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An Article on pubmed "

Incidence of Scarlet Fever in Children in Jeju Province, Korea, 2002-2016: An Age-period-cohort Analysis" (published in 2019). Explains that

here has been outbreaks of Scarlets Fever in Mexico, Hong Kong, and England. More and more cases keep showing up in younger children

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Scarlet fever epidemics were deadly to children across the globe in the 1800s, but in recent decades concerns about the disease have largely faded from the minds of medical experts, in part due to the power of antibiotics.

The bacteria causing scarlet fever has acquired toxins called superantigens

It is believed to have played a role in recent scarlet fever outbreaks in Asia and the UK

The superantigens have increased the virulence of the disease, researchers say

Recently though, the bacteria responsible for scarlet fever has been mutating and making a resurgence.

New research by scientists at the University of Queensland (UQ), in collaboration with scientists around the world, has suggested the Streptococcus pyogenes bacteria is growing stronger after being infected by viruses.

UQ Australian Infectious Diseases Research Centre director Mark Walker co-authored a paper on the topic that was recently published in the journal, Nature Communications.

Professor Walker said they started looking into Streptococcus pyogenes after an outbreak in Asia in 2011 and then in the UK in 2014.

Between 2014 and 2018, the UK National Health Service reported a 68 per cent increase in the number of lab reports of pyogenic streptococci.

Scarlet fever was once widely feared by parents because of its harsh effects on children.

Historically, septic complications such as brain abscess, meningitis, lung abscess, pneumonia, osteomyelitis (bone infection), middle ear and soft tissue infections could follow scarlet fever and cause early death.

According to ABC Health and Wellbeing, typical scarlet fever symptoms are a sore throat, sudden high fever, enlarged lymph nodes in the neck, and a rough, bright red rash on stomach and limbs.

'Three new genes'

Professor Walker said while one might expect that a virus infecting a bacteria was bad for the bacteria, this is not always the case.

"One of the big stand-outs for us was the presence of these three new genes," he said.

Professor Walker said the genes turned out to be from three viruses which had been "floating around" for a while but only recently have all come together.

"It was quite a surprise," he said.

UQ researchers have been collaborating with scientists around the world to analyse the changing bacteria.(
Supplied: UQ
)

"They (the bacteria) seem to have acquired a number of toxins that are called superantigens," Professor Walker said.

"These things are able to trigger the body's own immunity and that then results in a fever and a rash.

"We've been able to show that together, these three toxins have increased the virulence of Streptococcus pyogenes and also made it better able to colonise in an animal model."

'Better able to colonise the host'

Professor Walker said while one might expect that a virus infecting a bacteria was bad for the bacteria, this was not always so.

"In this case, the bacterial virus is carrying three new toxins and because it's carrying those toxins when it infects the bacteria, it gives the bacteria this extra virulence potential.

"We hypothesise that this allows the bacteria to better able to colonise the host.

"Because the bacteria is then able to last longer inside a child ... this new combination of toxins has time to act and then that, we think, is the trigger for this resurgence."

A colourised image of Streptococcus pyogenes bacteria on a human white blood cell.(
Supplied: Centers for Disease Control
)

Professor Walker said the toxins were particularly invasive as several targeted white blood cells - usually a key defence against foreign bacteria.

"Those toxins allow the bacteria to escape the white blood cells that are coming to the site of infection," he said.

Professor Walker said while scarlet fever was not causing lethal infections as it used to it was important to continue to highlight infection and vaccine research as outbreaks continued.

"There is no vaccine and what we've relied on previously is antibiotics to help treat infection when it occurs," he said.

" Streptococcus pyogenes is still susceptible to many antibiotics, but it's also gaining resistance.

"Developing vaccines to keep infection under control is a really important concept and goal."

Dr Meru Sheel from the National Centre for Epidemiology and Population Health at The Australian National University said she agreed there should be more surveillance of Streptococcus infections.

She said this particular bacteria also causes a series of diseases, not just scarlet fever including sore throat and skin infections as well as chronic conditions like rheumatic fever and rheumatic heart disease, which are particularly prevalent in remote Aboriginal and Torres Strait Islander communities.

"It causes a range of different diseases which all require some level of surveillance and quite often we do it using the genomic epidemiology but we don't necessarily do public health surveillance at the same level as we do for other infectious diseases," she said.

Dr Sheel also said it was good to build evidence for what may be causing these kinds of disease resurgence and she would be interested to see it examined at a population level.

She said she also thought this use of bacterial DNA analysis could be a useful example to encourage the technology to be used in disease surveillance.

