Scarlet fever, also known as scarlatina, is a bacterial infection that primarily affects children between 5 and 15 years old. This condition is caused by group A Streptococcus bacteria, the same bacteria responsible for strep throat. What distinguishes scarlet fever from a simple strep throat infection is the appearance of a distinctive red rash that spreads across the body. While scarlet fever was once considered a serious childhood illness, it has become less severe in recent decades thanks to improved medical care and antibiotic availability.
Recognizing the symptoms of scarlet fever early is crucial for prompt treatment and preventing complications. The infection typically begins with flu-like symptoms before the characteristic rash appears. Understanding these warning signs can help parents and caregivers seek medical attention quickly, ensuring better outcomes for affected children. In this comprehensive guide, we’ll explore the ten most common symptoms of scarlet fever, their causes, prevention strategies, and answers to frequently asked questions.
1. High Fever
One of the earliest and most prominent symptoms of scarlet fever is a sudden onset of high fever, typically ranging from 101°F (38.3°C) to 104°F (40°C) or higher. This fever usually appears abruptly and marks the beginning of the infection. The elevated body temperature is the immune system’s response to the streptococcal bacteria invading the body.
The fever associated with scarlet fever often comes with chills and body aches, making the child feel generally unwell. Parents may notice their child becoming lethargic, refusing to eat, or complaining of feeling cold despite having a high temperature. This fever typically precedes the appearance of the characteristic rash by 12 to 48 hours. It’s important to monitor the fever closely, as extremely high temperatures can lead to discomfort and, in rare cases, febrile seizures in young children.
The fever usually lasts for about 3 to 5 days if left untreated, but with appropriate medical intervention, it can subside much more quickly. Keeping the child hydrated and comfortable during this period is essential, and any fever in a young child should prompt a consultation with a healthcare provider.
2. Red, Sandpaper-Like Rash
The hallmark symptom of scarlet fever is the distinctive red rash that gives the disease its name. This rash typically appears 12 to 48 hours after the fever begins and has a unique texture that feels like fine sandpaper when touched. The rash consists of tiny red bumps that are close together, creating a rough, textured appearance on the skin.
The scarlet fever rash usually begins on the neck and chest before spreading to other parts of the body, including the arms, legs, and back. In the early stages, it may appear as mild scarlet fever rash with small red spots, but it quickly becomes more widespread and pronounced. The rash is typically more intense in skin folds, such as the armpits, elbows, and groin area, where the red lines may appear darker and more concentrated—a pattern known as Pastia’s lines.
One distinguishing feature of this rash is that it tends to spare the area around the mouth, creating a pale ring around the lips known as “circumoral pallor.” The rash usually blanches (turns white) when pressed, which can help differentiate it from other types of rashes. The strep rash associated with scarlet fever typically lasts for about a week, after which the skin may begin to peel, particularly on the fingers, toes, and groin area.
3. Strawberry Tongue
A characteristic and highly recognizable symptom of scarlet fever is the development of what doctors call “strawberry tongue.” This symptom appears in two distinct stages and is one of the key diagnostic indicators of the infection. Initially, the tongue develops a white or yellowish coating with red, swollen papillae (the small bumps on the tongue) protruding through it, creating a “white strawberry tongue” appearance.
After a few days, the white coating peels away, leaving the tongue bright red and bumpy, resembling the surface of a strawberry—hence the name “red strawberry tongue” or simply “strawberry tongue.” The papillae remain enlarged and prominent, giving the tongue its distinctive bumpy texture. This bright red, swollen appearance can be quite striking and is often accompanied by pain or discomfort when eating or drinking.
The strawberry tongue may feel tender and sensitive, particularly to hot, cold, or acidic foods and beverages. This symptom typically develops within the first few days of infection and can persist for about a week. The appearance of strawberry tongue, combined with other symptoms like fever and rash, strongly suggests scarlet fever and warrants immediate medical evaluation.
4. Severe Sore Throat
Since scarlet fever is caused by the same bacteria that causes strep throat, a severe sore throat is one of the primary symptoms. The throat pain is often described as intense and can make swallowing extremely difficult and painful. Children may refuse to eat or drink due to the discomfort, which can lead to concerns about dehydration.
Upon examination, the throat and tonsils typically appear bright red and inflamed, often covered with white or yellow patches of pus. The lymph nodes in the neck may also become swollen and tender to the touch. This inflammation is the result of the body’s immune response to the streptococcal infection and the toxins produced by the bacteria.
