Scarlet fever causes bright red rash, a high fever and a sore throat. It is still fairly common in children and there have been increasing outbreaks in recent years. According to the Centre for Health Protection, there are regular outbreaks in Hong Kong.
Here is an expert-reviewed guide to scarlet fever, with paediatrician Dr. Eddie Cheung.
Also known as scarlatina, scarlet fever is generally a mild bacterial infection. It is commonly seen in children between 5 and 15 years old. Those younger than 10 are mostly affected and it is rare in children under 3. Fever and most symptoms usually subside within 24-48 hours after appropriate and prompt initiation of antibiotic treatment.
Scarlet fever is caused by Group A Streptococcus which is the same type of bacteria responsible for other common infectious diseases, such as impetigo and strep throat. The characteristic red bumpy rash of scarlet fever is a result of the toxins produced by the bacteria.
During diagnosis, your doctor will look at the rash. In most situations, only a clinical diagnosis is needed and treatment can be initiated afterwards. Throat swab for a rapid strep test +/- culture test may sometimes be done to confirm the diagnosis.
Your child will usually recover without having complications. They are infrequent and often the result of bacteria extending to infect other body areas. Complications include infections of the ear, sinus and the skin, pneumonia, rheumatic fever, kidney inflammation, arthritis and swelling in lymph nodes in the neck.
Scarlet fever is contagious and is a notifiable disease according to the Department of Health. Children may go back to school at least 24 hours after commencing antibiotics and when fever has subsided.
Incubation period: 2-5 days.
Infectious period: At least until 24 hours after initiation of antibiotic treatment. Up to 2-3 weeks after symptoms start if not on antibiotics.
The bacteria that cause the infection live in the mouth, throat and nose. Coughing and sneezing produce respiratory droplets that carry the bacteria. One can get scarlet fever by breathing in or touching things on which these droplets land.
Direct contact with the infected mouth and nasal secretions, and infected skin wound, or sharing foods, drinks and personal items with an infected person can also spread scarlet fever.
Children with scarlet fever often first present with a sore throat, fever and swollen lymph nodes in the neck. They may also have chills, headache, nausea, vomiting, body aches, abdominal pain and loss of appetite.
Pink-red rash usually develops after a day or two with the following characteristics:
Other distinctive signs are
Seek medical advice if you suspect that your child has scarlet fever, especially when they
Antibiotics is the mainstay of treating scarlet fever if strep bacteria are found. Examples include amoxicillin and penicillin. For those who are allergic to penicillin, other antibiotics (e.g. erythromycin) will be given.
It is important to finish the entire course of antibiotics (usually 10 days) exactly as your doctor says, even if your child is getting better. It is to ensure that the bacteria are completely eliminated and to reduce the risks of developing complications such as rheumatic fever.
There are a few ways you can do to help your child feel better:
Currently, there is no vaccine to prevent scarlet fever. Here’s what you can do to protect your child from catching and avoid spreading the infection:
Dr. Eddie Cheung 張蔚賢醫生 is a specialist in paediatrics. He received his paediatric training in Queen Mary Hospital and post-fellow paediatric cardiology training in Grantham Hospital/ Queen Mary Hospital. He is a Fellow of the Hong Kong College of Cardiology, the Vice President of Hong Kong Society of Paediatric Cardiology and Consultant of Hong Kong Association of Cleft Lip and Palate. He is currently working as Director of Paediatric Centre of HK Medical Consultants and serves as Infection Control Officer at the Hong Kong Adventist Hospital.
This article was independently written by Healthy Matters. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.
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