"We're seeing it for COVID where we are using genomics ... to see how clusters are connected, we have done it with Streptococcus in the research area but we haven't been using it that widely for public health surveillance and that's probably in the future.

She also agreed there needs to be more development of a vaccine.

"This is one of the biggest global targets for vaccination there has been a vaccine in development for ... about 20 plus years and there has been Australia-wide movement and advocacy around building a vaccine for this disease ... not driven by scarlet fever but more by rheumatic heart disease.

"What we need is a vaccine that will work against the ... 180 to 200 types of bacteria but also not cause autoimmune diseases so the more we learn about strains the more it teaches us about what diseases it could protect."

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Scarlet fever making a comeback thanks to a toxic virus, researchers say

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Scarlet fever epidemics were deadly to children across the globe in the 1800s, but in recent decades concerns about the disease have largely faded from the minds of medical experts, in part due to the power of antibiotics.

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Dr. Mark Walker
The University of Queensland
https://scmb.uq.edu.au/profile/948/mark-walker

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Image from https://www.nhs.uk/conditions/scarlet-fever/

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If the rash is presented along with strep throat and a fever an antibiotic is given. To also help take Advil or Tylenol to lower the fever.

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Diagnosis

During the physical exam, your doctor will:

Look at the condition of your child's throat, tonsils and tongue

Feel your child's neck to determine if lymph nodes are enlarged

Assess the appearance and texture of the rash

Throat swab

If your doctor suspects strep is the cause of your child's illness, he or she will also swab the tonsils and back of your child's throat to collect material that may harbor the strep bacteria.

Tests for the strep bacteria are important because a number of conditions can cause the signs and symptoms of scarlet fever, and these illnesses may require different treatments. If there are no strep bacteria, then some other factor is causing the illness.

Treatment

If your child has scarlet fever, your doctor will prescribe an antibiotic. Make sure your child completes the full course of medication. Failure to follow the treatment guidelines may not completely eliminate the infection and will increase your child's risk of developing complications.

Your child can return to school when he or she has taken antibiotics for at least 24 hours and no longer has a fever.

Lifestyle and home remedies

You can take a number of steps to reduce your child's discomfort and pain.

Treat fever and pain. Use ibuprofen (Advil, Children's Motrin, others) or acetaminophen (Tylenol, others) to control the fever and minimize throat pain.

Provide adequate fluids. Give your child plenty of water to keep the throat moist and prevent dehydration.

Prepare a saltwater gargle. If your child is able to gargle water, give him or her salty water to gargle and then spit out. This may ease the throat pain.

Humidify the air. Use a cool mist humidifier to eliminate dry air that may further irritate a sore throat.

Offer lozenges. Children older than age 4 can suck on lozenges to relieve a sore throat.

Provide comforting foods. Warm liquids such as soup and cold treats like ice pops can soothe a sore throat.

Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.

Preparing for your appointment

You're likely to first see your family doctor or your child's pediatrician. However, when you call to set up your appointment, you may be urged to seek immediate medical care if your child is experiencing any of the following:

High fever

Severe sore throat with difficulty swallowing

Intense abdominal pain or vomiting

Severe headache

What you can do

Before your appointment, you might want to write a list of questions for the doctor:

How soon after my child begins treatment will he or she begin to feel better?

Is my child at risk of any long-term complications related to scarlet fever?

Is there anything I can do to help soothe my child's skin while it heals?

When can my child return to school?

Is my child contagious? How can I reduce my child's risk of passing the illness to others?

Is there a generic alternative to the medicine you're prescribing? What if my child is allergic to penicillin?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

When did your child begin experiencing symptoms?

Has your child had a sore throat or difficulty swallowing?

Has your child had a fever? How high was the fever, and how long did it last?

Has your child had abdominal pain or vomiting?

Has your child been eating adequately?

Has your child complained of headache?

Has your child recently had a strep infection?

Has your child recently been exposed to anyone with a strep infection?

Has your child been diagnosed with any other medical conditions?

Is your child currently taking any medications?

Does your child have medication allergies?

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During the physical exam, your doctor will: Look at the condition of your child's throat, tonsils and tongue Feel your child's neck to determine if lymph nodes are enlarged Assess the appearance and texture of the rash If your doctor suspects strep is the cause of your child's illness, he or she will also swab the tonsils and back of your child's throat to collect material that may harbor the strep bacteria.

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The Doctor will exam your tonsils and tongue

Feel around your neck to see  if their lymph nodes are swollen

Look at rash and feel the texture of it

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Scarlet Fever

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If your child has a sore throat and a rash, it may be scarlet fever (also called scarlatina). Your child's doctor can do a quick strep test to find out.

