Scarlet Fever

Scarlet fever is mostly a childhood disease that is transmitted by streptococcal bacteria. Typical signs of scarlet fever are a rash on the tongue, cough, sputum, runny nose and fever. Scarlet fever is usually transmitted by droplet infection or direct contact.

Scarlet Fever

What is scarlet fever?

Scarlet fever has been a well-known and formerly widespread childhood disease. Today it doesn’t happen that often anymore. It is caused by streptococcal bacteria, which can also be responsible for other diseases. These include angina tonsillaris, tonsillitis and erysipelas. Scarlet fever can also be a cause for secondary diseases such as rheumatic fever. See deluxesurveillance for Diffuse Esophageal Spasm Guide.

Scarlet fever occurs mostly in children in kindergarten and school and spreads among them through contact infection. Interestingly, by the age of six months, babies have natural immune protection against scarlet fever and other childhood diseases. But adults can also get scarlet fever. The risk of infection is seasonally highest between October and March.

If scarlet fever occurs, this disease must be reported to the doctor immediately in order to avoid further infections.


The cause of scarlet fever is an infection with streptococcus bacteria (also A streptococci, Streptococcus pyogenes). The bacteria are transmitted either through direct contact with an infected person or through droplet infection (cough, cold). Infected food, drinks and objects can also be considered as sources of infection.

Scarlet fever has already broken out within one to three days after infection and the symptoms appear as typical symptoms. Those affected can infect other people, so that isolation and treatment are absolutely necessary.

Symptoms, Ailments & Signs

The first symptom of the disease is a sore throat. They are accompanied by severe swallowing difficulties and often a very high fever of up to 40 °C. Headaches and nausea with vomiting also occur. Patients often complain of abdominal pain and poor general condition. They feel drained and tired, sometimes they have chills.

On the second day of the illness, the throat shows the typical red discoloration, the tongue is covered with pus, and the lymph nodes in the neck are swollen. The tonsils are enlarged, reddened and also covered with pus. In addition, a skin rash with pinhead-sized dots forms at this point.

This velvety, non-itchy rash starts on the chest, sometimes in the groin, and spreads throughout the body. It is most intense in the groin and on the inside of the thighs. The only area spared by the rash is the triangle-shaped area between the mouth and chin.

After three to four days, the white coating on the tongue comes off and is shed. The inflamed and swollen papillae become visible and cause the typical raspberry-like appearance of the tongue. The so-called raspberry tongue is considered a characteristic symptom of scarlet fever. After two to four weeks, the rash will disappear and the skin will peel off in scales.

Course of the disease

If scarlet fever is left untreated, it can cause immense damage. Above all, it can lead to poisoning of various organs, circulatory failure, diarrhea, myocarditis and vomiting. The streptococcal bacteria can also spread through the bloodstream and lead to blood poisoning (sepsis). Sinusitis and meningitis are also possible.

Late effects that can remain lasting in the course of scarlet fever are heart valve defects, kidney diseases and rheumatic fever. Pregnant women who contract scarlet fever leave no lasting damage to the unborn child. Children infected with scarlet fever who have been treated with antibiotics can return to school or kindergarten after a few days.


Today, serious consequential damage from scarlet fever is rarely to be feared, thanks to the use of antibiotic drugs. However, there is a risk if the infection is left untreated. In such cases, there is a risk of streptococcal secondary diseases such as rheumatic fever, rheumatic endocarditis or poststreptococcal glomerulonephritis. They are among the immunological diseases.

They are caused by the immune system’s immune response, which is directed against the causative germs of scarlet fever. They show up about four to six weeks after infection. In addition, there is a suspicion that streptococcal infections cause neuropsychiatric autoimmune diseases.

This can be minor chorea, Tourette’s syndrome or PANDAS. If the pathogens penetrate into the bloodstream, there is also a risk of a dangerous toxic shock syndrome (TSS), which causes severe organ and circulatory failure caused by the toxins of the bacteria.

Not infrequently, the streptococci are responsible for other secondary diseases of the scarlet fever infection. These purulent complications appear after the scarlet fever has healed. These are often inflammations of the paranasal sinuses, acute middle ear infections, meningitis (meningitis) or streptococcal sepsis.

