From the Guidelines
Scarlet fever is a bacterial infection caused by group A Streptococcus bacteria that requires prompt antibiotic treatment to prevent serious complications and improve quality of life. The recommended treatment is oral penicillin V (250-500 mg for children, 500 mg for adults) taken 2-3 times daily for 10 days, as this has been shown to effectively reduce morbidity and mortality [@\1@]. For those allergic to penicillin, alternatives include erythromycin (40 mg/kg/day divided into 2-4 doses for children, 250-500 mg for adults 4 times daily) or azithromycin (12 mg/kg once daily for children, 500 mg on day 1 and 250 mg for days 2-5 for adults). It is essential to complete the full course of antibiotics even if symptoms improve to prevent the development of rheumatic fever, kidney inflammation, and other inflammatory conditions [@\2@].
Some key features of scarlet fever include:
- A distinctive sandpaper-like rash
- Sore throat
- Fever
- A strawberry-appearing tongue These symptoms can be managed with rest, increased fluid intake, and over-the-counter pain relievers like acetaminophen. It is crucial to note that the infection spreads through respiratory droplets, so patients should stay home from school or work for at least 24 hours after starting antibiotics to prevent transmission to others.
Differential diagnosis is also important, as other diseases such as viral infections, staphylococcal scalded skin syndrome, and toxic shock syndrome can present with similar clinical findings [@\2@]. However, the presence of a strawberry-appearing tongue and a sandpaper-like rash can help distinguish scarlet fever from other conditions. Prompt antibiotic treatment is essential to improve outcomes and reduce the risk of complications, and patients should be closely monitored for signs of improvement or worsening of symptoms [@\1@].
From the Research
Symptoms of Scarlet Fever
- A distinctive macro-papular rash is usually present in patients with scarlet fever, typically in children 1
- The rash is often accompanied by other symptoms, such as a sore throat, and may not be the first symptom to appear 2
- The pattern of onset of symptoms can vary with age, with sore throat being more common at onset among children 5 years and older 2
Diagnosis and Treatment
- Scarlet fever can be initially overlooked, especially among older children presenting with sore throat, and may be attributed to viral infection 2
- Delay in diagnosis can occur, and cases with delayed diagnosis may take longer to return to baseline activities 2
- Treatment with antibiotics, such as phenoxymethylpenicillin (Penicillin V), is recommended to reduce the risk of complications and the spread of infection, regardless of the severity of illness 1, 3
Epidemiology and Impact
- There has been an increase in the incidence of scarlet fever, with most cases presenting in General Practice and Emergency Departments 1
- Scarlet fever can have a significant impact on cases and households, with consequences including delayed return to baseline activities and economic burden 2
- Raising awareness among carers and practitioners may aid identification and timely treatment of scarlet fever 2