The scarlet fever or scarlet fever usually starts very suddenly with symptoms such as high fever, dysphagia and sore throat. Affected patients complain of headaches, general aches, coughing, and nausea.

Later, red spots, about the size of pinheads, form all over the body. A typical symptom is also the presence of a red tongue, the so-called raspberry tongue.

What is Scarlet Fever?

Scarlet fever is an infectious disease caused by a bacteria called Streptococcus Pyogenes that usually affects children. Scarlet fever is highly contagious but, if treated with antibiotics, it is generally harmless and without consequential damage.

The incubation period, that is, the time between infection and the appearance of the first symptoms, is usually two to four days in scarlet fever (rarely up to eight days). A person suffering from scarlet fever can already infect other people during the incubation period.

Frequency of appearance of the disease

  • Children most often get sick between the ages of three and ten. The disease can also manifest itself in all other age groups.
  • Most illnesses occur in the months of October to March.
  • Babies under the age of six months still have the mother’s immune protection in the form of antibodies and generally cannot be infected.

Symptoms of Scarlet Fever

The typical symptoms of scarlet fever are caused by one or more toxins secreted by the bacteria.

Typical symptoms of scarlet fever are as follows:

  • Sudden onset of high fever with dysphagia.
  • Throat pain.
  • Headache and nausea.
  • The tonsils become enlarged and red and have small pus-filled spots (tonsillitis). The lymph nodes in the neck also swell.
  •  The tongue initially assumes a characteristic redness from the second day of the disease, which is also known as raspberry tongue.
  • The rash begins on the chest and then spreads throughout the body.
  • The triangle between the mouth and the chin is left out (perioral pallor).
  • In the groin, the rash is particularly pronounced.


The cause of scarlet fever is bacteria, more precisely streptococci (Streptococcus Pyogenes). They are usually transmitted by droplet infections (sneezing, coughing), more rarely by pus, contaminated food and water, or objects such as toys, silverware, or dishes (smear infection).

The natural reservoir for scarlet fever is humans, which means that many people carry these bacteria on themselves. Especially in the winter months, streptococci can be detected in the throat, which does not mean that the person is affected by it.

There are several subgroups of streptococci that can cause scarlet fever. This is the reason why some people get scarlet fever a second time, even though they are immune to the streptococcal subgroup of their first illness.

Treatment and therapy

Scarlet fever is treated with the antibiotic penicillin for a period of 10 days. The goal of therapy is to relieve symptoms and prevent complications. If penicillin is incompatible due to allergy or other reasons, erythromycin or cephalosporins can alternatively be used.

If a child suffers from scarlet fever, parents should also take the following measures:

  • Make sure the child is isolated when he has a fever to avoid contagion from others.
  • The child should drink as much water as possible so that the mucus in the lungs can dissolve better and be expelled with a cough.

Although scarlet fever is highly contagious, it is generally uncomplicated and has no subsequent consequences, especially if treated with antibiotics:

  • If left untreated, scarlet fever can be transmitted for up to three weeks.
  • If antibiotics are used, scarlet fever is no longer contagious after 24 hours.
  • If antibiotics are taken as prescribed and symptoms no longer occur, sick leave is generally required for only 48 hours. After that the children can get out of bed and start their activities.

Medical diagnosis and monitoring of the disease is necessary to treat scarlet fever.

By Dr. Eric Jackson

Dr. Eric Jackson provides primary Internal Medicine care for men and women and treats patients with bone and mineral diseases, diabetes, heart conditions, and other chronic illnesses.He is a Washington University Bone Health Program physician and is a certified Bone Densitometrist. Dr. Avery is consistently recognized in "The Best Doctors in America" list.

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