Published: 09:53 AM, 08 August 2025
Scarlet Fever: A Once-Feared Disease Making a Comeback!
S. M. M. Musabbir Uddin
Introduction
Scarlet fever, also known as scarlatina, is a bacterial illness that primarily affects children. It is caused by Streptococcus pyogenes, the same group A Streptococcus bacteria responsible for strep throat. Though it was once a major cause of childhood death in the 19th and early 20th centuries, scarlet fever became rare and mild with the introduction of antibiotics. However, in recent years, outbreaks in various countries have prompted renewed attention to this seemingly forgotten disease.
Causes and Transmission
Scarlet fever is caused by strains of Streptococcus pyogenes that produce a toxin known as erythrogenic exotoxin. This toxin leads to the characteristic rash of scarlet fever. The bacteria spread through respiratory droplets when an infected person coughs or sneezes. It can also spread by touching contaminated surfaces or sharing utensils.
Children between the ages of 5 and 15 are most commonly affected, particularly those in school or daycare environments where close contact facilitates the spread of infection.
The incubation period for scarlet fever is usually 2 to 5 days after exposure. The illness often begins with classic symptoms of strep throat, such as:
Sudden sore throat
High fever (101°F or higher)
Headache
Nausea or vomiting
Swollen tonsils, sometimes with white patches
Swollen lymph nodes in the neck
As the infection subsides, the rash fades, and the skin, particularly on the fingers and toes, may peel.
Diagnosis
Throat swab: To confirm the presence of group A Streptococcus via rapid antigen detection test (RADT) or throat culture.
Blood tests: In rare or complicated cases, blood work may be done to assess infection severity.
Treatment
Penicillin or amoxicillin (first-line)
Erythromycin or other macrolides (for patients allergic to penicillin)
Antibiotic treatment typically lasts for 10 days. It reduces symptoms, prevents complications, and limits the spread of infection. Symptoms often begin to improve within 24–48 hours of starting antibiotics.
Supportive treatments include:
Rest
Over-the-counter medications like acetaminophen or ibuprofen for fever and pain
Complications
If untreated, scarlet fever can lead to several serious complications, although they are now rare due to antibiotics:
Rheumatic fever – an autoimmune response affecting the heart, joints, and brain
Post-streptococcal glomerulonephritis – inflammation of the kidneys
Otitis media (middle ear infection)
Sinusitis
Pneumonia
Abscess formation around the tonsils or neck
Prompt treatment greatly reduces the risk of these complications.
Prevention
There is no vaccine for scarlet fever. However, preventive measures include:
Good hand hygiene
Avoiding close contact with infected individuals
Covering the mouth and nose when coughing or sneezing
Not sharing eating utensils, toothbrushes, or towels
Children diagnosed with scarlet fever should remain home from school or daycare until they have taken antibiotics for at least 24 hours and no longer have a fever.
Resurgence and Public Health Concern
In recent years, there has been a noticeable increase in scarlet fever cases in some countries, including the UK, China, and South Korea. Researchers believe this may be due to new bacterial strains, changes in population immunity, or improved reporting.
While the disease remains treatable, health authorities are monitoring these trends closely to prevent large-scale outbreaks and to update public health strategies accordingly. Some cases have appeared in Bangladesh. Bangladesh is now noticeable for scarlet fever.
Conclusion
S. M. M. Musabbir Uddin is a
student of Universal Medical
College, Dhaka.
