Strep Throat and Scarlet Fever

What is scarlet fever?
Scarlet fever is a disease caused by a bacteria called group A streptococcus, the same bacteria that causes strep throat. Scarlet fever is a rash that sometimes occurs in people that have strep throat. The rash of scarlet fever is usually seen in children under the age of 18.

How do you get scarlet fever?
This illness can be caught from other people if you come in contact with the sick person because this germ is carried in the mouth and nasal fluids. If you touch your mouth, nose or eyes after touching something that has these fluids on them, you may become ill. Also, if you drink from the same glass or eat from the same plate as the sick person, you could also become ill. The best way to keep from getting sick is to wash your hands often and avoid sharing eating utensils.

What are the symptoms of scarlet fever?
The most common symptoms of scarlet fever are:

A rash first appears as tiny red bumps on the chest and abdomen. This rash may then spread all over the body. It looks like a sunburn and feels like a rough piece of sandpaper. It is usually redder in the arm pits and groin areas. The rash lasts about 2-5 days. After the rash is gone, often the skin on the tips of the fingers and toes begins to peel.

The face is flushed with a pale area around the lips.

The throat is very red and sore. It can have white or yellow patches.

A fever of 101 degrees Fahrenheit (38.3 degrees Celsius) or higher is common. Chills are often seen with the fever.

Glands in the neck are often swollen.

A whitish coating can appear on the surface of the tongue. The tongue itself looks like a strawberry because the normal bumps on the tongue look bigger.
Other less common symptoms include:

Nausea and vomiting


Body aches

How is scarlet fever diagnosed?
Your doctor or health care provider will examine your child and swab the back of the throat with a cotton swab to see if there is a streptococcus infection.

What is the treatment for scarlet fever?
If the swab test (throat culture) shows that there is streptococcus, you will be given an antibiotic prescription for your child. Give this medicine exactly as you are told. It is very important to finish all of the medicine. Never share any of this medicine with family or friends. Ask your doctor or health care provider about over-the-counter medicine to lessen sore throat pain.

Is there anything else I can do to make my child feel better?
Warm liquids like soup or cold foods like popsicles or milkshakes help to ease the pain of the sore throat. Offer these to your child often, especially when he/she has a fever since the body needs a lot of fluid when it is sick with a fever. A cool mist humidifier will help to keep the air in your child's room moist which will keep the throat from getting too dry and more sore. Rest is important.

What should I do if I think my child has scarlet fever?
The best thing to do if you think your child may be ill is to call your doctor or health care provider.

What is group A streptococcus (GAS)?

Group A streptococcus is a bacterium often found in the throat and on the skin. People may carry group A streptococci in the throat or on the skin and have no symptoms of illness. Most GAS infections are relatively mild illnesses such as "strep throat," or impetigo. On rare occasions, these bacteria can cause other severe and even life-threatening diseases

How are group A streptococci spread?

These bacteria are spread through direct contact with mucus from the nose or throat of persons who are infected or through contact with infected wounds or sores on the skin. Ill persons, such as those who have strep throat or skin infections, are most likely to spread the infection. Persons who carry the bacteria but have no symptoms are much less contagious. Treating an infected person with an antibiotic for 24 hours or longer generally eliminates their ability to spread the bacteria. However, it is important to complete the entire course of antibiotics as prescribed. It is not likely that household items like plates, cups, or toys spread these bacteria.

What kind of illnesses are caused by group A streptococcal infection?

Infection with GAS can result in a range of symptoms:

No illness
Mild illness (strep throat or a skin infection such as impetigo)
Severe illness (necrotizing faciitis, streptococcal toxic shock syndrome)
Severe, sometimes life-threatening, GAS disease may occur when bacteria get into parts of the body where bacteria usually are not found, such as the blood, muscle, or the lungs. These infections are termed "invasive GAS disease." Two of the most severe, but least common, forms of invasive GAS disease are necrotizing fasciitis and Streptococcal Toxic Shock Syndrome. Necrotizing fasciitis (occasionally described by the media as "the flesh-eating bacteria") destroys muscles, fat, and skin tissue. Streptococcal toxic shock syndrome (STSS), causes blood pressure to drop rapidly and organs (e.g., kidney, liver, lungs) to fail. STSS is not the same as the "toxic shock syndrome" frequently associated with tampon usage. About 20% of patients with necrotizing fasciitis and more than half with STSS die. About 10%-15% of patients with other forms of invasive group A streptococcal disease die.

How common is invasive group A streptococcal disease?

About 9,400 cases of invasive GAS disease occurred in the United States in 1999. Of these, about 300 were STSS and 600 were necrotizing fasciitis. In contrast, there are several million cases of strep throat and impetigo each year.

Why does invasive group A streptococcal disease occur?

Invasive GAS infections occur when the bacteria get past the defenses of the person who is infected. This may occur when a person has sores or other breaks in the skin that allow the bacteria to get into the tissue, or when the person’s ability to fight off the infection is decreased because of chronic illness or an illness that affects the immune system. Also, some virulent strains of GAS are more likely to cause severe disease than others.

Who is most at risk of getting invasive group A streptococcal disease?

Few people who come in contact with GAS will develop invasive GAS disease. Most people will have a throat or skin infection, and some may have no symptoms at all. Although healthy people can get invasive GAS disease, people with chronic illnesses like cancer, diabetes, and kidney dialysis, and those who use medications such as steroids have a higher risk.

What are the early signs and symptoms of necrotizing fasciitis and streptococcal toxic shock syndrome?

Early signs and symptoms of necrotizing fasciitis;

Severe pain and swelling
Redness at the wound site
Early signs and symptoms of STSS;

A flat red rash over large areas of the body

How is invasive group A streptococcal disease treated?

GAS infections can be treated with many different antibiotics. Early treatment may reduce the risk of death from invasive group A streptococcal disease. However, even the best medical care does not prevent death in every case. For those with very severe illness, supportive care in an intensive care unit may be needed. For persons with necrotizing fasciitis, surgery often is needed to remove damaged tissue.

What can be done to help prevent group A streptococcal infections?

The spread of all types of GAS infection can be reduced by good hand washing, especially after coughing and sneezing and before preparing foods or eating. Persons with sore throats should be seen by a doctor who can perform tests to find out whether the illness is strep throat. If the test result shows strep throat, the person should stay home from work, school, or day care until 24 hours after taking an antibiotic. All wounds should be kept clean and watched for possible signs of infection such as redness, swelling, drainage, and pain at the wound site. A person with signs of an infected wound, especially if fever occurs, should seek medical care. It is not necessary for all persons exposed to someone with an invasive group A strep infection (i.e. necrotizing fasciitis or strep toxic shock syndrome) to receive antibiotic therapy to prevent infection. However, in certain circumstances, antibiotic therapy may be appropriate. That decision should be made after consulting with your doctor. would like to thank the Centers for Disease Control and Prevention (CDC) and their contributors for this information in striving to make daycare and childcare a more productive and efficient service.

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