Scarlet fever 92396 225725642 2008-07-15T02:41:46Z 69.21.166.10 /* History */ sp {{Infobox_Disease | Name = Scarlet fever | Image = Scharlach.JPG | Caption = | DiseasesDB = 29032 | ICD10 = {{ICD10|A|38||a|30}} | ICD9 = {{ICD9|034}} | ICDO = | OMIM = | MedlinePlus = 000974 | eMedicineSubj = derm | eMedicineTopic = 383 | eMedicine_mult = {{EMedicine2|emerg|402}}, {{EMedicine2|emerg|518}} | MeshID = D012541 }} '''Scarlet fever''' is a disease caused by an [[exotoxin]] released by Streptococcus pyogenes. It is characterized by [[sore throat]], [[fever]], a '[[strawberry tongue]]', and a fine sandpaper [[rash]] over the upper body that may spread to cover almost the entire body. Scarlet fever is not [[rheumatic fever]], but may progress into that condition. The rate of development of rheumatic fever in individuals with untreated streptococcal infection is estimated to be 3%. The rate of development is far lower in individuals who have received antibiotic treatment. ==Cause== ''[[Streptococcus pyogenes Bacterium]]'' (group A streptococcus) is responsible for scarlet fever. It can also cause simple [[angina]], [[erysipelas]], and serious toxin-mediated syndromes like [[necrotizing fasciitis]] and the so-called streptococcal [[Toxic shock syndrome|toxic shock]]-like syndrome. The virulence of group A streptococcus seems to be increasing lately. The [[exanthem]], or widespread rash, of scarlet fever is thought to be due to [[erythrogenic toxin]] production by specific streptococcal strains in a nonimmune patient. Besides erythrogenic toxins, the Group A streptococcus produces several other toxins and enzymes. Two of the most important are the streptolysins O and S. Streptolysin O, an [[Hemolysis|hemolytic]], [[thermolabile]] and [[Immunogenicity|immunogenic]] toxin, is the base of the [[anti-streptolysin O titer]], an assay for scarlet fever and erysipelas. ==History== This disease was known before the [[20th century|twentieth century]] as '''scarlatina''' (from the Italian ''scarlattina''). Since the middle of the twentieth century the disease has, for reasons which are not understood, become much milder in its effects, and the usage of the name scarlatina has now replaced the term "scarlet fever" in some areas.<ref>{{cite book |author=Susan Scott and Christopher Duncan |title=Human Demography and Disease |chapter=14.10 Reasons for the decline in scarlet fever mortality |pages=p316 |chapterurl=http://books.google.co.uk/books?id=KUDRR54P_t8C&pg=PA315&lpg=PA315&dq=%22scarlet+fever%22+mortality&source=web&ots=zoZJ7vOcCd&sig=zgJln1CYdqZpQJe4C67C06iVC9c&hl=en |isbn=052162052X}}</ref> Many novels depicting life before the [[19th century|nineteenth century]] (see ''[[Scarlet fever#Scarlet fever in popular culture|Scarlet fever in popular culture]]'' below) describe scarlet fever as an acute disease being followed by many months spent in [[convalescence]]. The convalescence was probably due to complications with rheumatic fever or even due to the treatments tried. Prior to an understanding of how streptococcus was spread and modern medicine, it was also not uncommon to destroy or burn the personal effects of a person afflicted with scarlet fever to prevent transmission to other people. ==Signs and Symptoms== [[Image:Scarlet fever 1.JPG|thumb|right|140px|The flushed cheeks and paleness around the mouth of scarlet fever.]] [[Image:Scarlet fever 2.jpg|thumb|right|140px|The scarlet fever rash.]] Early symptoms indicating the onset of scarlet fever can include:<ref name="Balentine">{{cite journal | author=Balentine J and Kessler D | title=Scarlet Fever | journal=[[eMedicine]] | id={{EMedicine2|emerg|518}} | date=March 7, 2006}}</ref><ref name="Dyne">{{cite journal | author=Dyne P and McCartan K | title=Pediatrics, Scarlet Fever | journal=[[eMedicine]] | id={{EMedicine2|emerg|402}} | date=October 19, 2005}}</ref> *[[Fever]] of 37 to 40 degrees C.(101-104 degrees F.) *[[Fatigue (physical)|Fatigue]] *[[Sore throat]] *[[Headache]] *Nausea or [[Vomiting]] *Abdominal pain *Flushed face with paleness around the mouth ([[perioral]] [[pallor]], circumoral pallor) *[[Tachycardia]] (rapid pulse) *[[Lymphadenopathy]] (enlarged [[lymph node]]s) *Punctate red [[macules]] on the hard and soft [[palate]] and [[uvula]] (Forchheimer spots). *Bright red tongue with a "strawberry" appearance *Characteristic rash, which: :*is fine, red, and rough-textured; it [[wikt:blanch|blanches]] upon pressure :*appears 12&ndash;48 hours after the fever :*generally starts on the chest, axilla (armpits), and behind the ears :*is worse in the [[skin fold]]s :*[[Pastia lines]] (where the rash becomes confluent in the arm pits and groins) appear and persist after the rash is gone *The rash begins to fade three to four days after onset and [[desquamation]] (peeling) begins. "This phase begins with flakes peeling from the face. Peeling from the palms and around the fingers occurs about a week later and can last up to a month."<ref name="Dyne"/> Peeling also occurs in axilla, groin, and tips of the fingers and toes.