Once one of the most dreaded diseases of childhood, scarlet fever is now far less prevalent and its symptoms are less severe.
It is characterized by a sore throat and a red, if not actually scarlet, rash. Scarlet fever, also known as scarlatina, is a disease caused by a toxin (erythrogenic exotoxin) released by Streptococcus pyogenes or group A beta-hemolytic streptococcus bacteria – the disease occurs in a small percentage of patients with strep infections, such as strep throat or impetigo.
Causes of Scarlet fever
Infection of the throat with toxin-producing group A streptococcus (strep) precedes scarlet fever. In some cases, streptococcal infection of the skin leads to scarlet fever.
However, not everyone who becomes infected with group A streptococcus develops Scarlet fever. The disease is transmitted through contact with the secretions of someone infected, including respiratory droplets produced by coughing or sneezing.
Touching something that has been contaminated with such infectious secretions, followed by touching one’s mouth, eyes, or nose, can also cause this illness
Pathophysiology of Scarlet fever
Infection with group A-hemolytic streptococcus (GABHS) usually occurs via direct contact or transmission of large nasal droplets. This if followed by an incubation period of 1 to 7 days, during which time the index case often manifests signs of infection.
The GABHS organism typically causes direct infection of the affected site- pharynx, skin, or wound. Infecting strains then elicit streptococcal pyrogenic exotoxins A and C, which circulate systemically and produce the characteristic rash and strawberry tongue of scarlet fever.
Symptoms of Scarlet fever
Scarlet fever usually starts within two to four days of incubation, although the incubation period can last between one and seven days.
One of the most characteristic aspects of the disease is that it starts in dramatic manner, with a sudden temperature accompanied by vomiting and a sore throat.
At this stage, the tonsils are infected and have a whitish crust, or exudates, on them. Less serious infections do not cause vomiting, and nowadays the disease can be so mild that children do not even have a sore throat.
The day after the disease starts, the rash that gives it its name breaks out. This is a diffuse reddening of the skin caused by all the little blood vessels opening up. If someone presses down over an area of affected skin, the skin will whiten with the pressure.
The rash starts on the face and then spreads down to affect the rest of the body. The farther away from the face it gets, the likelier it is to form actual spots rather than a uniform redness: these spots tend to be found on the legs and to a lesser extent on the hands. The rash usually lasts for about two or three days.
While the rash is appearing and then fading away, there are a series of changes that affect the tongue. First, there is creamy white exudate all over it, with the tongue’s little papillae pointing up through it. This is known as white strawberry tongue. As the exudate peels off, the tongue is left rather red and raw, with its papillae still showing prominently to make it look like a strawberry. This is called red strawberry tongue.
One of the most typical and striking effects of the disease then occurs as the rash begins to fade. The skin starts to peel off and, in more serious cases; it may peel off in great sheets (desquamation). In the past it was not uncommon to see an entire cast of a hand in the form of dead skin; now a days such occurrences are extremely rare.
Although the disease in nearly always caught from a sore throat, there are other ways it can be communicated. It may enter the skin through a wound of some sort, and in the past it was not uncommon for infection to enter through the womb or the vagina during childbirth.
Risk Factors in case of scarlet fever
Children 5 to 15 years of age are more likely than are other people to get scarlet fever. Scarlet fever germs spread more easily among people in close contact, such as family members or classmates.
Diagnosis of Scarlet fever
Clinical diagnosis of scarlet fever is based on findings of classic GABHS pharyngitis, accompanied by signs associated with toxin-producing strains, such as “strawberry tongue” and the characteristic exanthema.
Throat culture is the gold standard of diagnosis. The oropharynx revels diffuse erythema with palatal petechiae, significant tonsillar enlargement, and purulent exudates of the tonsils or posterior pharynx or both.
The rash usually is accentuated in the flexural creases of the neck, elbows, and groin. This is best demonstrated in the antecubital areas, where lines of papules, known as pastia’s lines, may be seen. The rest of the skin becomes diffusely erythematous; however, the perioral area may be spared, and patients are frequently described as having “circumoral pallor.
- Physical examination
- Throat swab
If we suspect strep as the cause of child’s illness, we’ll swab the tonsils and back of child’s throat to collect material that may harbor the strep bacteria. Tests for the strep bacterium are important because a number of conditions can cause the signs and symptoms of scarlet fever, and these illnesses may require different treatments. If there are no strep bacteria, then some other factor is causing the illness.
