Symptoms and Signs of Scarlet Fever

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Medically Reviewed on 3/11/2019

Doctor's Notes on Scarlet Fever

Scarlet fever (also termed scarlatina) is a childhood disease usually occurring in children 2 – 10 years of age (although it can occur in older children and adults) that is characterized by fever, sore throat and characteristic rash. The symptoms and signs of scarlet fever begin about four days after exposure to a streptococcal infection and may include sore throat with a white coating on the tonsils, headaches, fever, chills, malaise, abdominal pain, nausea, vomiting and swollen lymph nodes on the sides of the neck that may be tender to touch. The typical rash, consisting of multiple scarlet-red punctate lesions that are small and rough like sandpaper, begins on the chest, neck and armpits and then spreads to other areas of the body. The rash is darker appearing in skin creases; ruptured capillaries in these areas may appear to be lines (termed Pastia lines). The face may appear flushed and there may be paleness around the mouth. The white coating on the tongue starts in the first one or two days of illness and then it sloughs off revealing a red-colored tongue with prominent papillae (termed strawberry tongue). As the patient resolves the infection, the rash fades and the skin begins to peel off; this peeling may last for several weeks.

Scarlet fever is caused by infection with group A beta – hemolytic streptococci bacteria that secretes a toxin responsible for the scarlet-colored rash.

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.