Scarlet fever

Scarlet: Short overview

• Important symptoms: Strep throat, tonsillitis with redness, swelling, pain; “Raspberry tongue” (bright red colored tongue), characteristic rash
• Infection: Droplet infection (via sneezing, coughing, speaking), smear infection (use / contact of contaminated objects and surfaces), open wounds (rarely!)
• investigations: Neck examination, scarlet fever test, blood tests for bacteria and antibodies
• Treatment: Bed rest, gargling, pain and fever (paracetamol, ibuprofen), antibiotics (penicillin, cephalosporins or erythromycin)
• Complications and late effects: Almonds abscess, pneumonia, sinusitis, acute nephritis, rheumatic fever, endocarditis (inflammation of the heart’s lining) and myocarditis (myocarditis)

Scarlet fever: symptoms

Scarlet symptoms occur about one to three days after infection with bacterial pathogens first appearance (scarlet incubation period). Almost always, the disease begins suddenly out of the blue Sore throat, difficulties swallowing and often high fever, Also reddened cheeks, chills, Vomit, stomach pain (especially for smaller children) as well Headache and body aches are possible symptoms of scarlet fever.

However, signs like these are not clear and can also be found in many other diseases. Only typical scarlet fever symptoms bring certainty: beside strawberry tongue and a characteristic rash is one of them Scarlet angina, This is an inflammation of the palatine tonsils in the throat.

There are also people who suffer from scarlet fever or rash. Especially in elderly patients often do not show all the typical scarlet fever symptoms. Generally, the disease is easily overlooked in adults.

Scarlet angina

Nearly every person with scarlet fever develops a sore throat (tonsillitis). None of the other scarlet fever symptoms appear as regularly as this one. The reason for this is that the scarlet fever colonizes the pharyngeal mucosa. Thus, both the palatine tonsils and the entire pharynx can ignite. These areas are then reddened, the palatine tonsils are usually significantly swollen and sometimes covered with a white layer.

Other scarlet fever symptoms in the mouth are small, whitish deposits on the inside of the cheeks. Often they are also Cervical lymph nodes swollen, These scarlet fever symptoms are similar to the signs of normal tonsillitis.

strawberry tongue

The raspberry tongue is one of the specific scarlet fever symptoms. First, the tongue is covered with a white layer. This layer disappears after about four days and a raspberry red tongue appears.

Scarlet rash

Scarlet rash develops on the first or second day of illness. These are pinhead-sized, bright red and slightly raised spots that feel rough but do not itch. The scarlet rash is often the first in the inguinal region and on the inner sides of the thighs and then spreads over the entire body. Only a small triangle between the mouth and chin as well as the soles of the feet and palms are left out. After six to nine days, the rash disappears slowly again. As a result, the skin often begins to shed – even on the soles of the feet and palms.

Scarlet fever: complications and late effects

Scarlet fever symptoms usually improve very quickly with antibiotic therapy. Without treatment, however, scarlet fever symptoms can last longer and may be more severe: some patients develop one highly purulent tonsillitis, By encapsulation of the pus arises a abscess, Sometimes one accompanies one purulent otitis media (Otitis media). Possible consequence of failure to treat is deafness.

The germs from the pharynx can reach not only the middle ear but also the paranasal sinuses or lungs. Then one can Sinusitis (Sinusitis) respectively lung infection (Pneumonia) – in addition to the above-mentioned scarlet fever symptoms.

Very rare, but potentially life-threatening is the septic history of scarlet fever: The scarlet fever bacteria invade the bloodstream and spread throughout the body. It develops “sepsis” with a sudden high fever, vomiting, diarrhea, skin-mucous membrane bleeding, consciousness clouding, severe heart damage and shock.

A possible late complication of scarlet fever is one acute rheumatic fever, It occurs mainly in patients between the ages of three and fifteen. In the affected persons, various joints or organs (such as the heart) become inflamed. Also one acute nephritis (Glomerulonephritis) may develop as a late consequence of scarlet fever.

Scarlet fever: contagion

Scarlet fever is caused by infection with certain streptococcus bacteria. These are “Streptococcus pyogenes”, also called A streptococci. The germs settle mainly on the mucous membrane in the mouth and throat area and can cause inflammation here. In addition, they produce toxic metabolic products (toxins), which cause the typical skin changes.

