Scarlet fever: symptoms, progression and treatment

Scarlet fever is an infectious bacterial disease. Because it mainly affects children of nursery and primary school age, scarlet fever is commonly thought of as a childhood disease. 

However, scarlet fever is also contagious for adults. When tonsillitis, or angina tonsillaris, is accompanied by a characteristic rash or “strawberry tongue”, this is classed as scarlet fever. 

Scarlet fever is spread via airborne infection. The streptococcal bacteria that cause the disease are transmitted via tiny droplets when somebody talks, coughs or sneezes. People can also become infected by touching objects or via bodily fluids in rare cases. 

The symptoms of scarlet fever vary in children and adults. They also change as the illness progresses:

• Scarlet fever often begins with pain, fever and discomfort.
• Sore throat: scarlet fever causes problems in the throat. In addition to pain, you may also have difficulty swallowing.
• Fever: scarlet fever in young children and adults can cause a fever of up to 40°C, chills and a general feeling of being unwell. 
• Strawberry tongue: scarlet fever causes the tongue to become red and inflamed. In the early stages of scarlet fever, a white coating appears on the tongue. This then fades, revealing a reddened tongue with enlarged papillae, which is characteristic of scarlet fever. This particular reaction in the tongue is known as strawberry tongue, and sometimes as raspberry tongue.
• Mouth and throat: redness in the throat and on the roof of the mouth is a classic scarlet fever symptom that affects both children and adults.
• Swollen neck glands: swollen lymph nodes in the neck are another symptom of scarlet fever.
• Rash: this occurs after one to two days and affects both children and adults. It consists of pin-sized, close-set blotches. They are slightly raised, rough to the touch and light red. The rash triggered by scarlet fever first appears on the inner thighs and in the groin area before spreading to the abdomen and the rest of the body as the disease progresses. On the face, a small area around the mouth remains clear. The skin on the palms of the hands and soles of the feet is not affected either. The rash triggered by scarlet fever does not cause itching in children or adults. After six to nine days, the rash disappears. A little later, the skin may start to peel, especially on the soles of the feet and palms of the hands.
• Stomach ache: in some cases, those affected experience abdominal pain, possibly associated with nausea and vomiting. 
  

The incubation period for scarlet fever is very short, only lasting one to three days. This is the time it takes between infection and the first symptoms to appear. These are initially quite general, such as headaches and a sore throat.  

By the way, scarlet fever usually causes milder symptoms in adults than it does in children. That said, scarlet fever progresses in a similar way in adults and children, and the potential consequences are equally similar. However, as scarlet fever symptoms in adults are not as easy to spot, those affected sometimes overlook the signs. 

The duration varies considerably with scarlet fever. How long the illness lasts also depends on the treatment. If those affected take an antibiotic, the duration of scarlet fever is around 7 to 10 days. 

Scarlet fever: how long will my child be contagious for?

Scarlet fever is contagious even before the first signs appear. With antibiotics, the risk of infection ends about 24 hours after the first dose. Without antibiotic treatment, those affected can be contagious for up to three weeks.

This is how the symptoms of scarlet fever can be alleviated in adults and children:

• Soft and liquid food
• Plenty of fluids
• Cool drinks
• Medication to bring the fever down, if necessary

Scarlet fever is generally not dangerous in children or adults. Complications and long-term consequences are very rare:

• Pus-filled areas of inflammation: this includes abscesses around the tonsils, middle ear infections and sinusitis. These can occur when streptococcal bacteria spread unchecked. Pneumonia can also develop under certain circumstances.
• Rheumatic fever: this complication, which is very rare in Switzerland, can lead to inflammation of the joints and heart.
• Kidney inflammation: inflammation of the kidney cells is another very rare complication in Switzerland. It can lead to blood in the urine, water retention and high blood pressure.

You should talk to your doctor if you or your child experience any of these symptoms. 

Neither adults nor children are fully protected from scarlet fever. This is because there’s no scarlet fever vaccination available in Switzerland or anywhere else. Since there are different strains of streptococcus, it’s also possible to contract the illness more than once. So, what can you do to protect yourself and your child against scarlet fever, even if there’s no vaccination? 

• Avoid coming into contact with anyone close to you who has scarlet fever.
• Make sure you and your child keep your hands clean. Washing your hands regularly protects the body against various pathogens.

Scarlet fever is generally not dangerous, but it is highly contagious. You can help protect yourself and others with the measures described above. If you or your child experience any symptoms, contact your doctors’ office so you can start an appropriate course of treatment.