A Family Doctor's Tale - SCARLET FEVER

DOC I HAVE SCARLET FEVER

Scarlet Fever is an acute febrile infectious disease of the upper respiratory tract caused by the erythrogenic toxin associated with the bacillus Group A Streptococcus(GAS).

Scarlet Fever is transmitted through the air through
1.droplets from the infected tonsillar or pharyngeal area of infected patients.
2.infected articles or food,
3.infected wounds or
4.infected umbilical stumps of neonates

It is highly infectious, being communicable from 24 hours before onset of symptoms to 2 to 3 weeks after onset of symptoms.

Asymptomatic carriers can also spread the disease.

Incubation period is 2 - 5 days.

The organism enters the blood from the throat and produce an erythrogenic toxin which causes  the symptoms of fever and rash.

The rash is the main symptom which gives rise to the scarlet appearance, hence the name Scarlet Fever.

The infections occur in persons of all ages but peak incidence is 5- 15 years. Males are affected equally as females.

Usually 1 attack will confer permanent immunity to the erythrogenic toxin of GAS streptococcus.

The Signs and Symptoms of Scarlet Fever are:

Symptoms start off with:
1. sudden onset of headache


2. high fever 39-40 degrees centigrades


3. chills and rigors


4. sore throat(infected tonsils)


5. vomiting


6. cervical lymphadenopathy

Subsequent symptoms follows:
1.punctate erythrematous rash appearing 12 to 24 hours later after the fever, starting from the neck and chest then spreads rapidly.

The face is not affected.


2.Facial flushing and pale area around the mouth


3.Dark red lines along skin creases (Pastia's lines)


4.Rash blanches when pressed


5.Tongue coated with white fur with occasional red papillae (white strawberry tongue) The white fur peels on the third day and becomes red by the fourth day (red strawberry tongue)

How to diagnose Scarlet Fever?
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1.Symptoms of fever , rash and strawberry tongue


2.ESR raised very high sometimes > 80

3.moderate leucocytosis

4.Throat swab for culture ans sensitivity

The complications of Scarlet Fever are:
1.otitis media


2.rheumatic fever


3.glomerulonephritis


4.henoch-schonlein purpura

The Treatment of Scarlet Fever is:

Isolation in hospital may be needed.
1.Antibiotics (penicillin or amoxicillin) are used in the treatment of Scarlet Fever. Treatment is for at least 10 days.

Alternatives are cephalosporins such as cephelexin in penicillin sensitive patients

2.Paracetamol is given for fever and pain

3.Bed rest , fluids and general supportive care

The Prevention for Scarlet Fever is by:
Avoiding infected patients

Use a mask  in clouded places

General personal hygiene including washing hands after contact with possible contact with mucous discharge from nose, infected items or clothing and after meals


Recently in June 2011 there is an outbreak of  new cases of Scarlet Fever in Hong Kong.

Prognosis of Scarlet Fever is good.


In fact after the introduction of antibiotics, there is very few cases of Scarlet Fever.

Early therapy with antibiotics produce excellent recovery

In rare cases complications such as rheumatic fever and glomerulonephritis can occur