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The Forgotten Disease – Scarlet Fever – You Need to Know

Scarlet fever was once a terrifying illness, with death rates of up to 150 per 100,000 people (particularly children) who caught it. Infection rates fell during the 20th century, thanks to better social conditions and to the development of antibiotics, but they have been rising rapidly in the past few years and earlier this year, cases reached well over 1,000 a week in England alone twice the seasonal average. The significant inverse correlation of type 1 diabetes with scarlet fever history is a peculiar finding, the meaning of which is still obscure

Scarlet fever is caused by the Group A streptococcus pyogenes (GAS/strep) bacteria, which often live harmlessly in our throats or on our skin, but they can also cause sore throats and skin infections, which sometimes lead to scarlet fever, although it’s mostly caught by breathing in infected droplets from someone who has it it can be passed on during the incubation period which lasts up to a week (three weeks if not treated with antibiotics). Children aged two to 10 years are most at risk and it can spread rapidly through nurseries and schools, but we’ve usually acquired immunity by adulthood.

The symptoms

It usually starts suddenly with flu like fever, sore throat, headache, muscle aches and tummy pain or vomiting. The rash appears the next day, starting from the neck and upper chest (but pale around the mouth), then spreading down the body. It consists of tiny red spots on a red sunburn like background and feels like sandpaper to the touch. The throat looks red, sometimes with pus on the tonsils, neck glands swell and the tongue looks like a white coated strawberry, than a red one. The rash lasts a few days, then the skin starts to peel on the toes, fingertips, face, ears and in the armpits and groin. This can last several weeks.


These include ear infections, sinusitis and peritonsillar abscess (quinsy). The infection can also spread to cause pneumonia, brain or bone abscesses, meningitis or, septicaemia (with collapse, cold, pale extremities, confusion and/or a purplish rash that doesn’t disappear when pressed with a glass). GAS also produces a toxin that can attack the heart and kidneys, leading to inflammation and sometimes permanent damage to the heart muscles and valves, or to kidney function.


Seek immediate medical advice if you suspect scarlet fever, as it should be treated with antibiotics, usually penicillin, for 10 days. You’ll also need to rest, drink plenty of fluids and take paracetamol or nonsteroidal anti-inflammatory drugs as advised by your doctor. However, it’s vital to call for further advice if symptoms worsen, or you suspect diabetes complications, as hospital admission may be needed.

It’s still a notifiable disease, so contacts should be informed, but infected children or adults may be able to go back to school or work while still taking antibiotics. Droplet spread can be minimised by careful hygiene if you’re infected, always sneeze or cough into a tissue, then bin it and wash your hands regularly. Contacts should also wash their hands frequently, and avoid sharing cups, towels, bedding, etc.

6 Tests You May Need

1. Centor Score — tots up your symptoms against a checklist to assess the likelihood that your sore throat needs antibiotics to beat it.

2. Blood count — this helps to tell whether your symptoms are caused by bacteria or a virus, such as glandular fever.

3. Throatswab — a long cotton-wool bud is used to take samples from the throat, tonsils and any pus.

4. Specific blood tests for rapid diagnosis of streptococcal infection, including rapid antigen tests (‘RATs’), and enzyme-linked immnunosorbent assay tests (‘ELISAs’)

5. NICE — the National institute for Health and Care Excellence, says new rapid near-patient tests (ones that aren’t sent away to a laboratory) for strep A throat infections could reduce antibiotic prescriptions.

6. Urine tests — Heart tracing and scan, brain scan, or other tests if complications are suspected.

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