Scarlet fever

Scarlet fever is a disease caused by streptococci and is one of the bacterial infectious diseases. Symptoms of scarlet fever include a typical red skin rash - triggered by streptococcal exotoxins (superantigens), a raspberry-colored tongue and purulent inflammation of the palatine tonsils. However, not every (purulent) streptococcal angina that occurs along with a rash is scarlet fever.

Scarlet fever always occurs epidemically in kindergartens, schools, or other community settings because it is particularly easy to spread here. The disease usually occurs in the winter months (October to March). Colonization of the pharyngeal mucosa with scarlet fever pathogens without an outbreak of the disease is common and unproblematic.

Scarlet fever is caused by the bacterium Streptococcus pyogenes from the group of β-hemolytic A streptococci. Streptococci are gram-positive spherical bacteria that arrange themselves in chains or pairs. In addition to scarlet fever, Streptococcus pyogenes causes a number of other diseases such as localized inflammation of the skin(impetigo contagiosa, erysipelas, necrotizing fasciitis), pharynx and palatine tonsils (pharyngitis, tonsillar angina), and generalized disease caused by the bacteria (streptococcalsepsis) or their toxins (streptococcal toxic shock syndrome, rheumatic fever).

Transmission of the disease occurs by means of minute droplets through the airway when sneezing or talking. Rarely, smear infection, i.e. contaminated objects, is the cause. The incubation period, the time between infection and the appearance of the first symptoms, is one to four days. The duration of infectiousness depends on a possible therapy with antibiotics. With rapid drug therapy, this persists for about one to two days, without therapy three weeks or longer.

Scarlet fever is characterized by a typical symptomatology that occurs similarly in the majority of cases.

• Sudden onset of sore throat and difficulty swallowing.

• fever and headache

• red discoloration of the throat (enanthem) with inflammation of the throat wall (pharyngitis)

• purulent inflammation of the palatine tonsils (angina tonsillaris, tonsillitis acuta)

• abdominal pain, nausea and vomiting.

• swelling of the lymph nodes in the throat area

• initially white-coated tongue, which after a few days turns to a dark red raspberry tongue

• typical skin rash from the 2nd-3rd day. Beginning in the armpits, chest and groin region and spreading over the body. The face is usually affected by the rash as well, although the area around the mouth is usually left out.

• After 6 to 9 days, the rash subsides and the skin scales over the following days, especially on the palms and soles.

The diagnosis of scarlet fever is made on the basis of the typical symptoms and medical history, in combination with a throat swab.

In order to assess the risk of streptococcal pharyngitis, the two criteria catalogs Centor score and McIsaac score have become established, which include factors such as the absence of cough, swelling of the palatine tonsil and cervical lymph nodes, and fever.

The smear is particularly important in cases of atypical disease progression and for differentiation from other diseases. The smears are usually rapid antigen tests, which are particularly common in practices and outpatient clinics. Bacterial culture after smear with exact differentiation of the pathogen is also possible. Since acute tonsillitis is often caused by other pathogens, a smear test for streptococci is recommended only for children over 3 years of age with fever, sore throat, and swollen cervical lymph nodes. For younger children, adults and for signs of a mostly viral cold such as cold, cough and hoarseness, a smear test is explicitly not recommended, as the probability of scarlet fever is low here.

Antibiotics

Scarlet fever is treated with antibiotics in most cases. In mild courses, these can be dispensed with.

The drug offirst choice for therapy is penicillin, which is usually given as penicillin V to beswallowed.

Other related antibiotics (β-lactams) are also possible. Examples include:

• Amoxicillin

• Cephalosporins

Resistance of Streptococcus pyogenes to β-lactams is not known, according to the Robert Koch Institute.

If the ill person suffers from penicillin allergy, other antibiotics are used:

• Erythromycin or other macrolides.

Penicillin antibiotics are usually given for 10 days. In the case of erythromycin and cephalosporins, a shorter duration of use is also possible, especially in children. Antibiotic therapy shortens the period during which a sick person is contagious.

Further recommendations

• Always consult a doctor in case of skin rash, fever and throat complaints!

• To positively influence the course of the disease, rest and bed rest is advisable!

• Make sure you drink enough fluids!

• Fever can be reduced with medication, for example with ibuprofen or paracetamol.

• If swallowing is difficult, warm drinks such as tea and soup or lozenges can be pain-relieving.

Scarlet fever is a well-treatable disease with a good course if treated in time. The symptoms recede after a few days when antibiotics are taken.

Complications of scarlet fever are rare overall. Additional clinical pictures such as purulent melting of the tonsils (peritonsillar abscess), middle ear and sinusitis may occur.

Scarlet fever can have a severe (toxic) course, with vomiting, diarrhea, convulsions, and neurological abnormalities such as drowsiness.

What is feared is spread of the bacteria through the bloodstream(streptococcal sepsis). This is rare, but can lead to very severe courses.

Poststreptococcal diseases

Activation of the immune system by bacterial toxins and subsequent antibody and immune complex formation can lead to so-called poststreptococcal or streptococcal sequelae after an infection with streptococci.

Rheumatic fever
This disease usually occurs about 14 days after streptococcal infection and results in fever, joint inflammation (polyarthritis), heart inflammation (per-, myo-, and endocarditis), and skin rashes. A rare manifestation of rheumatic fever is chorea minor (chorea Sydenham). Here, damage to the brain results in uncontrolled, exaggerated movements of the arms and hands.

Acute postinfectious glomerulonephritis
Damage to the kidneys and consequences such as blood loss (hematuria) and protein loss (proteinuria) via the urine and, in the course, water retention (edema) and blood pressure problems.

It is discussed whether early antibiotic therapy reduces the probability of additional clinical pictures and streptococcal sequelae. However, there is insufficient scientific evidence for this.

Having experienced scarlet fever does not protect against re-infection with streptococci. However, immunity to the toxins responsible for the exanthema may occur. Thus, it is possible that if the streptococcal angina recurs, the exanthema will be absent.

Since scarlet fever is contagious, it is recommended to avoid contact with infected persons and to follow general hygiene recommendations. Hand washing and disinfection is very efficient against S. pyogenes.