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Scarletina - Scarlet Fever

Overview, Causes, & Risk Factors

Scarlet fever is a relatively rare infection. It affects people who have a throat or skin infection caused by certain strains of the group A streptococcus bacteria.

What is going on in the body?

Scarlet fever usually occurs after a throat infection with Streptococcus bacteria, such as strep throat. However, it may also occur after a strep infection of the skin, soft tissues, uterus, or a surgical wound. The bacteria that cause scarlet fever make a toxin that results in a skin rash. The rash usually spreads over most of the body, only to peel off a week later. Scarlet fever is now uncommon because of the regular use of antibiotics for strep infections.

What are the causes and risks of the infection?

Scarlet fever is caused by an infection with a strain of strep bacteria that makes the scarlet fever toxin. Strep throat is usually spread person to person through coughing or sneezing. Strep skin infections are usually caused by contact with infected skin.

Those at highest risk for scarlet fever are as follows:

  • children older than 2 years old
  • people in overcrowded environments, such as day care, school, or military camps
  • people who have been in contact with someone who has a strep throat or skin infection

  • Symptoms & Signs

    What are the signs and symptoms of the infection?

    The rash associated with scarlet fever usually starts on the neck, chest, armpits, and groin. Within a day, it can spread to the rest of the body. The rash is generally made up of a series of tiny pinkish-red spots and feels like sandpaper. About a week later, the rash usually peels off, much as the top layer of skin does after a sunburn. Other signs and symptoms are as follows:

  • abdominal pain
  • chills
  • fever
  • headache
  • malaise, or feeling lousy
  • sore throat
  • swollen and red tongue, known as strawberry tongue
  • vomiting

  • Diagnosis & Tests

    How is the infection diagnosed?

    Diagnosis of scarlet fever begins with a medical history and physical exam. The American Heart Association guidelines recommend that a throat culture be performed to confirm the diagnosis. A throat culture is done by swabbing the back of the throat to get a sample of the bacteria growing there. The swab is then put into a special container that allows bacteria to grow. This culture may take up to 24 hours to grow bacteria. With another test called ELISA, or quick strep, the diagnosis can often be made from the swab within a few minutes. Other tests may include a complete blood cell count to check for signs of infection in the blood.

    Prevention & Expectations

    What can be done to prevent the infection?

    Early treatment of strep infections with antibiotics can prevent this condition. Scarlet fever was much more common before antibiotics were widely used. Avoiding contact with people with sore throats may also decrease the risk.

    What are the long-term effects of the infection?

    In most cases, there are no long-term effects. Rarely, kidney or heart damage may occur from the strep infection. These are known as poststreptococcal glomerulonephritis, which affects the kidney, and rheumatic fever, which affects the heart. Both of these conditions permanently damage the body.

    Following are some other possible long-term effects of scarlet fever:

  • hearing impairment
  • meningitis, an inflammation of the membranes that cover the brain and spinal cord
  • pneumonia, an infection of the lungs
  • What are the risks to others?

    Scarlet fever is contagious and poses a risk to others. It is best not to share drinking glasses or utensils with someone who has a strep infection. Frequent hand-washing can also help prevent spread of this infection.

    Treatment & Monitoring

    What are the treatments for the infection?

    The most important part of treatment is antibiotics. Medicines from the penicillin class, such as penicillin or amoxicillin, are commonly used. Acetaminophen can be used for fever, headache, or throat pain, as needed.

    What are the side effects of the treatments?

    Antibiotics and acetaminophen may cause allergic reactions and stomach upset.

    What happens after treatment for the infection?

    Antibiotics almost always cure this condition. The skin quickly returns to normal once the rash peels off. In very rare cases, a person will need long-term treatment for heart or kidney damage from the infection.

    How is the infection monitored?

    Adults can usually monitor themselves or their children at home. If symptoms do not start to improve within 2 to 3 days or if they get worse, the healthcare provider should be contacted. Any new or worsening symptoms should also be reported to the healthcare provider.


    Author:John Riddle
    Date Written:
    Editor:Coltrera, Francesca, BA
    Edit Date:07/20/00
    Reviewer:Eileen McLaughlin, RN, BSN
    Date Reviewed:01/27/01


    Centers for Disease Control,

    "Family Health for Dummies," IDG Books, 1998, IDG Books, 919 E. Hillsdale Blvd., Foster City, CA 94404