize the pharyngeal mucosa. This can inflame the tonsils – and the entire throat. These areas are then reddened, the tonsils are usually significantly swollen and sometimes covered with a white layer.

Other scarlet fever symptoms in the mouth are small, white plaques on the inside of the cheeks. The neck lymph nodes are also often swollen . These scarlet fever symptoms are similar to the signs of common tonsillitis.

raspberry tongue

Raspberry tongue is one of the specific scarlet fever symptoms. First, the tongue is covered with a white layer. This layer disappears after about four days, revealing a raspberry-red tongue.

scarlet rash

Scarlet fever rash develops on the first or second day of illness: pinhead-sized, bright red, slightly raised spots (papules) appear that are rough to the touch but not itchy. The scarlet fever rash often first appears in the groin and inner thighs. As a result, it then spreads over the entire body. Only a small triangle between the mouth and chin as well as the soles of the feet and the palms of the hands are left out.

After six to nine days, the rash will slowly disappear. As a result, the skin often begins to flake – including on the soles of the feet and palms of the hands.

Rash on scarlet fever
One of the typical symptoms of scarlet fever is the characteristic skin rash.

Scarlet fever: complications and late effects

Scarlet fever symptoms usually improve very quickly with antibiotic therapy. Without treatment, however, the scarlet fever symptoms can last longer and may also be more serious: some patients develop severe purulent tonsillitis . An abscess results from encapsulation of the pus . Sometimes an accompanying purulent middle ear infection ( otitis media ) occurs. A possible consequence of missing treatment is hearing loss .

The germs from the pharynx can not only get into the middle ear , but also into the paranasal sinuses or lungs . Then a sinus infection ( sinusitis ) or pneumonia ( pneumonia ) can develop – in addition to the scarlet fever symptoms mentioned above.

The septic course of scarlet fever is very rare, but potentially life-threatening : the scarlet fever bacteria penetrate the bloodstream and spread throughout the body. “Blood poisoning” (sepsis) develops with sudden high fever, vomiting, diarrhea, bleeding from the skin and mucous membranes, clouding of consciousness, severe heart damage and shock

A possible late complication of scarlet fever is acute rheumatic fever . It occurs mainly in patients between the ages of three and fifteen years, usually after a symptom-free period of 19 days. Various joints or organs (such as the heart ) become inflamed in those affected . Acute kidney inflammation ( glomerulonephritis ) can also develop as a late consequence of scarlet fever (in the case of throat infections after one to five weeks, in the case of skin infections after three weeks).

Scarlet fever: contagion

Scarlet fever is caused by infection with certain streptococcal bacteria. This is “Streptococcus pyogenes”, also known as Group A streptococci. The germs attach themselves primarily to the mucous membrane in the mouth and throat area and can cause inflammation here. They also produce toxic metabolic products (toxins) that cause the typical skin changes.

How is scarlet fever transmitted?

The scarlet fever bacteria are found in the saliva of patients. They are transmitted from person to person by direct or indirect contact, more rarely by coughing, sneezing or speaking, packed in tiny droplets of liquid. Other people nearby can inhale these droplets and thereby become infected with scarlet fever ( droplet infection ). People who have close contact with scarlet fever patients are particularly at risk. The infectious disease therefore often spreads in community facilities such as kindergartens or schools.

If patients cover their mouths when coughing or sneezing, the droplets containing the bacteria end up on the palms of the hands From there they can be transferred to objects such as cutlery or doorknobs. If a healthy person uses the same cutlery or touches the contaminated objects and then puts his hand to his mouth or nose , he can also become infected with scarlet fever ( smear infection ).

Only very rarely does scarlet fever occur through contaminated food or water ( food infection ).

Occasionally, the scarlet fever pathogens penetrate the body through skin wounds ( scarlet fever ).

Cough secretion as a source of infection
Cover your mouth when you cough? Not a good idea! This is how you spread the bacteria and others can get infected.

How long is scarlet fever contagious?

With an acute streptococcal infection such as scarlet fever that is not specifically treated, patients can be contagious for up to three weeks. In the case of purulent excretions, the risk of infection can exist even longer without treatment.

However, once effective antibiotic treatment has been initiated, patients are no longer contagious after 24 hours.

Can you catch scarlet fever more than once?

It doesn’t matter whether scarlet fever is treated or not – after surviving the disease you are not immune to re-infection! In the course of an infection, the body forms a certain amount of protection against certain bacterial toxins. However, there are different strains of scarlet fever, so that an affected person can become infected several times. If, on the other hand, a person is attacked a second time by the same pathogen strain after a previous scarlet fever infection, it is highly unlikely that he or she will develop scarlet fever, but at most tonsillitis (angina tonsillaris).

By the way: Not everyone who carries the scarlet fever pathogen also falls ill. In up to 20 percent of the population, the throat is colonized with the bacteria, but there are no symptoms.

Scarlet fever in children and adults

As a childhood disease, scarlet fever is more common in children than adults. It is most common in children between the ages of six and twelve. In principle, scarlet fever can occur at any age. Only infants are relatively safe from infection because they carry corresponding antibodies from their mother (“nest protection”).

Scarlet fever in adults is often not recognized or only recognized late: In the event of a sudden fever, sore throat and difficulty swallowing, many do not think about the possibility of being infected with the pathogen of the “childhood disease” and do not go to the doctor at all or only too late. Under certain circumstances, this can have serious consequences: scarlet fever in adults, as in children, can cause complications and long-term effects such as rheumatic fever and heart and kidney inflammation.

Scarlet fever: pregnancy

If a pregnant woman falls ill with scarlet fever, then at first there is no particular cause for concern. The disease has no direct impact on the unborn child. In contrast to other childhood diseases such as rubella , mumps or measles , there is no specific risk of childhood malformations, miscarriage or stillbirth .