If your child has scarlet fever, antibiotics can help your child feel better faster and prevent long-term health problems. Antibiotics can also help protect others from getting sick.

Bacteria cause scarlet fever

Bacteria called group A Streptococcus (group A strep) cause scarlet fever. These bacteria are also the cause of strep throat. The bacteria sometimes make a toxin (poison), which causes a rash - the "scarlet" of scarlet fever.

How you get scarlet fever

Group A strep bacteria are very contagious. Generally, people spread the bacteria to others through

Respiratory droplets

Direct contact

Rarely, people can spread group A strep bacteria through food that is not handled properly (visit CDC's food safety page).

It usually takes two to five days for someone exposed to group A strep bacteria to become sick with strep throat or scarlet fever.

Respiratory droplets

Group A strep bacteria often live in the nose and throat. People who are infected spread the bacteria by talking, coughing, or sneezing, which creates respiratory droplets that contain the bacteria.

People can get sick if they:

Breathe in respiratory droplets that contain the bacteria

Touch something with those droplets on it and then touch their mouth or nose

Drink from the same glass or eat from the same plate as a person infected with group A strep

Direct contact

People can also spread group A strep bacteria from infected sores on their skin. Other people can get sick if they:

Touch sores on the skin caused by group A strep (impetigo) or come into contact with fluid from the sores

People are contagious even with no symptoms

Some people infected with group A strep do not have symptoms or seem sick. People who are sick with strep throat are more contagious than those who do not have symptoms.

Rash and fever are common symptoms

In general, scarlet fever is a mild disease. Illness usually begins with a fever and sore throat.
General symptoms
Some symptoms of scarlet fever are common to other infections, too. These may include:

Fever (101°F or higher) or chills

Sore throat and pain when swallowing

Headache or body aches

Stomach pain

Nausea or vomiting

Physical signs
Some physical signs are typical of scarlet fever. These show in the following areas:

Physical signs

Tongue, throat, and neck

Signs in these areas:

Whitish coating on the tongue, early in the illness

"Strawberry" (red and bumpy) tongue

Very red throat

Red and swollen tonsils

White patches or streaks of pus on the tonsils

Tiny, red spots on the roof of the mouth, called petechiae

Swollen lymph nodes in the front of the neck

The illustrations below show what these physical signs usually look like.

Skin rash

Signs of scarlet fever rash:

Red rash that feels rough like sandpaper

Brighter red skin in the creases of the underarm, elbow, and groin

A pale area around the mouth

Skin peeling as the rash fades

One to 2 days after the illness begins, a red rash usually appears. However, the rash can appear before illness or up to 7 days later.

The rash may first appear on the neck, underarm, and groin (the area where your stomach meets your thighs). Over time, the rash spreads over the body. The rash usually begins as small, flat blotches that slowly become fine bumps that feel like sandpaper.

Although the cheeks might look flushed (rosy), there may be a pale area around the mouth. Underarm, elbow, and groin skin creases may become brighter red than the rest of the rash.

The rash from scarlet fever fades in about 7 days. As the rash fades, the skin may peel around the fingertips, toes, and groin area. This peeling can last up to several weeks.

Some people are at increased risk

Anyone can get scarlet fever, but there are some factors that can increase the risk of getting this infection.

Age

Scarlet fever, like strep throat, is more common in children than adults. It is most common in children 5 through 15 years old. It is rare in children younger than 3 years old. Adults who are at increased risk for scarlet fever include:

Parents of school-aged children

Adults who are often in contact with children

Group settings

Close contact with another person with scarlet fever is the most common risk factor for illness. For example, if someone has scarlet fever, the bacteria often spread to other people in their household.

Infectious illnesses tend to spread wherever large groups of people gather. Crowded settings can increase the risk of getting a group A strep infection. These settings include:

Schools

Daycare centers

Military training facilities

Doctors can test for and treat scarlet fever

Many viruses and bacteria can cause an illness that includes a red rash and sore throat. A doctor will determine what type of illness you have by asking about symptoms and doing a physical exam. If they think you might have scarlet fever, they will swab your throat to test for strep throat. There are two types of tests for strep throat: a rapid strep test and throat culture.

Rapid strep test

A rapid strep test involves swabbing the throat and running a test on the swab. The test quickly shows if group A strep bacteria are causing the illness.

If the test is positive, doctors can prescribe antibiotics.

If the test is negative, but a doctor still suspects scarlet fever, then the doctor can take a throat culture swab.

