Scarlet fever: Bacterial infection with sore throat and rash

Scarlet fever is a bacterial infection that mainly affects children. Some typical symptoms include sore throat, color changes of the tongue and a skin rash. This mild disease is easily treated with penicillin, a type of antibiotic. Treatment is necessary to avoid serious and long-term complications. The disease can be prevented through a number of measures, because there is no vaccine for the bacterial infection.

  • Synonyms scarlet fever
  • Epidemiology bacterial infectious disease
  • Causes: Group A streptococci (bacteria)
  • Symptoms: Sore throat, color changes of the tongue and rash
  • Diagnosis and examinations
  • Treatment via penicillin (antibiotic)
  • Complications
  • Prevention

Synonyms scarlet fever

Scarlet fever is also known by these synonyms:

  • febris scarlatinosa
  • scarlatina
  • scarlet fever

Epidemiology bacterial infectious disease

The disease mainly affects children between the ages of two and ten, with a peak between three and six year olds. Scarlet fever occurs especially during the summer months. The infections occur sporadically or epidemically in residential settings such as schools, prisons and military institutions.

Causes: Group A streptococci (bacteria)

Scarlet fever is an acute highly contagious disease caused by group A streptococci, a type of bacteria responsible for a throat or skin infection. Group A streptococcal bacteria live in a patient’s nose and throat. The spread of the bacteria occurs through droplet infection (coughing or sneezing) of an infected patient. If someone comes into contact with these droplets through the mouth, nose or eyes, they will contract the infection. Sharing certain household items such as a glass or plate also results in contamination. Finally, scarlet fever can be transmitted by touching skin ulcers that are the result of a group A streptococcal infection that has affected the skin. The patient is contagious 10-21 days after the onset of the rash, unless he receives treatment with the antibiotic penicillin.

Symptoms: Sore throat, color changes of the tongue and rash

The incubation period of the relatively mild disease is on average two to four days after contamination with a streptococcal infection (usually in the pharynx).

General symptoms and sore throat

The disease usually starts with fever, sore throat and difficulty swallowing. Chills, vomiting, headache, swollen lymph nodes and abdominal pain also occur.

Color changes to the tongue

Early in the disease, the tongue has a white coating through which prominent bright red papillae can be seen. Later, the white coating disappears, giving the tongue a rough, bright red appearance (bright red tongue) (strawberry tongue). Occasionally a yellow tongue occurs with scarlet fever. Tongue bumps and tongue spots also occur.

Skin rash

Also, usually on the second day of the illness, a fine-looking rash appears on the neck, armpits, groin, chest, elbows and inner thighs. Usually the spots do not appear on the face, palms and soles of the feet, but in sporadic cases this is possible. The sometimes itchy rash consists of flowing red spots with countless dots. This makes the skin feel like sandpaper and look like red goosebumps. Some patients with scarlet fever have a maculopapular rash (skin rash with spots and bumps). The rash usually lasts for about five days and is followed by extensive peeling of the skin. The face has a pale and flushed appearance.

Diagnosis and examinations

Physical and diagnostic examination

The diagnosis of scarlet fever is made on the basis of the typical clinical features and the culture of a throat swab.

Differential diagnosis

Scarlet fever resembles the clinical picture of many possible conditions such as:

  • acute lupus erythematosus
  • side effects of medications
  • complications of an abortion
  • Kawasaki disease (inflamed blood vessels in the arteries)
  • a pneumonia
  • erythema infectiosum (mild disease with rash and joint pain)
  • erythema toxicum (benign skin condition in babies with white papules surrounded by red skin)
  • exfoliative dermatitis (inflammation with redness of the skin and loss of large areas of skin over large areas of the body)
  • pharyngitis (an infection of the throat)
  • toxic shock syndrome (severe bacterial infection with fever and organ damage)
  • skin complications of fifth disease
  • juvenile rheumatoid arthritis (inflammation of joints and organs at a young age)
  • glandular fever (viral infection with sore throat, swollen lymph nodes, fatigue and low-grade fever that occurs mainly in adolescents and young adults)
  • measles (viral infectious disease accompanied by symptoms in the eyes (conjunctivitis) and a skin rash)
  • rubella (rubella with rash on the face, trunk, arms and legs)
  • secondary syphilis (bacterial infection through sexual contact)
  • viral exanthema

Treatment via penicillin (antibiotic)

Scarlet fever is treated with the drug penicillin, which is a type of antibiotic. The patient takes this by mouth four times a day for ten days. Patients allergic to penicillin are treated with the drug erythromycin. By taking these medications, the patient often avoids serious complications. Painkillers, bed rest and plenty of fluids to prevent dehydration are other measures to combat the disease.


Complications of scarlet fever rarely occur when the patient receives antibiotic treatment. Left untreated, scarlet fever leads to numerous possible mild to serious side effects:

  • acute polyarthritis
  • acute renal failure
  • arthritis (an inflammation of the joints)
  • bronchopneumonia (inflammation of the trachea and lungs)
  • cervical lymphadenitis (inflammation of the lymph nodes in the neck)
  • a brain abscess (collection of pus in the brain)
  • inflammation of the meninges (meningitis)
  • a pharyngeal abscess
  • a myocardite
  • inflammation of the entire heart (pancarditis)
  • a peritonsillar abscess (abscess around the tonsils)
  • pneumonia (pneumonia)
  • ethmoiditis (inflammation of the ethmoid bone)
  • glomerulonephritis (kidney filter inflammation: inflammation of the blood vessels in the renal cortex, a form of kidney inflammation)
  • hepatitis (an inflammation of the liver)
  • skin infections
  • intracranial venous thrombosis sinus
  • osteomyelitis (an inflammation of the bone marrow)
  • otitis media (middle ear infection) and/or mastoiditis (inflammation of the nipple-shaped appendage of the petrous bone at the level of the face)
  • rheumatic fever (an inflammatory disease that affects the heart, joints, skin and brain)
  • sepsis (blood poisoning)
  • sinusitis
  • uveitis (a type of eye inflammation)
  • vasculitis (an inflammation of the blood vessels)

Good hand hygiene is necessary / Source: Gentle07, Pixabay


In the event of an epidemic of scarlet fever, the preventive use of penicillin or erythromycin is recommended. The best way to prevent contamination is to wash your hands often (good hand hygiene) (especially if you have a sore throat) and not to share products. There is no vaccine available for scarlet fever. Children with scarlet fever or strep throat remain at home for at least 24 hours after starting an antibiotic treatment against scarlet fever.

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