Scarlet Fever

Scarlet fever is relatively common infectious disease of childhood, which is caused by certain bacteria from the group streptococci. These bacteria produce toxins that are responsible for the occurrence of the typical rash. The most common way of transmission is respiratory – inhalation of the bacteria. The infection therefore usually starts in the nasopharynx and upper airways.


The disease initially begins like a classic tonsillitis with fever, sore throat and fatigue. The tonsils are swollen, red and covered with whitish coatings. The streptococci produce a toxin and it causes reddish skin rash. The rash appears most often in the neck, armpits and chest, where it gradually spreads. It may also occur in the face, but it usually spares the area around the mouth. With a certain simplification, we think about the scarlet fever as “tonsillitis with a rash”. Complications may occur very rarely when the streptococci affect other tissues – sinusitis, middle ear infections, etc. In addition, like in other streptococcal infections, even the scarlet fever may be followed by an immune disorder known as the rheumatic fever.


It is often said, that the infection by scarlet fever creates a lifelong immunity and the infection can to recur. However, this is only partly true as the immune system produces antibodies only against certain subtypes of streptococcal population. The risk of recurrence is lower, but it can not be completely excluded.


The diagnosis is usually determined by a general practitioner or a pediatrician. The basic finding is a clinical condition looking like classic tonsillitis and red rash. Blood tests may show classic signs of infection such as the elevated sedimentation rate and CRP. A throat swab may confirm the presence of streptococci.


Antibiotics are very effective in the therapy of all streptococcal infections; these bacteria are still very sensitive to ordinary penicillin. In addition, bed rest, adequate fluid intake and rest without physical exertion.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources