An acute contagious disease that results from infection with Streptococcus pyogenes (group A streptococci). It most often accompanies pharyngeal (throat) infections with this organism but is occasionally associated with wound infection or septicemia. Scarlet fever is characterized by the appearance, about 2 days after development of pharyngitis, of a red rash that blanches under pressure and has a sandpaper texture. Usually the rash appears first on the trunk and neck and spreads to the extremities. The rash fades after a week, with desquamation, or peeling, generally occurring during convalescence. The disease is usually self-limiting, although severe forms are occasionally seen with high fever and systemic toxicity. Appropriate antibiotic therapy is recommended to prevent the onset in susceptible individuals of rheumatic fever and rheumatic heart disease. See Medical bacteriology, Rheumatic fever, Streptococcus
an acute infectious disease occurring mainly in childhood and manifested by fever, sore throat, and a rash. The first clinical description of scarlet fever was given in the 17th century by T. Sydenham, who also gave the disease its name.
The causative agent of scarlet fever is a β-hemolytic streptococcus, which belongs to Group A and forms a toxin. The infection is transmitted by infected persons or by carriers. It is mainly airborne, but occasionally occurs through contact with an infected person’s belongings. Scarlet fever is mainly a disease of children up to the age of six or seven. Its incidence increases in the autumn and winter months, and periodic rises in incidence are noted every four to six years. Persons who have recovered from the disease develop specific immunity, with relapse occurring in 1.5–4 percent of the cases. Immunity is determined by observing the skin’s reaction to an inoculated toxin (the Dick test).
The incubation period of scarlet fever averages two to seven days. The onset of the disease is acute and is marked by fever, lethargy, malaise, vomiting, and sore throat. The mucosa of the throat becomes bright red, and spots sometimes appear on the palatine tonsils. The superficial cervical lymph nodes swell and become painful. On the first or occasionally the second day of the disease, a bright-pink or red punctate rash appears on the entire body. The tongue acquires a grayish white coating, which disappears by the fourth or fifth day of the disease; the tongue then becomes bright red and granular (raspberry tongue). The disease continues for three to six more days. After the rash disappears, large portions of the skin peel off.
Scarlet fever may be mild, moderately severe, or severe. The severe form may be toxic, with pronounced symptoms of toxic affection of the nervous and cardiovascular systems.
It may also be septic, with severe inflammation of the throat and a tendency to develop suppurative foci. When the severe form is toxicoseptic, both sets of symptoms are combined. The mild form of the disease predominates, and complications, which are observed in the severe form, seldom occur. Such complications include purulent cervical lymphadenitis, otitis, inflammation of the accessory cavities of the nose and joints, affection of the heart, nephritis, and sepsis. With modern methods of treatment, fatality has been reduced to tenths or hundredths of 1 percent. A very mild form of the disease, lacking in many of the symptoms, is often observed.
Scarlet fever is treated with antibiotics; the toxic form is treated with antitoxic scarlet-fever serum. Various therapeutic means are used to treat complications. Infected persons are isolated for at least ten days; with severe forms of the disease or when living conditions are unfavorable, children are hospitalized. Preschoolers and pupils in the first two grades are permitted to return to school 12 days after the end of the isolation period. Healthy children who have been in contact with infected persons are quarantined for seven days. The premises occupied by infected persons are subjected to regular disinfection.
S. D. NOSOV