Scarlet Fever: A Group A streptococcal infection

Not as common as it was 100 years ago, scarlet fever -- scarlatina -- is a bacterial infection caused by group A Streptococcus or "group A strep." This illness affects a small percentage of people who have strep throat or, less commonly, streptococcal skin infections. Scarlet fever is treatable with antibiotics and usually is a mild illness, but it needs to be treated to prevent rare but serious complications. Treatment with antibiotics also helps clear up symptoms faster and reduces spread to other children.

Although anyone can get scarlet fever, it usually affects children between 5 and 12 years of age. The classic symptom of the disease is not the fever, but a certain type of red rash that feels rough, like sandpaper.

Frequent hand washing is key in preventing scarlet fever.

Common symptoms

* A very red, sore throat

* A fever (101 degrees or above)

* A red rash with a sandpaper feel

* Bright red skin in underarm, elbow and groin creases

* A whitish coating on the tongue or back of the throat

* A "strawberry" tongue

* Headache

* Nausea and/or vomiting

* Swollen glands

* Body aches

Group A strep bacteria can live in a person's nose and throat. The bacteria are spread through contact with droplets from an infected person's cough or sneeze. If you touch your mouth, nose or eyes after touching something that has these droplets on it, you may become ill. If you drink from the same glass or eat from the same plate as the sick person, you could also become ill. It is possible to get scarlet fever from contact with sores from group A strep skin infections.

What to expect

The illness usually begins with a fever and sore throat. There also may be chills, vomiting and abdominal pain. The tongue may have a whitish coating and appear swollen. It may also have a strawberry-like (red and bumpy) appearance. The throat and tonsils may be very red and sore, and swallowing may be painful.

One or two days after the illness begins, the characteristic red rash appears (although the rash can appear before illness or up to seven days later). Certain strep bacteria produce a toxin (poison) which causes some people to break out in the rash -- the "scarlet" of scarlet fever. The rash may first appear on the neck, underarm and groin, then spread over the body. Typically, the rash begins as small, flat red blotches which gradually become fine bumps and feel like sandpaper.

Although the cheeks might have a flushed appearance, there may be a pale area around the mouth. Underarm, elbow and groin skin creases may become brighter red than the rest of the rash. These are called Pastia's lines. The scarlet fever rash generally fades in about seven days. As the rash fades, the skin may peel around the finger tips, toes and groin area. This peeling can last up to several weeks.

Complications from scarlet fever may include:

* Rheumatic fever (an inflammatory disease that can affect the heart, joint, skin and brain)

* Kidney disease (inflammation of the kidneys, called poststreptococcal glomerulonephritis)

* Ear infections (otitis media)

* Skin infections

* Abscesses of the throat

* Pneumonia

* Arthritis