The sore throat usually begins before the rash appears and may be one of the first symptoms parents notice. Children might complain of a scratchy or raw feeling in their throat, and their voice may sound different or strained. The pain can be constant or may worsen when swallowing, talking, or even just breathing through the mouth. This symptom, combined with the strep throat rash that may appear later, helps healthcare providers identify the infection as scarlet fever rather than simple pharyngitis.
5. Swollen Lymph Nodes
Lymphadenopathy, or swollen lymph nodes, is a common symptom of scarlet fever that occurs as the body’s immune system fights the bacterial infection. The lymph nodes most commonly affected are those in the neck, particularly the anterior cervical nodes located under the jaw and along the sides of the neck. These nodes may become noticeably enlarged, tender, and painful to touch.
The swelling occurs because lymph nodes act as filters for harmful substances and produce white blood cells to fight infection. When the streptococcal bacteria invade the throat, the nearby lymph nodes work overtime to trap and destroy the pathogens. As a result, they become inflamed and enlarged, sometimes reaching the size of a marble or even larger.
Parents may notice these swollen nodes as visible bumps on their child’s neck, or the child may complain of pain when turning their head or touching the area. The lymph nodes typically feel firm and may be quite tender when pressed. While swollen lymph nodes are not unique to scarlet fever and can occur with many infections, their presence alongside other symptoms like fever, rash, and sore throat helps confirm the diagnosis. The swelling usually subsides as the infection is treated and resolves.
6. Headache
Headaches are a frequent symptom of scarlet fever, affecting many children with the infection. These headaches can range from mild to severe and are often described as a dull, throbbing pain that affects the entire head. The headache typically accompanies the fever and may be one of the initial symptoms that children complain about.
The headache associated with scarlet fever is believed to result from several factors, including the body’s inflammatory response to the infection, the fever itself, and the production of toxins by the streptococcal bacteria. Dehydration, which can occur due to the fever and difficulty swallowing, may also contribute to the intensity of the headache.
Children experiencing headaches from scarlet fever may appear irritable, have difficulty concentrating, or want to rest in a quiet, dark room. The pain may worsen with physical activity or sudden movements. Parents should ensure their child stays well-hydrated and rests adequately, as these measures can help alleviate headache discomfort. While headaches are uncomfortable, they typically resolve as the infection is treated and the other symptoms improve.
7. Nausea and Vomiting
Gastrointestinal symptoms, particularly nausea and vomiting, are relatively common in scarlet fever, especially in the early stages of the infection. These symptoms may appear before the characteristic rash develops and can sometimes be mistaken for a stomach virus or food poisoning. The nausea can range from mild queasiness to severe discomfort that leads to actual vomiting.
The vomiting associated with scarlet fever is thought to be caused by the toxins produced by the group A Streptococcus bacteria, which can affect the digestive system. Additionally, the high fever and the body’s overall immune response to the infection can trigger nausea. Some children may also experience a reduced appetite, refusing to eat or showing little interest in food.
These gastrointestinal symptoms can be particularly concerning because they increase the risk of dehydration, especially when combined with fever and difficulty swallowing due to a sore throat. Parents should monitor their child for signs of dehydration, such as dry mouth, decreased urination, or lethargy. Offering small, frequent sips of clear fluids and bland foods can help manage these symptoms. If vomiting is persistent or severe, medical attention should be sought promptly to prevent complications.
8. Abdominal Pain
Many children with scarlet fever experience abdominal pain or stomach cramps as part of their symptom constellation. This pain can vary in intensity from mild discomfort to severe cramping that causes significant distress. The abdominal pain typically occurs in the early stages of the infection and may accompany other gastrointestinal symptoms like nausea and vomiting.
The exact mechanism causing abdominal pain in scarlet fever isn’t completely understood, but it’s believed to be related to the bacterial toxins affecting the gastrointestinal tract, inflammation, and the body’s immune response. In some cases, the lymph nodes in the abdomen may also become swollen, contributing to the discomfort. Children might describe the pain as cramping, aching, or a general feeling of discomfort in the stomach area.
This symptom can sometimes lead to diagnostic confusion, as parents and even healthcare providers might initially suspect a gastrointestinal infection or appendicitis rather than scarlet fever. However, when abdominal pain appears alongside the characteristic fever, sore throat, and rash, it becomes clear that it’s part of the scarlet fever symptom complex. The abdominal pain typically resolves as the infection is treated and the other symptoms improve.
9. Flushed Face
A distinctive symptom of scarlet fever is a flushed, reddened face that gives the child a characteristic appearance. The cheeks and face become noticeably red and may feel warm to the touch due to the fever and increased blood flow to the skin. This facial flushing is often one of the more visible signs of the infection and can be quite pronounced.
