Scarlet Fever

Droplet Precautions

Scarlet fever, also known as scarlatina, is an illness that results from group A beta-hemolytic streptococcal infection. It occurs most frequently as a complication of streptococcal pharyngitis but may also result from wound infections, urosepsis, sinusitis, bronchopneumonia, meningitis, and puerperal sepsis. A more lethal illness prior to the 19th century, scarlet fever currently follows a more benign course with decreased mortality resulting from the use of antibiotics. It’s most common in children ages 4 to 8. The incubation period usually lasts 2 to 4 days but may be as short as 1 day or as long as 7 days. Scarlet fever occurs mainly in the summer and fall and in areas where the temperature is warmer.

Causes

Group A beta-hemolytic streptococci cause scarlet fever. The infecting strain produces one of three erythrogenic toxins that trigger a sensitivity reaction in the patient. Transmission occurs by inhalation of respiratory droplets from infected patients. Risk factors include crowded conditions, such as in schools and institutions. Immunity is type specific and occurs after infection, and 80% of people have developed protective antibodies by age 10. The presence of maternal anti-exotoxin antibodies protects children younger than age 2; therefore, scarlet fever is very rare in this age group.

Complications

Scarlet fever can lead to severe disseminated toxic illness, septicemia, rheumatic heart disease, and liver damage. Glomerulonephritis may develop if the patient contracts a nephritogenic strain of group A beta-hemolytic Streptococcus. Other complications include otitis media, bronchopneumonia, brain abscess, intracranial venous sinus thrombosis, vasculitis, and uveitis.

Assessment Findings

After a 1- to 4-day incubation period, signs and symptoms appear suddenly, with the patient reporting a sore throat, headache, chills, anorexia, abdominal pain, nausea, vomiting, and malaise. The patient is likely to have a sudden temperature of 100° to 103° F (37.8° to 39.4° C) and commonly has had contact with a person with a sore throat.

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