scarlet fever

Scarlet Fever 

Definition

Scarlet fever is an infection that is caused by a bacteria called streptococcus. The disease is characterized by a sore throat, fever, and a sandpaper-like rash on reddened skin. It is primarily a childhood disease. If scarlet fever is untreated, serious complications such as rheumatic fever (a heart disease) or kidney inflammation (glomerulonephritis) can develop.

Description

Scarlet fever, also known as scarlatina, gets its name from the fact that the patient's skin, especially on the cheeks, is flushed. A sore throat and raised rash over much of the body are accompanied by fever and sluggishness (lethargy). The fever usually subsides within a few days and recovery is complete by two weeks. After the fever is gone, the skin on the face and body flakes; the skin on the palms of the hands and soles of the feet peels more dramatically.

This disease primarily affects children ages two to ten. It is highly contagious and is spread by sneezing, coughing, or direct contact. The incubation period is three to five days, with symptoms usually beginning on the second day of the disease, and lasting from four to ten days.

Early in the twentieth century, severe scarlet fever epidemics were common. Today, the disease is rare. Although this decline is due in part to the availability of antibiotics, that is not the entire reason since the decline began before the widespread use of antibiotics. One theory is that the strain of bacteria that causes scarlet fever has become weaker with time.

Causes and symptoms

Scarlet fever is caused by Group A streptococcal bacteria (S. pyogenes). Group A streptococci can be highly toxic microbes that can cause strep throat, wound or skin infections, pneumonia, and serious kidney infections, as well as scarlet fever. The Group A streptococci are; hemolytic bacteria, which means that the bacteria have the ability to lyse or break red blood cells. The strain of streptococcus that causes scarlet fever is slightly different from the strain that causes most strep throats. The scarlet fever strain of bacteria produces a toxin, called an erythrogenic toxin. This toxin is what causes the skin to flush.

The main symptoms and signs of scarlet fever are fever, lethargy, sore throat, and a bumpy rash that blanches under pressure. The rash appears first on the upper chest and spreads to the neck, abdomen, legs, arms, and in folds of skin such as under the arm or groin. In scarlet fever, the skin around the mouth tends to be pale, while the cheeks are flushed. The patient usually has a "strawberry tongue," in which inflamed bumps on the tongue rise above a bright red coating. Finally, dark red lines (called Pastia's lines) may appear in the creases of skin folds.

Diagnosis

Cases of scarlet fever are usually diagnosed and treated by pediatricians or family medicine practitioners. The chief diagnostic signs of scarlet fever are the characteristic rash, which spares the palms and soles of the feet, and the presence of a strawberry tongue in children. Strawberry tongue is rarely seen in adults.

The doctor will take note of the signs and symptoms to eliminate the possibility of other diseases. Scarlet fever can be distinguished from measles, a viral infection that is also associated with a fever and rash, by the quality of the rash, the presence of a sore throat in scarlet fever, and the absence of the severe eye inflammation and severe runny nose that usually accompany measles.

The doctor will also distinguish between a strep throat, a viral infection of the throat, and scarlet fever. With a strep infection, the throat is sore and appears beefy and red. White spots appear on the tonsils. Lymph nodes under the jawline may swell and become tender. However, none of these symptoms are specific for strep throat and may also occur with a viral infection. Other signs are more characteristic of bacterial infections. For example, inflammation of the lymph nodes in the neck is typical in strep infections, but not viral infections. On the other hand, cough, laryngitis, and stuffy nose tend to be associated with viral infections rather than strep infections. The main feature that distinguishes scarlet fever from a mere strep throat is the presence of the sandpaper-red rash.

Laboratory tests are needed to make a definitive diagnosis of a strep infection and to distinguish a strep throat from a viral sore throat. One test that can be performed is a blood cell count. Bacterial infections are associated with an elevated white blood cell count. In viral infections, the white blood cell count is generally below normal.

A throat culture can distinguish between a strep infection and a viral infection. A throat swab from the infected person is brushed over a nutrient gel (a sheep blood agar plate) and incubated overnight to detect the presence of hemolytic bacteria. In a positive culture, a clear zone will appear in the gel surrounding the bacterium, indicating that a strep infection is present.

Treatment

Although scarlet fever will often clear up spontaneously within a few days, antibiotic treatment with either oral or injectable penicillin is usually recommended to reduce the severity of symptoms, prevent complications, and prevent spread to others. Antibiotic treatment will shorten the course of the illness in small children but may not do so in adolescents or adults. Nevertheless, treatment with antibiotics is important to prevent complications.