How is scarlet fever carried out?

The scarlet fever bacteria are in the saliva of patients. They are released when coughing, sneezing or talking in tiny liquid droplets into the ambient air. Other people nearby can breathe in these droplets, infecting them with scarlet fever (droplet infection). Those at particular risk are people who are in close contact with scarlet fever patients. The infectious disease therefore often spreads in community facilities such as kindergartens or schools.

When patients hold their hands over their mouths when coughing or sneezing, the bacteria-containing droplets reach the palms of their hands. From there, they can be transferred to items such as cutlery or door handles. If a healthy person uses the same utensils or touches the contaminated objects and then grabs his mouth or nose with his hand, he may also become infected with scarlet fever (contact infection).

Only very rarely does scarlet fever be spread over contaminated food or water (Foodborne infection).

Occasionally, the scarlet fever penetrate into the body via skin wounds (wound scarlet) How long is scarlet fever contagious?

In acute streptococcal infection, such as scarlet fever, which is not specifically treated, patients may be contagious for up to three weeks. With purulent excretions, the risk of infection can last even longer without treatment.

However, once effective antibiotic treatment has been initiated, patients are no longer infectious after 24 hours.

Is it possible to catch several times with scarlet fever?

Regardless of whether a scarlet fever disease is treated or not – after overcoming illness one is not immune to a renewed infection. In the course of an infection the body forms a certain protection against certain bacterial toxins. But there are several scarlet strains, so that a victim can catch several times. However, if a person is attacked a second time by the same pathogen strain after a previous scarlet fever infection, he is most likely not suffering from scarlet fever, but at most from tonsillitis (angina tonsillaris).

By the way: Not everyone who has the scarlet fever in them, also falls ill. In up to 20 percent of the population, the throat is colonized with bacteria, but there are no symptoms.

Scarlet fever in children and adults

As a childhood disease, scarlet fever is more common in children than in adults. Most children fall between the ages of six and twelve years. Scarlet fever can occur in principle at any age. Only infants are relatively safe from infection because they carry appropriate antibodies from the mother (“nest protection”).

Scarlet fever in adults is often not or only recognized late: In sudden fever, sore throat and swallowing symptoms many do not think of the possibility of having infected themselves with the causative agent of the “children’s disease” and do not go or late to the doctor. This may have serious consequences: scarlet fever in adults, as in children, can cause complications and long-term effects such as rheumatic fever, heart and kidney infections.

Scarlet fever: pregnancy

If a pregnant woman suffers from scarlet fever, there is no cause for concern at first. The disease has no direct influence on the unborn child. In contrast to other childhood diseases such as rubella, mumps or measles, there is no specific risk for childhood malformations, miscarriages or stillbirths.

Indirectly, however, scarlet fever during pregnancy can have a negative effect on the child. If, for example, the expectant mother develops complications such as inflammation of the heart muscle, this can affect the care of the unborn child with oxygen and nutrients and thus the child’s development.

A scarlet fever pregnancy should therefore be treated early with antibiotics. In addition, the pregnant women and their unborn child are medically monitored – as with all infectious diseases during pregnancy.

Read more about the topic Scarlet fever and pregnancy.

Scarlet fever: examinations and diagnosis

The typical symptoms of disease usually cause the doctor to quickly suspect scarlet fever. To be sure, he raises the first medical history (Anamnese). He asks the patient (in the case of children: the parents), for example, when the fever has started and if people in the area are currently suffering from scarlet fever.

Then follows the physical examination: The doctor checks whether the throat and palate tonsils are red, swollen or white. He also feels the lymph nodes around his neck. They can swell with scarlet fever. The doctor also looks at the skin all over. If there is a rash, he asks where he started and if he itches. A scarlet rash temporarily fades under the pressure of a wooden spatula. Sometimes a rash also forms on the mucous membranes in the patient’s mouth.

For one Scarlet rapid test The doctor takes a swab of the pharynx to examine it for streptococci. After just a few minutes, the result is clear. However, it is not completely reliable: If the result is positive, it is very likely that there is an infection with group A streptococci. A negative test result does not exclude such an infection. Then you can send the throat swab to the laboratory to breed any pathogens that may be present (bacterial culture) and to determine.

