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Scarlet Fever – Causes, Symptoms, Diagnosis And Treatment

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Scarlet Fever – Causes, Symptoms, Diagnosis And Treatment


scarlet fever

Scarlet fever is an infectious disease common to children under the age of 10. Studies show that boys are more often affected than girls.  Also there appears to be an autumn-winter periodicity.
Scarlet fever is characterized by a sudden onset with fever, altered general state, streptococcal angina  and a characteristic sign a skin rash, followed by skin peeling. Scarlet fever is caused by a toxin released by the beta-hemolytic streptococcus (group A) .

Contamination with scarlet fever is done by respiratory means : coughing, sneezing, laughing, talking, from patients with scarlet fever or healthy carriers of beta-hemolytic streptococcus in the oropharynx.

Sources of infection are represented by:

– persons infected with scarlet fever;
– patients with streptococcal angina, caused by a strain of beta-hemolytic streptococcus which has the ability to release the toxin responsible for the occurrence of scarlet fever;
– patients with mild disease symptoms that may go unnoticed or healthy carriers of the beta-hemolytic streptococcus (group A);

It’s estimated that approximately 20% of the population are carriers of the beta-hemolytic streptococcus in the oropharynx.

Signs and symptoms :

  • Onset period

The incubation period ranges from 2 to 6 days. The disease starts suddenly with fever, altered general condition, vomiting and soreness of the throat upon swallowing. The fever can reach values of 39°-40°C and is often preceded by shivers and tachycardia.

In infants and young children the symptoms can be also accompanied by seizures.

The face has a characteristic appearance with paleness around the mouth and congestion of the cheeks, a sign described as “Filatov’s mask” or “slapped face” Changes appear to the tongue as well, following a specific cycle : in the onset period it is covered by a whitish deposit, giving it a specific look described as “porcelain tongue”.

  • Status period

After 24-48 hours following the onset, a characteristic rash appears manifesting itself through : scarlet redness, rough papule formations more intense on the internal front side of the limbs and on the front side of the elbow joint where a hemorrhagic line ( Pastia sign).

The lingual cycle consists of daily changes of the to tongue aspect :

– 1st day: a whitish deposit : “porcelain tongue” ;

– 2nd day: peeling in a peak to base direction ;

– 3rd day: the peak is fully peeled while the base  shows white deposits;

– 4th day: fully peeled tongue with the papillae visible : “raspberry tongue”

General signs persist, the fever continues for 2 to 3 days after taking antibiotics. Only in toxic and severe forms we can mention, circulatory changes with tachycardia, hypo tension, collapse, enlargement of the liver,  neuro-psychiatric symptoms (agitation, delirium, convulsions).

  • Convalescence period

During the convalescent period tissue regeneration takes place  the tongue appearing  varnished : “varnished tongue.”


The diagnosis is suspected when the characteristic rash appears alongside fever and angina .

Tests that help confirm suspicion of scarlet fever are:
– laboratory testing for evidence of inflammatory syndrome: leukocytosis,, eosinophilia,  accelerated ESR;
– bacteriological tests : highlighting in cultures the beta-hemolytic streptococcus (mandatory for acceptance of diagnosis);
– serological tests : ASO.


Etiological treatment consists in penicillin injections, replaced by a macrolide in case of allergy to penicillin.

Symptomatic treatment consists in antipyretics and vitamin C.

After the infection with scarlet fever a lasting immunity remains , based on antitoxin antibodies.