Since penicillin injections are painful, oral penicillin may be preferable. If the patient is unable to tolerate penicillin, alternative antibiotics such as erythromycin or clindamycin may be used. However, the entire course of antibiotics, usually 10 days, will need to be followed for the therapy to be effective. Because symptoms subside quickly, there is a temptation to stop therapy prematurely. It is important to take all of the pills in order to kill the bacteria. Not completing the course of therapy increases the risk of developing rheumatic fever and kidney inflammation.

If the patient is considered too unreliable to take all of the pills or is unable to take oral medication, daily injections of procaine penicillin can be given in the hip or thigh muscle. Procaine is an anesthetic that makes the injections less painful.

Bed rest is not necessary, nor is isolation of the patient. Aspirin or Tylenol (acetaminophen) may be given for fever or relief of pain.

Prognosis

If treated promptly with antibiotics, full recovery is expected. Once a patient has had scarlet fever, they develop immunity and cannot develop it again.

Prevention

Avoiding exposure to children who have the disease will help prevent the spread of scarlet fever.

Resources

Books

Bennett, J. Claude, and Fred Plum, editors. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1996.

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fever /fe·ver/ (fe´ver)

1. pyrexia; elevation of body temperature above the normal (37°C).

2. any disease characterized by elevation of body temperature.

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blackwater fever  a dangerous complication of falciparum malaria, with passage of dark red to black urine, severe toxicity, and high mortality.

boutonneuse fever  a tickborne disease endemic in the Mediterranean area, Crimea, Africa, and India, due to infection with Rickettsia conorii, with chills, fever, primary skin lesion (tache noire), and rash appearing on the second to fourth day.

cat-scratch fever  see under disease.

central fever  sustained fever resulting from damage to the thermoregulatory centers of the hypothalamus.

childbed fever  puerperal septicemia.

Colorado tick fever  a tickborne, nonexanthematous, febrile, viral disease caused by an arenavirus and seen in the Rocky Mountain area of the United States.

continued fever  one that varies only slightly in 24 hours.

Crimean-Congo hemorrhagic fever  a hemorrhagic fever caused by the Crimean-Congo hemorrhagic fever virus, transmitted by ticks and by contact with blood, secretions, or fluids from infected animals or humans; it occurs in the Crimea, Central Asia, and regions of Africa.

drug fever  febrile reaction to a therapeutic agent, such as a vaccine, antineoplastic, or antibiotic.

elephantoid fever  a recurrent acute febrile condition occurring with filariasis; it may be associated with elephantiasis or lymphangitis.

enteric fever  any of a group of febrile illnesses associated with enteric symptoms caused by salmonellae, especially typhoid fever and paratyphoid fever.

epidemic hemorrhagic fever  an acute infectious disease characterized by fever, purpura, peripheral vascular collapse, and acute renal failure, caused by viruses of the genus Hantavirus, thought to be transmitted to humans by contact with saliva and excreta of infected rodents.

familial Mediterranean fever  a hereditary disease usually seen in Armenians and Sephardic Jews, with short recurrent attacks of fever, pain in the abdomen, chest, or joints, and erythema like that of erysipelas; it may be complicated by amyloidosis.

Haverhill fever  the bacillary form of rat-bite fever, due to Streptobacillus moniliformis, and transmitted through contaminated raw milk and its products.

hay fever  a seasonal form of allergic rhinitis, with acute conjunctivitis, lacrimation, itching, swelling of the nasal mucosa, nasal catarrh, and attacks of sneezing, an anaphylactic or allergic reaction excited by a specific allergen (such as pollen).

hemorrhagic fevers  a group of diverse, severe viral infections seen around the world but mainly in the tropics, usually transmitted to humans by arthropod bites or contact with virus-infected rodents; they all have certain common features, including fever, hemorrhagic manifestations, thrombocytopenia, shock, and neurologic disturbances.

humidifier fever  malaise, fever, cough, and myalgia caused by inhalation of air that has been passed through humidifiers, dehumidifiers, or air conditioners contaminated by fungi, amebas, or thermophilic actinomycetes.

intermittent fever  an attack of malaria or other fever, with recurring fever episodes separated by times of normal temperature.

Katayama fever  fever associated with severe schistosomal infections, accompanied by hepatosplenomegaly and by eosinophilia.

