Scarlet Fever

– An acute, contagious bacterial disease characterized by a skin rash and a strawberry tongue.

Causes and Incidence

The cause of scarlet fever is a circulating erythrotoxin that is produced by a group A beta-hemolytic streptococcus. It is spread by airborne droplets, by contact with nasopharyngeal secretions, or by ingestion of contaminated milk or other food. It is communicable from the point of infection through the active disease phase, and post disease in individuals with sinusitis or otitis media. The disease is seen predominantly in children.

Disease Process

The invading streptococcus releases an erythrogenic toxin that stimulates a sensitivity reaction in the individual. The result is widespread dilation of small capillaries and toxic injury to the vascular epithelium, particularly in the kidneys, liver, and heart.


Signs and symptoms appear 1 to 3 days after exposure to the agent, starting with a prodromal period.

Abrupt high fever, chills, tachycardia, nausea, vomiting, headache, abdominal pain, malaise, sore throat

Enlarged, reddened tonsils covered with patchy exudate; red, edematous pharynx; after the first day, the tongue is coated and white with red, swollen papillae (white strawberry tongue) until the white coat sloughs off on the fourth day, leaving a red strawberry tongue; red punctate lesions on the palate

Rash appears 12 hours after prodromal symptoms; rash is pinhead-size red lesions that rapidly cover the body except for the face; the rash concentrates in the axial folds, on the neck, and in the groin and lasts 4 to 10 days; the face is flushed on the cheeks with a circumoral pallor; after a week, desquamation and peeling begin on the palms and soles

Potential Complications

Complications include otitis media, sinusitis, peritonsillar abscess, and severe, disseminated toxic or septic disease (fulminating scarlet fever), which may cause septicemia and hepatic damage.

Diagnostic Tests

The diagnosis is made from clinical signs and a positive Schultz-Charlton reaction skin test or a positive throat culture.



Antiinfective drugs to combat the streptococcal agent; antipyretics for fever; analgesics for pain.

Bed rest while febrile; isolation with secretion precautions for 24 hours after initiation of antibiotics; adequate fluids; gargles and throat washes for throat; room humidification for comfort.