What makes this symptom particularly notable is the contrast it creates with the area around the mouth. While the cheeks are bright red and flushed, the area around the mouth typically remains pale, creating what’s known as “circumoral pallor.” This pale ring around the lips stands out against the flushed cheeks and is considered a classic sign of scarlet fever. This distinctive pattern can help healthcare providers distinguish scarlet fever from other childhood infections that cause facial redness.
The flushed face usually appears early in the course of the illness, often around the same time as the fever develops, and may persist throughout the infection. The intensity of the flushing can vary depending on the severity of the fever and the individual child’s response to the infection. While a flushed face alone doesn’t confirm scarlet fever, when combined with other symptoms like the characteristic rash and strawberry tongue, it becomes a valuable diagnostic clue.
10. Skin Peeling
One of the later symptoms of scarlet fever is skin peeling, which typically occurs as the infection resolves and the rash begins to fade. This peeling, also known as desquamation, usually begins about a week after the rash first appears and can continue for several weeks. It’s a natural part of the healing process as the skin recovers from the inflammation caused by the bacterial toxins.
The peeling typically starts on the face and progresses to the trunk and limbs. It’s often most noticeable on the fingers and toes, where the skin may peel off in large sheets, revealing fresh, new skin underneath. The peeling can also be prominent in areas where the rash was most intense, such as the skin folds of the armpits, elbows, and groin. In some cases, the skin on the palms of the hands and soles of the feet may peel in a characteristic pattern.
While skin peeling can look dramatic and may cause some concern for parents, it’s generally not painful or uncomfortable. However, the new skin underneath may be temporarily more sensitive and should be protected from harsh soaps or excessive sun exposure. The peeling skin should be allowed to shed naturally rather than being forcibly removed, as pulling it off can cause irritation or increase the risk of infection. This symptom, while occurring late in the disease course, is so characteristic of scarlet fever that its presence can help confirm the diagnosis retrospectively.
What Causes Scarlet Fever?
Scarlet fever is caused by an infection with group A Streptococcus bacteria, specifically strains that produce erythrogenic toxins. These toxins are responsible for the characteristic red rash that distinguishes scarlet fever from a simple strep throat infection. Understanding the causes and transmission methods of this infection is essential for prevention and early recognition.
Primary Bacterial Cause: The group A Streptococcus bacteria (Streptococcus pyogenes) is the sole cause of scarlet fever. Not all strains of this bacteria produce the toxin necessary to cause the distinctive rash, which is why some people who get strep throat never develop scarlet fever. The bacteria typically infect the throat and tonsils, causing pharyngitis, and the toxins they release into the bloodstream cause the systemic symptoms and rash.
Transmission Methods: Scarlet fever spreads through respiratory droplets when an infected person coughs or sneezes. The bacteria can also spread through direct contact with infected wounds or sores on the skin. Children can contract the infection by sharing utensils, cups, or personal items with someone who is infected. The bacteria can survive on surfaces for short periods, making indirect contact another possible transmission route.
Risk Factors: Several factors increase the likelihood of contracting scarlet fever. Age is a significant factor, with children between 5 and 15 years old being most susceptible, though younger children and adults can also be affected. Close contact environments such as schools, daycare centers, and households with multiple children facilitate the spread of the bacteria. A weakened immune system or having had recent infections can also increase susceptibility.
Seasonal Patterns: Scarlet fever tends to be more common during late fall, winter, and early spring, coinciding with the peak season for strep throat infections. During these months, people spend more time indoors in close proximity to others, creating ideal conditions for the bacteria to spread from person to person.
Prevention Strategies
While it’s not always possible to completely prevent scarlet fever, there are several effective strategies that can significantly reduce the risk of infection. These preventive measures focus on limiting exposure to the bacteria and maintaining good hygiene practices.
Hand Hygiene: Regular and thorough handwashing is one of the most effective ways to prevent the spread of streptococcal bacteria. Children and adults should wash their hands with soap and water for at least 20 seconds, especially before eating, after using the bathroom, and after coughing or sneezing. When soap and water aren’t available, alcohol-based hand sanitizers containing at least 60% alcohol can be used as an alternative.
Respiratory Etiquette: Teaching children to cover their mouth and nose with a tissue or their elbow when coughing or sneezing can help prevent the spread of respiratory droplets containing the bacteria. Used tissues should be disposed of immediately, and hands should be washed afterward. This practice is crucial in preventing transmission to others.
Avoid Sharing Personal Items: Children should be taught not to share drinking glasses, utensils, toothbrushes, or personal items with others, especially when someone is sick. This is particularly important in school and daycare settings where the infection can spread rapidly among groups of children.