Lassa fever  a highly fatal, acute, febrile disease seen in West Africa, caused by a virulent arenavirus and characterized by increasing prostration, sore throat, ulcerations of the mouth or throat, rash, and general aching.

metal fume fever  a disease of welders and others working with volatilized metals, marked by sudden thirst, metallic taste in the mouth, high fever with chills, sweating, and leukocytosis.

mud fever  a type of leptospirosis seen in workers in flooded fields and swamps in Germany and Russia.

nonseasonal hay fever , hay fever, perennial nonseasonal allergic rhinitis.

Oroya fever  see Carrión's disease.

paratyphoid fever  paratyphoid.

parenteric fever  a disease clinically resembling typhoid fever and paratyphoid, but not caused by Salmonella.

parrot fever  psittacosis.

pharyngoconjunctival fever  an epidemic disease due to an adenovirus, seen mainly in school children, with fever, pharyngitis, conjunctivitis, rhinitis, and enlarged cervical lymph nodes.

phlebotomus fever  a febrile viral disease of short duration, transmitted by the sandfly Phlebotomus papatasi, with dengue-like symptoms, seen in Mediterranean and Middle Eastern countries.

Pontiac fever  a self-limited disease marked by fever, cough, muscle aches, chills, headache, chest pain, confusion, and pleuritis, caused by a strain of Legionella pneumophila.

pretibial fever  an infection due to a serovar of Leptospira interrogans, marked by a rash on the pretibial region, with lumbar and postorbital pain, malaise, coryza, and fever.

puerperal fever  septicemia accompanied by fever, in which the focus of infection is a lesion of the mucous membrane of the parturient canal due to trauma during childbirth; usually due to a streptococcus.

Q fever  a febrile rickettsial infection, usually respiratory, first described in Australia, caused by Coxiella burnetii.

rat-bite fever  either of two clinically similar acute infectious diseases, usually transmitted through a rat bite, one form (bacillary) of which is caused by Streptobacillus moniliformis and the other form (spirillary) by Spirillum minor.

recurrent fever 

1. relapsing f.

2. recurrent paroxysmal fever occurring in various diseases, such as malaria.

relapsing fever  any of a group of infectious diseases due to various species of Borrelia, marked by alternating periods of fever and apyrexia, each lasting from five to seven days.

remittent fever  one that shows significant variations in 24 hours but without return to normal temperature.

rheumatic fever  a febrile disease occurring as a sequela to Group A hemolytic streptococcal infections, characterized by multiple focal inflammatory lesions of connective tissue structures, especially of the heart, blood vessels, and joints, and by Aschoff bodies in the myocardium and skin.

Rift Valley fever  a zoonotic febrile disease with dengue-like symptoms, due to an arbovirus, transmitted to humans by mosquitoes or by contact with diseased animals; first observed in the Rift Valley, Kenya.

Rocky Mountain spotted fever  infection with Rickettsia rickettsii, transmitted by ticks, marked by fever, muscle pain, and weakness followed by a macular petechial eruption that begins on the hands and feet and spreads to the trunk and face, with other symptoms in the central nervous system and elsewhere.

rose fever  a form of hay fever caused by grass pollens released while roses or other flowers are blooming.

scarlet fever  an acute disease caused by Group A β-hemolytic streptococci, marked by pharyngotonsillitis and a skin rash caused by an erythrogenic toxin produced by the organism; the rash is a diffuse, bright red erythema, and desquamation of the skin begins as fine scaling with eventual peeling of the palms and soles.

Sennetsu fever  a febrile disease seen in Japan and Malaysia and caused by Ehrlichia sennetsu, characterized by headache, nausea, lymphocytosis, and lymphadenopathy.

septic fever  fever due to septicemia.

South African tickbite fever  boutonneuse f.

trench fever  a louse-borne rickettsial disease due to Bartonella quintana, transmitted by the body louse, Pediculus humanus corporis, and characterized by intermittent fever, generalized aches and pains, particularly severe in the shins, chills, sweating, vertigo, malaise, typhus-like rash, and multiple relapses.

typhoid fever  infection by Salmonella typhi chiefly involving the lymphoid follicles of the ileum, with chills, fever, headache, cough, prostration, abdominal distention, splenomegaly, and a maculopapular rash; perforation of the bowel may occur in untreated cases.

fever of unknown origin  (FUO) a febrile illness of at least three weeks' duration (some authorities permit a shorter duration), with a temperature of at least 38.3°C on at least three occasions and failure to establish a diagnosis in spite of intensive inpatient or outpatient evaluation (three outpatient visits or three days' hospitalization).

