Scarlet Fever: A Disease to Know and Prevent

Last week, someone asked me about a fever in children that, when sick, causes bumps on the tongue and—if not properly treated—can develop into heart disease. The question was whether this disease really exists and how serious it is, as they were concerned for their young children and relatives. So today, I would like to introduce you to scarlet fever.

What is Scarlet Fever?

This disease does exist. Its official name is Scarlet Fever, and it occurs most often in children aged 5–15 years. It is caused by infection with the bacterium Streptococcus pyogenes—commonly known as Group A Streptococcus. This bacterium can cause many different diseases in both children and adults, and once infected, it can result in various illnesses.

Infection and Symptoms

This infection is common among children, especially school-aged children (5–15 years). A common illness caused by this bacterium is strep throat, which presents with:

• Sore throat
• Difficulty swallowing
• High fever
• Headache
• Nausea and vomiting
• Red, swollen tonsils—sometimes with white spots or a whitish coating
• Swollen and tender lymph nodes in the neck

Cough is usually absent. If not treated properly, it may lead to significant complications. For example, scarlet fever occurs when the bacteria produce toxins that cause a red rash across the body. The rash usually starts on the neck and chest and spreads across the body. The tongue develops prominent red bumps, giving it a “strawberry-like” appearance. After the rash subsides, the skin may peel.

Other Complications

Another possible illness is rheumatic fever, which is not directly caused by the bacteria itself, but rather by the body’s immune system producing antibodies to fight the bacteria. Unfortunately, these antibodies can mistakenly attack the body’s own tissues—such as the heart, joints, brain, and skin. This condition usually appears around 2–4 weeks after a strep throat infection caused by the same bacteria.

Severity and Treatment

The seriousness of this infection depends on whether it is treated appropriately and promptly at the initial stage. In fact, if diagnosed early, it is not difficult to treat. The standard treatment is penicillin-class antibiotics, or other types if the patient is allergic to penicillin. Importantly, the course of antibiotics must be long enough—generally, 10 consecutive days. If a child is promptly taken to a doctor for accurate diagnosis and completes the full antibiotic course, along with symptom-based care, there is a strong likelihood of avoiding serious complications.

Preventing the Infection

Prevention is important, especially among school-aged children, as the bacteria spread easily through contact with respiratory secretions from infected individuals. Good personal hygiene is the first line of defense:

• Teach children to wash their hands properly with soap and clean water—especially after coughing or sneezing, before meals, and after using the toilet.
• Avoid sharing cups, utensils, handkerchiefs, or personal items.
• When coughing or sneezing, use a tissue or the inside of the elbow to cover the mouth and nose, dispose of the tissue in a trash bin immediately, and wash hands thoroughly.
• Avoid crowded places, especially those with poor ventilation.

Strengthening Immunity

Maintaining good health through a nutritious diet, regular exercise, and adequate rest helps strengthen the body’s immune system to fight infections. When illness occurs, following medical advice and taking medications correctly will help prevent complications that are more difficult to treat.

Assoc. Prof. Dr. Nattada Areepiam and Assoc. Prof. Dr. Bodin Tiwasuwan

Faculty of Pharmacy Chulalongkorn University