Indirectly, however, scarlet fever during pregnancy can have a negative effect on the child: if the expectant mother develops complications such as inflammation of the heart muscle, this can impair the supply of oxygen and nutrients to the unborn child and thus impair child development.

Scarlet fever during pregnancy should therefore be treated with antibiotics at an early stage. In addition, the pregnant woman and her unborn child are medically monitored – as with all infectious diseases during pregnancy.

You can read more about this topic in the article Scarlet Fever and Pregnancy .

Scarlet Fever: Investigations and Diagnosis

The typical symptoms of the disease usually quickly lead the doctor to suspect scarlet fever. To be on the safe side, he first collects the medical history (anamnesis). He asks the patient (in the case of children: the parents), for example, when the fever started and whether people in the area are currently suffering from scarlet fever.

This is followed by a physical examination : the doctor checks whether the throat and tonsils are red, swollen or white. He also feels the lymph nodes in the neck. They may swell with scarlet fever. The doctor also looks at the skin all over the body. If there is a rash, he asks where it started and if it itches. A scarlet rash temporarily fades under pressure from a wooden spatula. Sometimes patients also develop a rash on the mucous membranes in the mouth.

Palpation of the lymph nodes
When taking anamnesis, the lymph nodes are palpated – often they swell with scarlet fever.

For a rapid scarlet fever test, the doctor takes a swab of the throat mucosa to examine it for streptococci. After just a few minutes, the result is clear. However, it is not entirely reliable: if the result is positive, there is a high probability of an infection with group A streptococci. However, a negative test result does not rule out such an infection with certainty. Then you can send the throat swab to the laboratory to cultivate any pathogens it may contain ( bacterial culture ) and then determine them.

The blood values ​​can also give indications of a scarlet fever infection. In general, when there is an inflammation, the white blood cells ( leukocytes ) and the blood sedimentation rate are often increased.

There is also the possibility of examining the patient’s blood for antibodies against the scarlet fever pathogen . However, this only makes sense if a secondary streptococcal disease such as rheumatic fever is suspected.

Scarlet fever: treatment

Scarlet fever therapy usually consists of the administration of an antibiotic . It allows the symptoms to subside a little faster and prevents complications. In addition, patients are no longer contagious to other people 24 hours after the start of antibiotic therapy.

Generally, scarlet fever is treated with penicillin . The antibiotic is given orally (as a tablet) or parenterally (as an injection). It must be used for ten days. Discontinuing the antibiotic earlier increases the risk of recurrence.

If someone is allergic to penicillin, scarlet fever therapy is done with another antibiotic. For example, cephalosporins and erythromycin are suitable.

In severe cases such as sepsis (blood poisoning), the antibiotic clindamycin should be administered in addition to penicillin injections .

In some patients, scarlet fever leads to rheumatic fever as a late effect. Those affected have an increased risk of reinfection with streptococcus A. Such relapses can be much more severe and worsen existing heart damage. Therefore, in rheumatic fever, prolonged treatment with penicillin is recommended to prevent recurrence. This recurrence prophylaxis should be carried out for at least five years.

Scarlet Fever Therapy: More Tips

  • Patients should be kept in bed , especially if they have a fever.
  • In the first two days of antibiotic therapy, patients should also avoid contact with other people . This reduces the risk of infecting others with scarlet fever. For the same reason, patients should always cough or sneeze into a handkerchief or into the crook of their arm and then wash their hands thoroughly with soap and water.
  • Gargling solutions with medicinal plants such as sage or marshmallow as well as warm neck wraps help against the unpleasant sore throat associated with scarlet fever (read more about the effect and use of wraps here ).
  • Because of the pain when swallowing, soft or liquid food is recommended. The diet should be low in salt and protein .
  • If patients have a fever, they should drink plenty of fluids . For example, lime blossom tea sweetened with honey is recommended. Water or diluted juices are also suitable.
  • If necessary, ibuprofen or paracetamol can also be taken to relieve the pain and fever . Both active ingredients relieve pain and reduce fever.
  • Antibiotic therapy can throw the intestinal flora off balance. To avoid this, yoghurt should be eaten regularly – albeit at a different time than antibiotic administration.

Sometimes homeopathy and other alternative healing methods are recommended to support the conventional medical treatment of scarlet fever. Anyone interested in this should seek advice from an experienced doctor or therapist.

The concept of homeopathy and its specific effectiveness are controversial in science and have not been unequivocally proven by studies.

Children and young people who are proven or suspected to have scarlet fever are temporarily not allowed to attend community facilities (such as kindergarten, school). Sick of employees such a facility are only allowed to go back to work when they are no longer contagious. The attending doctor or the health department decides on this.

Scarlet fever: course of the disease and prognosis

With early antibiotic therapy, the scarlet fever symptoms usually subside after a few days. In most cases, people recover completely once antibiotic treatment is completed.

Complications and late effects

In rarer cases, the childhood disease scarlet fever takes a severe course or has long-term effects. These include acute kidney inflammation (acute glomerulonephritis) and acute rheumatic fever . The latter can be accompanied by joint pain and inflammation of the inner lining of the heart (endocarditis), the heart muscle (myocarditis) or the pericardium (pericarditis). Rheumatic fever can also affect the brain and cause a form of movement disorder (chorea minor, syn. Sydenham).

The risk of complications and long-term consequences of contracting snoring can be reduced by treating with antibiotics at an early stage.

Scarlet fever: prevention

There is no vaccination against scarlet fever. But you can reduce the risk of illness in other ways: Avoid close contact with sick people and wash your hands regularly with soap. For people with serious underlying conditions or a weakened immune system, the doctor may prescribe a prophylactic antibiotic to protect them from contracting scarlet fever .

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