Throat culture

A throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time, a throat culture sometimes finds infections that the rapid strep test misses.

Culture is important to use in children and teens since they can get rheumatic fever from an untreated scarlet fever infection. For adults, it is usually not necessary to do a throat culture following a negative rapid strep test. Adults are generally not at risk of getting rheumatic fever following scarlet fever.

Antibiotics are used for treatment

Doctors treat scarlet fever with antibiotics. Benefits of antibiotics include:

Decreasing how long someone is sick

Decreasing symptoms (feeling better)

Preventing the bacteria from spreading to others

Preventing serious complications like rheumatic fever

When to return to work, school after illness
People with scarlet fever should stay home from work, school, or daycare until they:

AND

Have taken antibiotics for at least 12 to 24 hours; ask the doctor how long you should stay home after starting antibiotics

Antibiotic dos and don'ts

1. Do take the prescription exactly as the doctor says to.

2. Don't stop taking the medicine, even if you or your child feels better, unless the doctor says to stop.

You can find more guidance on taking antibiotics on CDC's Antibiotic Do's & Don'ts Page.

Long-term health problems are not common

Complications can occur after having scarlet fever. This can happen if the bacteria spread to other parts of the body. Complications can include:

Treatment with antibiotics can prevent most of these health problems.

Protect yourself and others

People can get scarlet fever more than once. Having scarlet fever does not protect someone from getting it again in the future. While there is no vaccine to prevent scarlet fever, there are things people can do to protect themselves and others.

Good hygiene

The best way to keep from getting or spreading group A strep is to wash your hands often. This is especially important after coughing or sneezing and before preparing foods or eating.

To prevent group A strep infections, you should:

Cover your mouth and nose with a tissue when you cough or sneeze.

Put your used tissue in the waste basket.

Cough or sneeze into your upper sleeve or elbow, not your hands, if you don't have a tissue.

Wash your hands often with soap and water for at least 20 seconds.

Use an alcohol-based hand rub if soap and water are not available.

You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are safe for others to use once washed.

Antibiotics

Antibiotics help prevent someone with strep throat from spreading the bacteria to others.

Related diseases

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If your child has a sore throat and rash, it may be scarlet fever, a group A strep infection. Do you know the symptoms of this contagious illness and treatment options?

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Scarlet Fever also known as Scarlatina, is a bacterial illness that is caused by strep throat. Scarlet Fever can be identified as a bright red rash that can cover majority of the body. Scarlet Fever usually effects children 5-15 years old. Due to new medical advancements it is not considered a serious illness.

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Scarlet fever is a bacterial illness that develops in some people who have strep throat. Also known as scarlatina, scarlet fever features a bright red rash that covers most of the body. Scarlet fever almost always includes a sore throat and a high fever.

Scarlet fever is most common in children 5 to 15 years of age. Although scarlet fever was once considered a serious childhood illness, antibiotic treatments have made it less threatening. Still, if left untreated, scarlet fever can result in more-serious conditions that affect the heart, kidneys and other parts of the body.

The signs and symptoms that give scarlet fever its name include:

Red rash. The rash looks like a sunburn and feels like sandpaper. It typically begins on the face or neck and spreads to the trunk, arms and legs. Pushing on the reddened skin makes it turn pale.

Red lines. The folds of skin around the groin, armpits, elbows, knees and neck usually become a deeper red than the other areas with the rash.

Flushed face. The face may appear flushed with a pale ring around the mouth.

Strawberry tongue. The tongue generally looks red and bumpy, and it's often covered with a white coating early in the disease.

Signs and symptoms of scarlet fever also include:

Fever of 100.4 F (38.0 C) or higher, often with chills

Very sore and red throat, sometimes with white or yellowish patches

Difficulty swallowing

Enlarged glands in the neck (lymph nodes) that are tender to the touch

Nausea or vomiting

Belly (abdominal) pain

Headache and body aches

The rash and the redness in the face and tongue usually last about a week. After these signs and symptoms have gone away, the skin affected by the rash often peels.