Furthermore, the formation of abscesses in the connective tissue of the tonsils is possible. The risk of scarlet fever complications is particularly pronounced in adult patients. Those affected usually try self-therapy first, instead of rushing to see a doctor.

When should you go to the doctor?

Rising fever and the characteristic red coloring of the throat and tongue indicate scarlet fever. The child should be seen by a doctor if symptoms appear to appear overnight and do not resolve within a few hours. If the lymph nodes in the neck also swell or there are accompanying symptoms such as abdominal pain and discomfort, it is best to consult the doctor immediately. An immediate visit to the doctor is also indicated if a streptococcal infection is going around in the child’s kindergarten or school.

Adults who notice these symptoms should see their family doctor as soon as possible. Other contact points are the dermatologist or an internist. If scarlet fever is treated early, it should go away within a few days. Very high fever and increased gastrointestinal symptoms indicate a complicated course of the disease. If the patient’s condition does not improve despite bed rest and medication, hospitalization may be needed. The family doctor or pediatrician should be informed immediately of persistent symptoms and complaints.

Treatment & Therapy

The regular treatment for scarlet fever is antibiotics (penicillin). In any case, a doctor should be consulted in the case of scarlet fever, since there is an obligation to report and self-treatment is strongly discouraged. Above all, the unpleasant symptoms of the disease, such as cough, headache, sore throat, fever and body aches, should be alleviated and the streptococcal bacteria should be eliminated.

If the person concerned cannot tolerate the antibiotic medication or is allergic to it, alternatives such as cephalosporin, roxithromycin or erythromycin can also be prescribed by the doctor. In addition to the general initial examination, a second examination should also be carried out by the doctor after one to two weeks. Here, a urine sample is usually taken and examined. The aim is to determine whether a so-called nephritis has developed in the body or in the urine. You should also check for blood residue in the urine.

In addition to the medical examination and treatment, the person affected by scarlet fever should definitely observe strict bed rest. In addition, the child should not be able to infect other people. Therefore, the patient should be treated in relative isolation. Children with scarlet fever in particular should drink a lot and cough up the cough phlegm regularly. Cough relieving agents can be purchased in all common pharmacies, mostly without a prescription. Furthermore, you should ensure that the air in the rooms is slightly damper and cooler.


Surviving scarlet fever, which mostly occurs in children, does not require any special aftercare. If the child has been treated with antibiotics, it can usually go back to kindergarten or school after three weeks. Re-infection can be prevented above all by isolating sick children from other children as quickly as possible for the time being treated and until the disease has abated, and by treating them quickly.

This is because scarlet fever usually spreads via droplet infection. It is therefore advisable to disinfect the area around the affected child and the toy to prevent it from spreading. The doctor has to decide when the child can go back to daycare. In order to avoid scarlet fever, washing your hands regularly with soap is also important to limit the bacteria on your hands.

In rare cases, scarlet fever can have long-term effects. Therefore, it is important that the affected person is treated by a doctor and that he can also determine when the disease is over or may require further treatment. However, this usually does not happen, so follow-up care for scarlet fever is not necessary.

You can do that yourself

In the case of scarlet fever, some measures can be taken by the patient himself, in addition to medical treatment.

First of all, the affected child should take it easy. Adequate sleep is important for the recovery process, as the immune system is heavily burdened by the disease and needs rest. Parents should also make sure that the child drinks enough water or tea. A balanced fluid balance is particularly important for small children and babies in order to avoid drying out of the mucous membranes or dehydration. The humidity in the premises should be as high as possible. A damp towel on the heater or an air humidifier are proven ways to moisten the indoor climate.

Gargling solutions, inhalations and neck wraps help with a sore throat. Classics like chicken soup also help, because they supply the body with minerals and have an anti-inflammatory effect. They also keep the mucous membranes moist and serve to supply fluids. Calf wraps and cooling pads help with fever. Parents should be aware of any warning signs. If the fever continues to rise or if severe coughing spasms occur, the doctor must be consulted.

The scarlet fever should subside after a few days. If symptoms persist, medical advice is also required, as there may be complications. The doctor can also prescribe homeopathic remedies such as belladonna, stromonium and ipecacuanha. The medicinal plant ointment helps as well as nasturtium, Iceland moss and salt pastilles.