Do you know the signs and symptoms of scarlet fever?

Registered medical practitioners in England and Wales have a statutory duty to notify local authorities to report suspected cases of certain infectious diseases, such as Covid-19, measles, and whooping cough. Scarlet fever is also on the list collected by the UKHSA, with 12,176 cases of scarlet fever notified between 1st January and 24^th March this year alone.

Scarlet fever, once a major cause of childhood mortality, has seen a resurgence in recent years. Understanding the signs and symptoms is crucial for timely diagnosis and treatment.

Here, we look at the key signs and symptoms of scarlet fever, what to look for in children, and the necessary steps if you suspect an infection, according to NHS guidelines.

Main signs and symptoms of scarlet fever

Scarlet fever is caused by the Group A Streptococcus bacteria, the same bacteria responsible for strep throat. It typically affects children aged 5 to 15, but it can still occur in younger children and adults.

The primary signs and symptoms include:

1. Sore throat: Often one of the first symptoms, it can be severe and persistent.
2. High fever: A sudden onset of a high temperature, usually 38.3°C (101°F) or higher, which can last 24-48 hours.
3. Rash: A distinctive red rash that feels like sandpaper to the touch. It usually starts on the chest and stomach before spreading to other parts of the body. On brown and black skin, it may be harder to see a change in colour, but you can still feel the rash and see the raised bumps.
4. Red lines: These are red streaks or lines in the folds of the skin, particularly in the armpits, elbows, and knees.
5. Strawberry tongue: The tongue may appear red and bumpy, resembling the surface of a strawberry. It can be swollen and covered with a white coating early in the infection.
6. Flushed face: The face may appear flushed with a pale area around the mouth.
7. Headache and body aches: These symptoms are common and can be quite severe.
8. Nausea and vomiting: Some children may experience stomach upset and vomiting.

What parents should look out for

Parents should be vigilant if their child exhibits any of the above symptoms, particularly if multiple symptoms occur simultaneously. The distinctive rash and high fever are strong indicators of scarlet fever.

It is important to know that if a child complains of a sore throat accompanied by a rash or “strawberry” tongue, it is imperative to seek medical advice promptly. Early intervention can prevent complications.

What GPs and nurses should look out for

Healthcare professionals should conduct a thorough examination if scarlet fever is suspected. Key diagnostic steps include:

• Physical examination: Checking for the characteristic rash, red lines, and strawberry tongue.
• Throat swab: A swab test can confirm the presence of Group A Streptococcus bacteria.
• Medical history: Reviewing the patient’s recent health history and symptoms to differentiate scarlet fever from other illnesses with similar presentations.

Scarlet fever UK statistics

According to the UKHSA, scarlet fever has seen a resurgence in the UK in recent years, with a significant increase in reported cases. For instance, in 2018, there were 30,768 reported cases, the highest in 50 years. More recent data from 2023 indicated a continuation of this trend, with thousands of cases reported, especially during the winter and spring months. Increased awareness and reporting may contribute to these figures, emphasising the importance of vigilance among parents and healthcare professionals.

What to do if you suspect scarlet fever

If you or your child exhibit symptoms of scarlet fever, it is crucial to seek medical advice immediately. Here’s what to do:

1. Contact your GP: Make an appointment for a thorough evaluation, and be sure to tell the receptionist or care navigator who is booking your appointment that you suspect scarlet fever.
2. Follow medical advice: If diagnosed, adhere to the prescribed antibiotic treatment. Penicillin or amoxicillin is typically prescribed for 10 days.
3. Isolate the patient: To prevent the spread of infection, keep the affected individual at home and avoid close contact with others, especially during the first 24 hours of antibiotic treatment.
4. Monitor symptoms: Watch for any signs of complications, such as ear infections, pneumonia, or rheumatic fever, and report these to your doctor.

Treatment for scarlet fever

Treatment for scarlet fever involves a full course of antibiotics, and it is crucial to complete the entire course to prevent complications and recurrence. Symptoms typically improve within a few days of starting antibiotics, but the rash can take a couple of weeks to fully resolve. Patients are advised to stay home from school or work for at least 24 hours after beginning antibiotic treatment, to reduce the risk of spreading the infection. Rest and hydration is also crucial to enabling recovery.

Conclusion

Scarlet fever, while less dangerous than in the past due to modern antibiotics, still requires prompt attention and treatment. Recognising the signs and symptoms of scarlet fever early on can lead to swift diagnosis and effective treatment, minimising complications. With proper care, most individuals recover fully within a week to 10 days, allowing them to return to their normal activities.

If you have symptoms you are concerned about, please contact your Primary Care 24 GP practice as soon as possible.