Talk to your health care provider if your child has a sore throat with:

A fever of 100.4 F (38.0 C) or higher

Swollen or tender glands in the neck

A red rash

Signs and symptoms that need emergency evaluation

In children and teens, any of the following symptoms need emergency evaluation:

New shortness of breath at rest

Trouble breathing (grunting, pulling-in chest muscles between the ribs, nostril flaring)

Noisy, wheezy or raspy breathing that does not clear with coughing

Rapid breathing

Chest pain

Inability to swallow liquids or saliva, muffled voice, or inability to open mouth fully

Confusion, lack of energy, or inability to stay alert and awake

Dizziness when sitting or standing

Drooling (if age 3 years or older)

Persistent or severe vomiting or diarrhea

Dehydration

For infants less than 2 months old, additional symptoms needing emergency evaluation include:

Inability to be comforted

Breathing that repeatedly starts and stops

Temperature less than 96.0 F (35.5 C) or greater than 100.4 F (38 C)

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Scarlet fever is caused by the same type of bacteria that causes strep throat - group A streptococcus (strep-toe-KOK-us), also called group A strep. In scarlet fever, the bacteria release a toxin that produces the rash and red tongue.

The infection spreads from person to person by droplets released when an infected person coughs or sneezes. The incubation period - the time between exposure and illness - is usually 2 to 4 days.

Children 5 to 15 years of age are more likely than are other people to get scarlet fever. Scarlet fever germs spread more easily among people in close contact, such as family members, child-care groups or classmates.

Scarlet fever most often occurs after a strep throat infection. Sometimes scarlet fever may occur after a skin infection, such as impetigo. People can get scarlet fever more than once.

If scarlet fever goes untreated, the bacteria may spread to the:

Tonsils

Skin

Blood

Middle ear

Sinuses

Lungs

Heart

Kidneys

Joints

Muscles

Rarely, scarlet fever can lead to rheumatic fever, a serious inflammatory disease that can affect the heart, joints, nervous system and skin.

A possible relationship has been suggested between strep infection and a rare condition called pediatric autoimmune neuropsychiatric disorder associated with group A streptococci (PANDAS). Children with this condition experience worsened symptoms of neuropsychiatric conditions, such as obsessive-compulsive disorder or tic disorders, with strep. This relationship currently remains unproved and controversial.

There is no vaccine to prevent scarlet fever. The best ways to prevent scarlet fever are the same as the standard precautions against infections:

Wash your hands. Show your child how to wash hands thoroughly with warm soapy water for at least 20 seconds. Alcohol-based hand sanitizer can be used if soap and water are not available.

Don't share dining utensils or food. As a rule, your child shouldn't share drinking glasses or eating utensils with friends or classmates. This rule applies to sharing food, too.

Cover your mouth and nose. Tell your child to cover the mouth and nose when coughing and sneezing to prevent the potential spread of germs.

If your child has scarlet fever, wash drinking glasses and utensils in hot soapy water or in a dishwasher after your child uses them.

1. Ferri FF. Scarlet fever. In: Ferri's Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed Dec. 21, 2021.

2. Scarlet fever: All you need to know. Centers for Disease Control and Prevention. https://www.cdc.gov/groupastrep/diseases-public/scarlet-fever.html. Accessed Dec. 21, 2021.

3. Scarlet fever: Information for clinicians. Centers for Disease Control and Prevention. https://www.cdc.gov/groupastrep/diseases-hcp/scarlet-fever.html. Accessed Dec. 21, 2021.

4. Streptococcal infections. Merck Manual Professional Version. https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-cocci/streptococcal-infections. Accessed Dec. 21, 2021.

5. AskMayoExpert. Scarlet fever (child). Mayo Clinic; 2021.

6. Acute rheumatic fever: Information for clinicians. Centers for Disease Control and Prevention. https://www.cdc.gov/groupastrep/diseases-hcp/acute-rheumatic-fever.html. Dec. 21, 2021.

7. Sore throat. Centers for Disease Control and Prevention. https://www.cdc.gov/antibiotic-use/sore-throat.html. Accessed Dec. 21, 2021.

8. Drutz JE. Acute pharyngitis in children and adolescents: Symptomatic treatment. https://www.uptodate.com/contents/search. Accessed Dec. 22, 2021.

9. Pichichero ME. PANDAS: Pediatric autoimmune neuropsychiatric disorder associated with group A streptococci. https://www.uptodate.com/contents/search. Accessed Dec. 22, 2021.

10. Ristagno EH (expert opinion). Mayo Clinic. Dec. 23, 2021.

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The difference between scarlet fever and strep throat-Scarlet fever - Symptoms & causes - Mayo Clinic

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Learn more about the symptoms, causes, complications and treatment of this strep bacterial infection that causes a red rash, sore throat and high fever.

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Group A Streptococcus or also known as group A strep

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What are the  Symptoms of Scarlets Fever

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What are the  Symptoms of Scarlets Fever

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-Red Rash
-Flushed Face
- Sore Throat
-Fever
-Difficulty Swallowing