Just when you thought that modern medicine can eradicate diseases from the past, they keep on coming back.
Our Disease in Focus today is Scarlet fever, a 19th century killer disease that is making its way back, infecting thousands of people, mostly children in UK since last year. Scarlet fever or scarlatina is also referred to as strep throat with a rash. It occurs as a result of a group A Streptococcus (group A strep) infection. Streptococcus pyogenes is usually a pathogenic, aerotolerant bacteria that can cause several infections including strep throat and scarlet fever. It usually affect children aged between 5-15 years old but it can also affect older people.
Scarlet fever got its name from the characteristic red rash breaking out on patients' skin.
Photomicrograph of Streptococcus pyogenes bacteria, CDC, Wikipedia
It is a very old disease which may date back from the time of Hippocrates but it was medically recorded first in the 1553 book De Tumoribus praeter Naturam by the Sicilian anatomist and physician Giovanni Filippo Ingrassia, where he referred to it as rossalia or rosania.
In recent years, the cases of Scarlet fever is reportedly rising in Europe, particularly in England and Wales, and in East Asian countries including South Korea, China, Hong Kong, and Vietnam.
Symptoms and Transmission
Scarlet fever has the same symptoms as strep throat except for the rash. Patients may experience symptons such as high fever, sore throat and difficulty swallowing, white and yellow spots or coating in the throat or tonsils, swollen lymph nodes in the neck, whitish coating on tongue, and "strawberry tongue".
Strawberry tongue in patient with scarlet fever, Afag Azizova, Wikipedia
Patients, particularly children may have accompanying chills, general body pains, headache, abdominal pains, nausea, and vomiting.
The rash of scarlet fever, Estreya, Wikipedia
After 1 or 2 days of illness, a red rash may appear. In some cases, the rash may appear before the other symptoms or up to 7 days later. This is the primary characteristic and the most noticeable sign of scarlet fever. It is caused by the toxins produced by strep bacteria causing changes in color and texture of the skin. The rash begins as small, flat red blotches and gradually become fine bumps and may feel like sandpaper and it may itch.
It usually appears first on the face and neck leaving an area around the mouth. The rash will then spread to the chest, abdomen and to the back and finally to the rest of the body in 1 to 2 days. It is more apparent and redder in skin folds particulary in groins, armpits and elbow creases. The rash will eventually fade in 7 days. Skin peeling which could last for weeks may occur in fingertips and toes, and groin area.
Group A strep bacteria can live in our nose and throat so we can transfer it by the droplets we spread when sneezing or coughing. If a person who touches an object with that droplet touches his mouth or nose, that person can be infected. Sharing spoon, glass or plates with sick person can also spread the disease. In some cases, scarlet fever can be transmitted from skin contact with people who have group A strep skin infections.
Diagnosis and Treatment
A review of clinical signs and symptoms can diagnose Scarlet fever. For confirmation, a throat culture may be required. If your child has sore throat, a doctor can take sample by swabbing the throat. This sample can be used for strep test to see if there is an infection.
While there is no available vaccine for scarlet fever, it can be treated with antibiotics. Penicillin VK and erythromycin are the common antistreptococcal drugs prescribed to treat the infection. Early detection and proper treatment will speed up recovery and are key to avoid serious complications and long term health problems including rheumatic fever, rheumatic heart disease, inflammation of the kidneys, ear and skin infections, abscesses of the throat, pneumonia, and arthritis. The spread of streptococci in blood and uncontrolled immune response can also lead to sepsis.
Prevention
Proper handwashing is one of the keys in preventing this disease. If someone from the household is sick, people are advised not to share food utensils and other personal items. Children with scarlet fever should stay at home for at least 24 hours after starting taking antibiotics. Avoiding contact with people would prevent the disease from spreading.
Previously on Disease in Focus:
Norovirus
Sepsis
Gonorrhea
Disclaimer: Disease in Focus is written to provide information but should not be used as basis for diagnosis and treatment. If you have symptoms of any disease discussed here, please seek advice from medical professionals.
Sources: Wikipedia | WebMD | HealthLine | CDC | Lancet | CNN | MSN
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