West Nile fever  see under encephalitis.

yellow fever  an acute, infectious, mosquito-borne viral disease, endemic primarily in tropical South America and Africa, marked by fever, jaundice due to necrosis of the liver, and albuminuria.

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scar·let fever (skärlt)

n.

An acute contagious disease caused by a hemolytic streptococcus, occurring predominantly among children and characterized by a scarlet skin eruption and high fever. Also called scarlatina.

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scarlet fever

[skär′lit]

Etymology: OFr, escarlate + L, febris, fever

an acute contagious disease of childhood caused by an erythrotoxin-producing strain of group A hemolytic Streptococcus. Also called scarlatina.

observations Signs and symptoms appear 1 to 3 days after exposure to the agent, starting with an abrupt high fever, chills, tachycardia, nausea, vomiting, headache, abdominal pain, malaise, and a sore throat. The tonsils become enlarged, reddened, and covered with patchy exudate. The pharynx is red and edematous. The tongue is coated and white with red, swollen papillae (white strawberry tongue) until the white coat sloughs off about the fourth day, leaving a red strawberry tongue and red punctate lesions on the palate. A rapidly erupting rash appears 1 to 2 days after the onset of the sore throat. The rash displays as pinhead-size red lesions, which rapidly cover the body except for the face. The rash concentrates in the axial folds, on the neck, and in the groin and lasts 4 to 10 days. The face is flushed on the cheeks with a circumoral pallor. After a week, desquamation and peeling begin on the palms and soles. Diagnosis is made from clinical signs and a positive Schultz-Charlton reaction skin test or a positive throat culture. Complications include otitis media; sinusitis; peritonsillar abscess; and severe, disseminated toxic or septic disease (fulminating scarlet fever), which may cause septicemia and hepatic damage.

interventions Treatment is aimed at eradicating the streptococcal infection through administration of antibiotics. Antipyretics are given for fever, and analgesics are given for sore throat pain.

nursing considerations Nursing measures are largely supportive and include bed rest during the febrile phase; adequate fluids; gargles, throat lozenges, and throat washes for sore throat room humidification for comfort. Respiratory precautions should be instituted until 24 hours after initiation of antibiotics because of the edema in the pharynx and tonsils. Environmentally imposed restraints are used until 24 hours after the initiation of antibiotics to reduce the spread of this communicable disease. Distractive techniques with appropriate developmental activities are used to relieve pain and social isolation. Careful handwashing techniques are used to decrease risk of infection.

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scarlet fever,

n an infection characterized by high fever and a red rash caused by
Streptococcus.

Scarlet fever.

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fever (pyrexia)

(pīrek´sē),
n an elevation of the body temperature.

hand-foot-and-mouth fever, aphthous,

n See disease.

fever, cat-scratch,

n See disease, cat-scratch.

fever, hay,

n rhinitis and conjunctivitis resulting from allergy; frequently caused by allergy to pollens.

fever, of unknown origin,

n the persistent elevation of body temperature without an identifiable cause.

fever, rheumatic

n a severe, apparently infectious disease produced by hemolytic streptococci organisms or associated with their presence in the body; characterized by upper respiratory tract inflammation, cervical lymphadenopathy and lymphadenitis, polyarthritis, cardiac involvement, and subcutaneous nodules. The disease may be produced by an autoantibody reaction.

fever, scarlet (scarlatina),

n an acute disease caused by a specific type of
Streptococcus organism and characterized by a rash and strawberry tongue.

fever, uveoparotid (Heerfordt's syndrome, uveoparotitis)

n 1. a disease characterized by inflammation of the parotid gland and of the uveal regions of the eye.
2. the firm, nodular enlargement of the parotid glands, uveitis, and cutaneous lesions may be present. Considered to be a form of sarcoidosis.
3. a syndrome consisting of sarcoidosis affecting the parotid glands, inflammation of the lacrimal glands, and inflammation of the uveal tract of the eye.

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scarlet fever

Scarlatina Infectious disease A reaction to pharyngitis by Streptococcus group A–which produces an erythrogenic toxin, consisting of an oral enanthema–'raspberry' tongue, 'strawberry' tongue, generalized blanching erythema–sparing the palmoplantar region and mouth with circumoral pallor and linear petechiae–Pastia's lines. See Strep throat.