Isolation of Infected Individuals: Children diagnosed with scarlet fever should stay home from school or daycare until they have been on appropriate treatment for at least 24 hours and no longer have a fever. This helps prevent the spread of infection to other children. Similarly, household members should practice good hygiene to avoid contracting the infection.
Environmental Cleaning: Regularly cleaning and disinfecting frequently touched surfaces, especially when someone in the household is sick, can help reduce the spread of bacteria. This includes doorknobs, light switches, toys, and countertops. Using disinfectants that are effective against streptococcal bacteria is important.
Prompt Treatment of Strep Infections: If a child develops symptoms of strep throat, seeking prompt medical attention and completing the full course of prescribed treatment can help prevent the development of scarlet fever and reduce the risk of spreading the infection to others.
Strengthening Immunity: Maintaining overall health through a balanced diet, adequate sleep, regular physical activity, and stress management can help support a strong immune system that’s better able to fight off infections. While this won’t guarantee prevention, it can reduce susceptibility to various illnesses, including bacterial infections.
Frequently Asked Questions
Is scarlet fever contagious?
Yes, scarlet fever is highly contagious. It spreads through respiratory droplets when an infected person coughs or sneezes, and through direct contact with infected individuals or contaminated surfaces. A person with scarlet fever is most contagious when they have active symptoms, but they can spread the bacteria even before symptoms appear. With appropriate treatment, a person typically becomes non-contagious within 24 hours of starting antibiotics.
How long does scarlet fever last?
Without treatment, scarlet fever symptoms typically last about 1 to 2 weeks. However, with appropriate medical treatment, most symptoms improve within 4 to 5 days. The characteristic rash usually lasts about a week, followed by skin peeling that can continue for several weeks afterward. It’s important to complete the full course of treatment as prescribed by a healthcare provider, even if symptoms improve earlier, to prevent complications and ensure complete recovery.
Can adults get scarlet fever?
Yes, adults can get scarlet fever, although it’s much less common than in children. Adults may have milder symptoms or, in some cases, no symptoms at all while still being carriers of the bacteria. When adults do develop scarlet fever, they experience similar symptoms to children, including the characteristic rash, sore throat, and fever. Adults who develop symptoms should seek medical attention just as children should.
What is the difference between scarlet fever and strep throat?
Both scarlet fever and strep throat are caused by group A Streptococcus bacteria, but scarlet fever occurs when the bacterial strain produces specific toxins that cause a distinctive red rash. Essentially, scarlet fever is strep throat plus a rash. All the symptoms of strep throat (sore throat, fever, swollen lymph nodes) are present in scarlet fever, but scarlet fever has the additional characteristic symptoms of the sandpaper-like rash, strawberry tongue, and facial flushing with circumoral pallor.
When should I see a doctor for scarlet fever symptoms?
You should seek medical attention promptly if you or your child develops a severe sore throat combined with a fever, especially if a rash appears. Other warning signs that warrant immediate medical evaluation include difficulty swallowing or breathing, extreme lethargy, severe headache, persistent vomiting, signs of dehydration, or if symptoms don’t improve within a few days. Early diagnosis and treatment are important to prevent complications and reduce the spread of infection.
Can you get scarlet fever more than once?
Yes, it is possible to get scarlet fever more than once, although it’s relatively uncommon. Having scarlet fever does provide some immunity, but this immunity is strain-specific. Since there are different strains of group A Streptococcus bacteria that can produce the toxins causing scarlet fever, a person who had scarlet fever from one strain could potentially be infected by a different strain. However, repeat infections are less common than initial infections.
Is scarlet fever dangerous?
While scarlet fever was once considered a very serious and potentially deadly disease, it has become much less dangerous due to modern antibiotics. When treated promptly and appropriately, scarlet fever typically resolves without complications. However, if left untreated, it can lead to serious complications affecting the kidneys (post-streptococcal glomerulonephritis), heart (rheumatic fever), joints, or other organs. This is why early diagnosis and complete treatment are so important.
Does the scarlet fever rash itch?
The scarlet fever rash can sometimes cause mild itching, though this is not always the case. The degree of itching varies from person to person – some individuals experience no itching at all, while others may find it moderately uncomfortable. The rash’s distinctive sandpaper-like texture is usually more noticeable than any itching. If itching does occur and becomes bothersome, consulting with a healthcare provider about safe ways to manage the discomfort is recommended.
References:
- Centers for Disease Control and Prevention – Scarlet Fever
- Mayo Clinic – Scarlet Fever
- NHS – Scarlet Fever
- World Health Organization – Streptococcal Infections
- American Academy of Pediatrics – Group A Streptococcal Infections
The information on this page is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making decisions related to your health.
Read the full Disclaimer here →