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Scarlet Fever: A Group A Streptococcal Infection

Photo: Doctor examing young girl's throat

If your child has a sore throat and a rash, it may be scarlet fever. Your child’s doctor can do a quick strep test to find out. If your child has scarlet fever, antibiotics can help your child feel better faster and prevent long-term health problems. Antibiotics can also help protect others from getting sick.

Scarlet fever – or scarlatina – is a bacterial infection caused by group A Streptococcus or “group A strep.” These bacteria cause many types of infections, including strep throat and skin infections. Certain strep bacteria produce a toxin (poison) that can cause a red rash—the “scarlet” of scarlet fever. Scarlet fever is usually a mild illness that most commonly affects children between 5 and 15 years old.

People Can Spread Scarlet Fever Germs to Others

Group A strep bacteria can live in a person’s nose and throat. The bacteria spread through contact with droplets from an infected person’s cough or sneeze. If you touch your mouth, nose, or eyes after touching something with these droplets on it, you may become ill. You can also get sick after drinking from the same glass or eating from the same plate as a sick person. People can get scarlet fever from contact with sores from group A strep skin infections.

Common Symptoms of Scarlet Fever

  • A very red, sore throat
  • A fever (101° F or above)
  • A red rash with a sandpaper feel
  • Bright red skin in the creases of the underarm, elbow, and groin
  • A whitish coating on the tongue
  • A “strawberry” (red and bumpy) tongue
  • Swollen glands in the neck

Other general symptoms include:

  • Headache or body aches
  • Nausea, vomiting, or abdominal pain

Scarlet Fever: What to Expect

Illness usually begins with a fever and sore throat. There also may be chills, vomiting, or 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. Although the cheeks might have a flushed appearance, there may be a pale area around the mouth.

Usually the characteristic red rash appears one or two days after the illness begins. However, the rash can appear before illness or up to 7 days later. The rash usually appears first on the neck, underarm, and groin (the area where your stomach meets your thighs). Over time, the rash spreads over the body. Typically, the rash begins as small, flat red blotches that gradually become fine bumps and feel like sandpaper.

Underarm, elbow, and groin skin creases may become brighter red than the rest of the rash. Doctors call these Pastia’s lines. The scarlet fever rash generally fades in about 7 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.

Doctors Can Test for and Treat Scarlet Fever

Many viruses and bacteria can cause an illness that includes a red rash and sore throat. Ask the doctor about getting a strep test if your child has a red rash and a sore throat. A strep test involves swabbing the throat and testing the swab to see if group A strep is causing the illness. If the test is positive, your child’s doctor will prescribe antibiotics. Antibiotics help someone with scarlet fever feel better sooner, prevent long-term health problems, and protect others from getting sick.

Boy washing hands
It is important for anyone with a sore throat to wash his or her hands often.

Long-term Health Problems from Scarlet Fever

Long-term health problems from scarlet fever are rare. They include:

  • Rheumatic fever (an inflammatory disease that can affect the heart, joints, skin, and brain)
  • Kidney disease (inflammation of the kidneys, called post-streptococcal glomerulonephritis)
  • Otitis media (ear infections)
  • Skin infections
  • Abscesses (pockets of pus) of the throat
  • Pneumonia (lung infection)
  • Arthritis (joint inflammation)

Treatment with antibiotics can prevent most of these health problems.

Preventing Infection: Wash Those Hands

There is no vaccine to prevent scarlet fever. The best way to keep from getting or spreading the bacteria that cause scarlet fever is to:

  • Wash your hands often, especially after coughing or sneezing and before preparing foods or eating
  • Wash glasses, utensils, and plates after someone who is sick uses them
  • Stay home from work, school, or daycare until you no longer have a fever and have taken antibiotics for at least 24 hours

It is especially important for anyone with a sore throat to wash his or her hands often.