What is the difference between Scarlet Fever and Erythema Infectiosum (Fifth Disease)?

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From the Guidelines

Scarletina (scarlet fever) and Fifth disease are two distinct childhood illnesses caused by different pathogens, with scarletina being caused by group A Streptococcus bacteria and Fifth disease being caused by parvovirus B19, and they have different symptoms, treatment approaches, and contagiousness periods. The key differences between the two diseases are:

  • Cause: Scarletina is caused by group A Streptococcus bacteria 1, while Fifth disease is caused by parvovirus B19.
  • Symptoms: Scarletina typically presents with a sandpaper-like red rash, high fever, sore throat, strawberry tongue, and swollen tonsils, while Fifth disease features a distinctive "slapped cheek" rash on the face followed by a lace-like rash on the trunk and limbs.
  • Treatment: Scarletina requires treatment with antibiotics, usually penicillin or amoxicillin for 10 days, to prevent complications like rheumatic fever, while Fifth disease is self-limiting and typically only requires symptomatic treatment with acetaminophen or ibuprofen for fever and discomfort.
  • Contagiousness: Scarletina patients are contagious until 24 hours after starting antibiotics, while Fifth disease patients are most contagious before the rash appears and are generally no longer contagious once the rash develops. It's essential to note that while both diseases are typically mild, scarletina can lead to complications like rheumatic fever if left untreated, emphasizing the importance of prompt antibiotic treatment 1. In contrast, Fifth disease is usually mild and self-limiting, but can cause more severe symptoms in adults, particularly those with underlying medical conditions 1.

From the Research

Scarletina and Fifth Disease: Key Differences

  • Scarletina, also known as scarlet fever, is an infectious disease resulting from a group A Streptococcus (group A strep) infection, the same bacteria that cause strep throat 2, 3.
  • Fifth disease, also known as erythema infectiosum, is a common and highly contagious childhood illness caused by parvovirus B19 2, 3.

Clinical Presentation

  • Scarletina is characterized by a bright red rash that covers most of the body, a red, bumpy tongue, and a high fever 2, 3.
  • Fifth disease is characterized by a distinctive "slapped-cheek" rash on the face, followed by a lacy red rash on the arms, legs, and torso, and mild fever 2, 3.

Treatment and Management

  • Scarletina is typically treated with antibiotics, such as azithromycin or clarithromycin, to combat the underlying strep infection 2, 3, 4.
  • Fifth disease is usually a self-limiting illness that resolves on its own with rest, hydration, and symptom management, and does not require specific treatment 2, 3. There are no research papers to assist in answering the question about the difference between scarletina and fifth disease in the provided studies.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

The newer macrolides. Azithromycin and clarithromycin.

Infectious disease clinics of North America, 1995

Research

The newer macrolides: azithromycin and clarithromycin.

Infectious disease clinics of North America, 2000

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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