<ref name="Balentine"/> Diagnosis of scarlet fever is clinical. The blood tests shows marked [[leukocytosis]] with [[neutrophilia]] and conservated or increased eosinophils, high [[erythrocyte sedimentation rate]] (ESR) and [[C-reactive protein]] (CRP), and elevation of antistreptolysin O titer. [[Blood culture]] is rarely positive, but the streptococci can usually be demonstrated in throat culture. The complications of scarlet fever include septic complications due to spread of streptococcus in blood and immune-mediated complications due to an aberrant immune response. Septic complications, today rare, include ear and sinus infection, [[Bacterial pneumonia|streptococcal pneumonia]], [[Empyema|empyema thoracis]], meningitis and full-blown [[sepsis]], upon which the condition may be called malignant scarlet fever. Immune complications include acute [[glomerulonephritis]], rheumatic fever and [[erythema nodosum]]. The secondary scarlatinous disease, or secondary malignant syndrome of scarlet fever, includes renewed fever, renewed angina, septic [[Otolaryngology|ear, nose, and throat]] complications and kidney infection or rheumatic fever and is seen around the eighteenth day of untreated scarlet fever. ==Treatment== Other than the occurrence of the diarrhea, the treatment and course of scarlet fever are no different from those of any [[strep throat]]. In case of penicillin allergy, [[clindamycin]] or [[erythromycin]] can be used with success. ==Scarlet fever in popular culture== * ''[[Little Women]]'' by [[Louisa May Alcott]] (1868) - Beth contracts scarlet fever, seems to recover, but progresses to [[rheumatic fever]] and ultimately succumbs to [[congestive heart failure]]. * ''[[By the Shores of Silver Lake]]'' by [[Laura Ingalls Wilder]] - Laura's sisters Mary, Carrie, and Grace and their mother contract scarlet fever, the family recovers, but Mary is left blind as a result. * ''[[The Velveteen Rabbit]]'' by [[Margery Williams]] (1922) - The main protagonist, a small boy, contracts scarlet fever and his toys are all burned. Indeed, the velveteen rabbit itself, the boy's favorite toy, was going to be burned by a nurse, but at the book's climax, the toy rabbit comes alive and joins the "real" rabbits outside in the garden. * ''All-of-a-Kind Family'' by Sydney Taylor - Four of the five sisters come down with it, and the house goes under quarantine; no lasting harm to any of the patients. * ''[[Frankenstein]]; or, The Modern [[Prometheus]]'' by [[Mary Wollstonecraft Shelley]] (1818) - [[Victor Frankenstein]]'s adoptive sister Elizabeth contracts scarlet fever and recovers. But Victor's mother, who contracts the scarlet fever from Elizabeth, dies. * ''[[The Witch of Blackbird Pond]]'' (1958) by Elizabeth George Spears - A young girl from [[Barbados]] is accused of giving scarlet fever to her cousins by using [[witchcraft]]. * ''[[Fever Dream]]'' by [[Ray Bradbury]] - the young protagonist is diagnosed with scarlet fever, though it appears to mutate into something much more sinister. *''[[Private Peaceful]]'' by [[Michael Morpurgo]] - Molly gets scarlet fever and survives. * The first episode of the television show ''[[Ozzy & Drix]]'' featured a villain named Scarlet Fever, who died after getting sucked into the [[spleen]] and shredded. * In the 2001 film ''[[Osmosis Jones]]'', the main [[antagonist]] is a [[Strain (biology)|strain]] of scarlet fever known as "Thrax," whose goal is to "get his own chapter in the [[Medical handbook|medical book]]" after taking out his host, Frank, in 48 hours. He had the ability to [[Infection|light fire]] to anything he touched, but was killed when he fell into a jar of [[Isopropyl alcohol|rubbing alcohol]]. Thrax is voiced by [[Laurence Fishburne]]. * An American soldier in [[The Steel Helmet]] lost all of his hair as a child due to Scarlet Fever. * Anna Jones, mother of the young [[Indiana Jones|Henry 'Indiana' Jones]] died of Scarlet Fever during the year of 1912. *In his memoir [[Survival in Auschwitz]], [[Primo Levi]] describes his stay at the [[Auschwitz concentration camp]]. In the later part of the book<ref>Levi, Primo: "Survival in Auschwitz", page 151. Simon & Schuster, 1996</ref>, he mentions that he has developed Scarlet fever. * ''Scarlet Fever'' is also the title of a 1983 hit single by [[Kenny Rogers]].{{fact|date=March 2008}} * "Casualty 1907" Episode 3 (BBC) Probationer Bennett contracts Scarlet Fever after caring for an infected patient. She ended up having to sweat it out along with Saline solution injections. * ''[[The Moffats]] by Eleanor Estes (1945) - ''The youngest son, Rufus Moffat, gets scarlet fever. The whole Moffat family is under quarantine for several weeks while Rufus recovers. Mama, Sylvie, Jane, and Joe go through one night when they worry that Rufus might die.'' ==References== <!-- ---------------------------------------------------------- See http://en.wikipedia.org/wiki/Wikipedia:Footnotes for a discussion of different citation methods and how to generate footnotes using the <ref>, </ref> and <reference /> tags ----------------------------------------------------------- --> {{reflist}} {{Exanthema}} {{Bacterial diseases}} [[Category:Pediatrics]] [[Category:Dermatology]] [[Category:Bacterial diseases]] [[bg:Скарлатина]] [[ca:Escarlatina]] [[da:Skarlagensfeber]] [[de:Scharlach (Krankheit)]] [[es:Escarlatina]] [[fr:Scarlatine]] [[id:Skarlatina]] [[it:Scarlattina]] [[he:שנית]] [[ku:Sûreta]] [[la:Scarlatina]] [[lv:skarlatīna]] [[nl:Roodvonk]] [[ja:猩紅熱]] [[pl:Płonica]] [[pt:Escarlatina]] [[ru:скарлатина]] [[fi:Tulirokko]] [[sv:Scharlakansfeber]] [[zh:丹痧]]