Scarlet fever overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]


Scarlet fever is an exotoxin-mediated disease that occurs most often in association with a sore throat and rarely with impetigo or other streptococcal infections. It is characterized by sore throat, fever, a 'strawberry' tongue, and a fine sandpaper rash over the upper body that may spread to cover almost the entire body. Scarlet fever is not rheumatic fever, but may progress into that condition as the infection develops (rheumatic fever is an autoimmune disease that can occur after infection with Group A strep).

Scarlet fever is an infectious disease which most commonly affects 4-8 year old children. Symptoms include sore throat, fever and a characteristic red rash. It is usually spread by inhalation. There is no vaccine, but the disease is effectively treated with antibiotics.

Before the availability of antibiotics, scarlet fever was a major cause of death. It could also cause late complications such as glomerulonephritis and endocarditis leading to heart valve disease, all of which were protracted and often fatal afflictions at the time.

Scarlet fever is caused by erythrogenic toxin, a substance produced by the bacterium Streptococcus pyogenes (group A strep.) when infected by a certain bacteriophage.

The term scarlatina may be used interchangeably with scarlet fever, though it is most often used to indicate the less acute form of scarlet fever seen since the beginning of the twentieth century.[1]

Epidemiology and Demographics

Scarlet fever usually develops in children, just like colds or the flu are common in children. This disease is most common in 3-15 year olds with males and females being equally affected.[2] By the age of 10 years most children have acquired protective antibodies and scarlet fever at this age or older is rare.[3][dubious ]


Laboratory Findings

Diagnosis of scarlet fever is clinical. The blood tests shows marked leukocytosis with neutrophilia and conservated or increased eosinophils, high ESR and CRP , and elevation of antistreptolysin O titer. Blood culture is rarely positive, but the streptococci can usually be demonstrated in throat culture.

Medical Therapy

Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any strep throat. In case of penicillin allergy, clindamycin or erythromycin can be used with success. Antibiotic treatment is usually given. It has however never been shown to reduce the chance that rheumatic fever develops.


  1. Scarletina (Scarlet Fever)
  2. Czarkowski, M. P.; Kondej, B.; Staszewska, E. (2011). "Scarlet fever in Poland in 2009". Przegl Epidemiol. 65 (2): 209–212. PMID 21913461.
  3. Czarkowski, M. P.; Kondej, B. (2010). "Scarlet fever in Poland in 2008". Przegl Epidemiol. 64 (2): 185–188. PMID 20731219.

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