Scarlet fever

My grandson was diagnosed with scarlet fever about a month ago. My daughter's attitude is rather casual. When I was growing up scarlet fever was considered dangerous and could lead to long term side effects such as damage to the heart. Are there things to be aware of concerning long-term effects.

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

To understand what we know about scarlet fever, it is helpful to realize a few things about what we know about the bacteria that causes it. The Group A beta-hemolytic streptococcus bacteria is the technical name for the bacteria which causes scarlet fever. This bacteria is very interesting because it has a role in a large number of other infections and diseases. Most people know this bacteria because it causes strep throat infections, however, it also causes other relatively mild illnesses such as simple skin infections. This bacteria can also cause life-threatening infections such as deep tissue and bone infections and toxic shock syndrome. In addition, this bacteria, when left untreated, can cause the body to have an destructive immune reaction in the form of causing kidney problems (called glomerulonephritis) and heart damage (acute rheumatic fever). And finally, there are diseases we do not know the cause of but have a suspicion that this bacteria may be playing some role. As you can see, there is a lot we do know about Group A strep but there is still a lot of learning to do concerning some of the diseases it does cause. Fortunately, scarlet fever is one disease in which we have a good grasp of what is going on.

Scarlet fever is most often caused by strep throat. The bacteria releases a toxin which is irritative to the skin. This causes the skin to become quite red with little bumps. It is sometimes described as having a "sandpaper" appearance. Not all children who get strep throat get this rash. The reason for this is not completely understood except it may be that some strains of strep are more likely to cause it. Unfortunately, there are currently no medications that work directly against the toxin, so all that can be done is to kill the bacteria with antibiotics. Fortunately, this is all that is needed for scarlet fever because it responds well to antibiotics. Essentially, scarlet fever is just a special term for a strep throat which has a particular rash associated with it. The rash is simply a symptom of the strep throat just like the fever is. The cause and risk of future problems is no greater with scarlet fever than it is with strep throat without the rash. However, there is one benefit to having scarlet fever. The rash is so characteristic and recognizable that a throat culture does not need to be done to confirm the diagnosis of strep throat which saves the child from the unpleasant swabbing of the throat.

You are certainly right about the concern for future problems with strep infections in the form of acute rheumatic fever. However, this condition is generally caused by a strep infection that goes without treatment. Assuming that your grandson was started on antibiotics, he is at no increased risk for future complications than if he had strep throat alone. I commend you for looking into your grandson's health. You are clearly a loving and caring grandfather.

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