From the Guidelines
Scarlet fever is a bacterial infection that requires prompt identification and management to prevent complications, and its diagnosis is primarily clinical, based on symptoms such as fever, headache, chills, myalgia, conjunctival suffusion, and less frequently by meningitis, rash, jaundice, or renal insufficiency, as defined by the Centers for Disease Control and Prevention 1. The clinical presentation of scarlet fever can vary, with symptoms sometimes being biphasic, making early diagnosis crucial for effective management.
- Key symptoms include:
- Fever
- Headache
- Chills
- Myalgia
- Conjunctival suffusion
- Less common symptoms are:
- Meningitis
- Rash
- Jaundice
- Renal insufficiency Given the potential severity of complications, such as rheumatic fever and kidney inflammation, it is critical to initiate antibiotic treatment promptly upon diagnosis, typically with oral penicillin V or alternatives for those allergic to penicillin, such as erythromycin or azithromycin, as these are standard treatments for group A Streptococcus infections, the cause of scarlet fever. The recommended approach to managing scarlet fever involves completing a full course of antibiotics, even if symptoms improve, along with supportive care measures like rest, hydration, and the use of acetaminophen or ibuprofen for fever and discomfort management 1. It's also important for patients to stay isolated from others, especially in school or work settings, until they have been on antibiotics for at least 24 hours to prevent the spread of the infection. Scarlet fever's distinctive symptoms, such as a sandpaper-like rash and strawberry-colored tongue, aid in its diagnosis, but the absence of these does not rule out the infection, emphasizing the need for a thorough clinical assessment based on the case definitions provided by public health authorities 1.
From the Research
Symptoms of Scarlet Fever
- A distinctive macro-papular rash, usually in children, is a common symptom of scarlet fever 2
- The rash is often accompanied by other symptoms such as a sore throat, which can be more common at onset among children 5 years and older 3
- The pattern of onset of symptoms can vary with age, with sore throat being more common among older children 3
Diagnosis and Treatment
- Early clinical diagnosis is crucial to exclude drug eruptions, prompt initiation of antibiotic treatment, and prevention of potentially fatal outcomes 4
- A prescription of a suitable antibiotic such as phenoxymethylpenicillin (Penicillin V) should be made immediately to reduce the risk of complications and the spread of infection 2
- National guidance recommends treating people with scarlet fever with antibiotics regardless of severity of illness to speed recovery, reduce the length of time the infection is contagious, and reduce the risk of complications 5
Complications and Outcomes
- Scarlet fever can lead to severe systemic complications and even death if left untreated or if diagnosis is delayed 4
- Delayed diagnosis can result in a longer time to return to baseline activities, highlighting the importance of raising awareness among carers and practitioners to aid identification and timely treatment 3
- The use of antibiotics can help prevent nonsuppurative and suppurative complications, and decrease the risk of contagion, while minimizing the unnecessary use of antibiotics 6