What is scarlet fever?

Causes and Symptoms

The bacteria
Streptococcus pyogenes that cause scarlet fever (which is also known as scarlatina) produce erythrogenic toxins A, B, and C. Historically, scarlet fever has been associated with toxin A-producing streptococcal strains, but by the late twentieth century there was a prevalence of toxins B and C. Nevertheless, a resurgence of toxin A-producing streptococci has also been observed.

The bacteria are spread by inhalation of air that has been contaminated by the coughing or sneezing of an infected person. After exposure, the incubation period is between two and four days. The disease is characterized by a sore throat, fever, and rash; it may follow throat infections and, occasionally, wound infection and septicemia (blood poisoning). The face is flushed, resembling sunburn with goosebumps, with a pale area around the mouth. The mucous membranes of the mouth, throat, and tongue become strawberry red. The irritation usually appears first on the upper chest but quickly spreads to the neck, abdomen, legs, and arms.

Treatment and Therapy

Penicillin and erythromycin (given to people who are allergic to penicillin) have reduced the complications of scarlet fever to a minimum. In mild cases, recovery takes two to three days. To decrease its contagious effect, isolation for the patient for the first twenty-four hours is recommended. A few days after the body temperature returns to normal, peeling off of the skin takes place at the site of the rash, especially on the hands and feet. The rare complications that might arise include ear infections, rheumatic fever, and kidney inflammation (nephritis). A child with scarlet fever should rest and be given plenty of fluids and antipyretics (fever-reducing agents), such as acetaminophen, to reduce discomfort.

Perspective and Prospects

Scarlet fever was first clearly distinguished from measles and other rash-producing diseases in 1860. Fifty years later, Russian scientists associated its cause to streptococcus, a hemolytic microorganism (one that destroys red blood cells). In 1924, George and Gladys Dick isolated the rash-causing substance in the medium used to grow hemolytic streptococci. They applied it to susceptible individuals in an attempt to establish immunity in them, but the technique was not successful. The loss of human life as a result of scarlet fever continued until the development of antibiotics in the 1940s. For an unknown reason, the incidence of the disease had declined drastically by the end of the twentieth century.

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