Scarlet fever
Scarlet fever is an infection caused by toxin producing strains of Streptococcus pyogenes (also known as group A streptococcus, or GAS). It was associated with high levels of deaths and complications when epidemics were common in the 18th and 19th centuries in Europe and the USA.
Scarlet fever or ‘scarlatina’ is the name given to a disease caused by an infective Group A Streptococcal (GAS) bacteria. For many years, scarlet fever was very rare. But, once of a sudden, there has been a recent increase in the number of cases worldwide.
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Treatment
As no vaccine is available to prevent scarlet fever, the early diagnosis of this condition is important in reducing the risk of spread, and developing local and systemic complications, which include acute rheumatic fever, glomerulonephritis, bacteremia, pneumonia, endocarditis, and meningitis.
Even with proven strep pharyngitis, it is controversial whether children at low risk for rheumatic fever (RF) should routinely be prescribed antibiotics, as the number needed to treat to prevent one case of rheumatic fever is undoubtedly very large.
Guidelines vary by country, but antibiotics are commonly recommended for proven Strep throat (GAS) as they may prevent rare but severe complications, in particular rheumatic fever. In this era of antimicrobial stewardship, it should be extremely rare that antibiotics are prescribed for presumed strep throat before it is confirmed with the rapid test or a throat culture.
Antibiotics
When antibiotic treatment is prescribed by the doctor, the antibiotics of choice are penicillin or amoxicillin. A 10-day oral course is recommended as shorter courses appear to be less likely to clear carriage of strep. However, no one knows if strep carriers really are at risk for complications, such as rheumatic fever. Also, it was found that carriers without symptoms are unlikely to pass this bacteria to others.
The problem of clindamycin resistance has been a clinically serious issue for many years. Historically, clindamycin plus penicillin is the recommended treatment of severe strep infections by reducing toxin and superantigen production (Wong and Yuen, 2012).
However, the use of clindamycin is potentially detrimental in the presence of clindamycin resistance because it can paradoxically increase the production of exotoxins. In the recent scarlet fever outbreaks in Hong Kong and mainland China, clindamycin resistance was present in 85.6% and 97% of the isolates respectively.
This high prevalence of macrolide and clindamycin resistance may necessitate the use of alternative adjunctive therapy such as linezolid in the treatment of severe GAS infections.
After you start antibiotic treatment for scarlatina, it is important to complete the course, even if all symptoms improved. Dropping an antibiotic treatment will create resistant strep, so it will nor respond to the treatment if you get a strep throat again.
Lifestyle and home remedies
in most of the mild scarlatina cases support care measures are sufficient for a disease self-cure. Pain OTC medications can be used for discomfort relief or sore throat. The rash does not need any special treatment, other than moisturizers. Antihistamines can be used for itching, but are not necessary. A child care is extremely important for recovery – comfort and sufficient sleep will help to overcome the illness.
in general, it is important to keep a healthy lifestyle to prevent scarlet fever:
- Spend time outdoors
- Eat healthy balanced meals
- Exercise and walk daily
- Have plenty of sleep and rest
References
Scarlet Fever Incident Management Team Genome analysis following a national increase in scarlet fever in England 2014. Chalker V., Jironkin A., Coelho J., Al-Shahib A., Platt S., Kapatai G., Daniel R., Dhami C., Laranjeira M., Chambers T., Guy R., Lamagni T., Harrison T., Chand M., Johnson A.P., Underwood A., BMC Genomics. 2017 – PMC – PubMed
Resurgence of scarlet fever in England, 2014–16: a population-based surveillance study. Lamagni T., Guy R., Chand M., Henderson K.L., Chalker V., Lewis J., Saliba V., Elliot A.J., Smith G.E., Rushton S., Sheridan E.A., Ramsay M., Johnson A.P. Lancet Infect. Dis. 2017 – PubMed
Epidemiological and molecular characteristics of clinical isolates of Streptococcus pyogenes collected between 2005 and 2008 from Chinese children. Liang Y., Liu X., Chang H., L J., Huang G., Fu Z., Zheng Y., Wang L., Li C., Shen Y., Yu S., Yao K., Ma L., Shen X., Yang Y. J. Med. Microbiol. 2012;61:975–983. – PubMed
Scarlet fever epidemic, Hong Kong, 2011. Luk E.Y., Lo J.Y., Li A.Z., Lau M.C., Cheung T.K., Wong A.Y., Wong M.M., Wong C.W., Chuang S.K., Tsang T. Emerg. Infect. Dis. 2012;18:1658–1661. – PMC – PubMed
Streptococcus pyogenes: Basic Biology to Clinical Manifestations. Stevens D.L., Bryant A.E. Severe group A streptococcal infections. In: Ferretti J.J., Stevens D.L., Fischetti V.A., editors. University of Oklahoma Health Sciences Center; Oklahoma City: 2016. pp. 741–769.https://www.ncbi.nlm.nih.gov/books/n/spyogenes/pdf/