Also the blood values can give evidence of a scarlet fever infection. Some blood values ​​generally indicate a bacterial infection: Thus, then often the white blood cells (leukocytes) and the erythrocyte sedimentation rate are increased.

There is also the possibility of putting the patient’s blood on Antibodies to the scarlet fever to investigate. This only makes sense in suspected streptococcal disease such as rheumatic fever.

Scarlet fever: treatment

Scarlet therapy usually consists in the gift of one antibiotic, It reduces the symptoms a little faster and prevents complications. In addition, patients are no longer contagious to other people 24 hours after starting antibiotic therapy.

In general, scarlet fever is treated with penicillin. The antibiotic is administered orally (as a tablet) or parenterally (as a syringe). It has to be used for ten days. If the antibiotic is discontinued earlier, the risk of relapse increases.

If someone is allergic to penicillin, scarlet fever therapy is done with another antibiotic. Suitable examples are cephalosporins or erythromycin.

In severe disease (such as sepsis = blood poisoning) should be administered in addition to penicillin syringes, the antibiotic clindamycin.

In some patients, scarlet fever results in a rheumatic fever as a late consequence. Those at risk are at increased risk of re-streptococcal A infection. Such relapses can be significantly more severe and exacerbate existing heart damage. Therefore, for rheumatic fever, prolonged penicillin treatment to prevent relapses is recommended. This relapse prophylaxis should be performed for at least five years.

Scarlet Therapy: More tips

Especially in case of fever, patients should bed rest comply. In the first two days of antibiotic therapy you should also Avoid contact with other persons, This reduces the risk of infecting others with scarlet fever. For the same reason, patients should cough or sneeze in a tissue or in the elbow and then wash their hands thoroughly with soap and water.

To help against the unpleasant sore throat in scarlet fever gargles with medicinal plants like sage or marshmallow as well warm neck wrap, Because of the pain when swallowing, will soft or liquid food recommended. The diet should be low in salt and protein.

If patients are feverish, they should much liquid to eat. It is recommended, for example, honey-swept lime blossom tea. Also water or diluted juices are suitable.

If necessary can be against the pain and the fever too Ibuprofen or acetaminophen be taken. Both active ingredients relieve pain and reduce the fever.

Antibiotic therapy can upset the intestinal flora. To avoid that, should be regular yogurt be eaten – but with a time delay to antibiotics.

Sometimes homeopathy and other alternative medicines are recommended as a supportive treatment for scarlet fever. Whether this makes sense should be discussed with the attending physician.

By the way: Children and adolescents with proven or suspected scarlet fever may temporarily not attend community facilities (such as kindergarten, school). Diseased employees of a community facility may not return to work until they are no longer infectious. This is decided by the attending physician or the responsible health department.

Scarlet fever: disease course and prognosis

With early antibiotic therapy, the scarlet fever symptoms usually resolve after a few days. In most cases, sufferers are fully recovered once the antibiotic treatment is completed.

In rare cases, the childhood disease scarlet fever takes a difficult course or has long-term consequences. The long-term consequences include acute nephritis (acute glomerulonephritis) and acute rheumatic fever. The latter may be associated with joint pain and inflammation of the heart lining (endocarditis), myocardium (myocarditis) or pericardium (pericarditis). In addition, rheumatic fever can affect the brain and cause a form of movement disorder (Chorea sydenham). The risk of complications and long-term consequences of a Schlarlach disease can be reduced by treating with antibiotics early on.

Scarlet fever: prevention

There is no vaccine against scarlet fever. Nevertheless, one can reduce the risk of infection by taking certain precautions. So you should avoid close contact with the sick and regularly wash their hands with soap. People with severe underlying conditions or a weakened immune system may be able to prescribe a prescription antibiotic to protect them from contracting Scarlet fever to protect.

Additional information

Guideline:

• S2k guideline “Treatment of Inflammatory Diseases of the Palatine tonsils – Tonsillitis” of the Association of Scientific Medical Societies e.V. (page 30, as of 2015)