- A rapid antigen detection test
- Conditionof child’s throat, tonsils and tongue.
- Child’s neck to determine if lymph nodes are enlarged.
- Assess the appearance and texture of the rash
Sometimes referred to as a rapid strep test, may provide results within several minutes, while a throat culture (which is more sensitive) may require 24-48 hours before the results are available.
- A complete blood count
May demonstrate evidence of infection, and streptococcal antibody testing (for example, the antistreptolysin O test) can provide evidence of a previous streptococcal infection, though this test is not useful in the acute phase of the illness.
Clinical Complications of Scarlet fever
Complications include Otitis media, sinusitis, retropharyngeal or Para-pharyngeal abscess, cervical adenitis, and sepsis. Post-streptococcal glomerulonephritis may develop despite treatment. A unique complication of scarlet fever is progression to the life threatening toxic shock syndrome.
Management of scarlet fever
Children with scarlet fever require supportive therapy, including hydration, pain control, and anti-pyresis.
Antibiotic therapy may shorten the duration of illness and reduce symptoms; more importantly, it prevents supportive complications and rheumatic fever. GABHS is susceptible to standard penicillin which remains the first-line therapy, although studies have documented similar efficacy of easier dosed penicillin’s and cephalosporins. For penicillin allergic patients, a course of clinda-mycin or a macrolide antibiotic is efficacious.
Homeopathic treatment of Scarlet fever
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach.
This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering.
The aim of homeopathy is not only to treat Scarlet fever but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available for Scarlet fever which can be selected on the basis of cause, location, sensation, modalities and extension of the complaints.
For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. Some important homeopathic remedies for Scarlet fever are given below:
Belladonna: head remedy for scarlet fever. Scarlet fever smooth, red and shiny eruptions, hot dry and red throat, very irritable stomach causing nausea and vomiting, High temperature, Acts also as a preventive. Bright red rosy hue to the skin; throat bright red; strawberry tongue and the glandular swelling. Symptoms of cerebral irritation, such as delirium, twitching of muscles, uneasy sleep.
Ailanthus gland: Exceeding acrid coryza. When the regular rash does not come out, Malignant fever, fetid odor from mouth and nose, State of stupor from which it is difficult to arouse, Suppression of natural manifestations, Inability to concentrate, loss of memory, stupor, delirium after suppressed scarlet fever.
Rhus tox: Is indicated when in additions to regular scarlet fever, there is a vesicular eruption. Drowsiness with muttering delirium, Eruptions slow to appear.
Apis mel: It is only useful when there is oedema with kidney troubles. The skin is mottled, red and white blotches. The face is pale and puffy. Swelling of the throat with sharp stinging pain, Absence of thirst and aggravation from heat should not be over looked.
Lachesis: The blood affection first and the mucus membrane second are prominent. Sloughing ulceration of the throat, Pain in tonsils. Child is drowsy and the rash comes out imperfectly and slowly, is dark, interspersed with a military rash; inflammation of throat, of cervical glands, tongue is dirty yellow.
Scarlatinum: Should be used as an intercurrent remedy and as preventive for scarlet fever.
Gelsemium – here the patients are quiet and listless; stupid and prostrated; the pulse is throbbing, but compressible. The asthenic form, with great prostration, is more often met with in poorly nourished children, and here Gelsemium is often the remedy.
Arsenic album – rash does not come out properly; child is thrown into convulsions and lies pale and in a sort of stupor with restlessness and moaning; suddenly it seems to arouse, goes into convulsions, and then relapses again into stupor.
Aconite – scarlet rash with high fever, full, quick pulse; dry, hot, burning skin, over sensitiveness to external impressions. Scarlet fever, throat dark-red, with burning and sticking pain when swallowing, which may extend to ears; auricle red, sensitive, hot to touch and swollen.
Arnica Montana – typhoid scarletina, with nosebleed and haemotope, aggravation from coughing; head and breast warm; sweat sour, and offensive, sometimes cold; repeated attacks of heat.
Ammonium carb – useful remedy in scarlet fever; swelling of throat internally and externally; tonsils are swollen and bluish; glands are enlarged.