Dr. Krishna Vakharia, a general practitioner and a mother, is the clinical director of Patient.info. In light of the recent increase in reported cases of scarlet fever, she discusses the information you should be aware of and the steps you should take if you are concerned.
When does a fever or a sore throat become something more serious? When does it become scarlet fever? A few months ago, when our son was three years old, he became ill with a fever, immediately threw up, and eventually felt better. Since this is our third child, we are well-versed in managing constant fevers, runny noses, and being sick; therefore, we attributed it to a bug because we are well-versed in managing these symptoms. A day later, he stopped eating and had a slightly higher temperature than usual. I noticed some signs of scarlet fever when I looked into his mouth. In addition, he had developed a rash, yet another indicator that helped with the diagnosis.
I was a general practitioner, so I was aware of the symptoms, and after calling the 111 services, I was given a prescription for antibiotics a couple of hours later. Within the first two days after the treatment, he felt significantly better and began to eat more. We found out later that a few children attending his nursery had been diagnosed and treated for scarlet fever.
What exactly is this “scarlet fever”?
Bacteria that are referred to as Group A streptococcus (GAS) are capable of causing a variety of infections. These infections include impetigo, cellulitis, and strep A throat (bacterial tonsillitis). These bacteria are also capable of causing scarlet fever. This infection typically strikes children under ten but can also spread to adults because it is highly contagious.
The occurrence of new cases of scarlet fever occurs periodically, even though the disease has been around for centuries. As a result of people living in overcrowded houses in the 1800s, it was the leading cause of death in children under the age of 10; however, now that people live in more spread out communities, the infection tends to be more contained, and as a result, there are fewer deaths.
It has been observed that new strains of Group A streptococcus have been present during previous outbreaks of scarlet fever; however, this does not appear to be the case in 2022. The increase in reported cases has been attributed to increased social interaction, which results in fewer people wearing masks and less social distancing.
What is the reason that an alert for scarlet fever has been issued?
In the United Kingdom, there are typically only a few cases of scarlet fever reported each year. Most of these cases occur in children and are characterized by relatively mild symptoms. There is typically a period every few years that is significantly more difficult than other times. The most recent outbreak occurred in 2017-2018 when the highest number of cases ever recorded dating back to 1960 was tallied.
There appears to be an outbreak, as there have been significantly more cases reported in 2022 compared to the same period in 2021. Most importantly, we have seen an increase in the number of children who are not feeling well and have been diagnosed with pneumonia or invasive Group A streptococcus, which causes infection to spread more widely.
People can become extremely ill, and in some cases, death can result if the Group A streptococcus enters the bloodstream or goes somewhere else in the body where it shouldn’t, such as the muscles or the lungs. This strain of Strep A is referred to as invasive Group A strep (iGAS).
The invasive pressure of group A streptococcus is highly uncommon; however, there have been four times as many cases reported in 2022 as during the surge in 2017. As of the 4th of December 2022, six deaths have occurred among children under ten. This compares to a total of four deaths during the same period in 2017.
Which symptoms are associated with strep A?
General practitioners use the Centor criteria to determine whether or not a patient requires antibiotic treatment for strep throat caused by Group A strep. The classic symptoms of Group A strep throat are those of tonsillitis. When two or more of these symptoms are present, the likelihood of a sore throat caused by Group A streptococcus increases significantly.
This criterion is difficult to use in children because children frequently have various symptoms, some of which may not fit the requirements. In situations like these, we conduct a comprehensive evaluation to determine the likelihood of the patient suffering from strep A.
Manifestations of Strep A
- I have a sore throat.
- Fever is defined as temperatures that are higher than 38 degrees Celsius.
- The tonsils have some white spots on them.
- Lymph nodes in the neck that are swollen and painful.
Scarlet fever can develop from Group A strep throat, but it can be challenging to determine when this will happen.
How to tell if it’s scarlet fever and what to do about it
First, I noticed that my son had a sore throat and red and white spots on his tonsils. Then, I observed that he had a “strawberry tongue,” characterized by a red tongue covered in white areas. On his stomach, he developed a rash that looked red and bumpy and had the texture of sandpaper.
Because the rash is frequently difficult to see on people with darker skin, doctors typically rely on their sense of touch to diagnose these patients. This rash can affect the entire body and cause the skin to peel.
Antibiotics will, in most instances, result in patients feeling better. Staying away from other people while you have symptoms of group A streptococcus and for 24 hours after you begin taking antibiotics is all that is required to prevent the disease from spreading to others and becoming more widespread. The rash can last up to seven days, and during that time, children may feel quite tired regularly.
Once you have been taking antibiotics for 24 hours and your fever has subsided, you are well enough to resume your normal activities, such as going to school or working.
When should we start to be concerned?
If you are experiencing any of the following symptoms, you should seek medical attention as soon as possible by calling your doctor or going to the nearest emergency room.
- There was no sign of improvement after the first round of antibiotics.
- If the patient’s temperature does not drop after being administered paracetamol and ibuprofen.
- Fever that has lasted longer than five days.
- Symptoms are getting worse.
- If there is no longer evidence that children are eating or drinking.
- Whenever there are fewer than three good wet diapers available, whenever it has been more than 12 hours since the child last urinated or defecated, or whenever the child is wearing a dry diaper.
Call 999 or the emergency number if:
- Your child appears listless and is not responding to you.
- They have a temperature and a headache, and their neck is not moving.
- The rash does not go away when subjected to the glass test, which involves pressing the edge of a glass against the inflammation and determining whether or not it is still visible.
- When they speak, they need to make more sense.
- Their eyes are being affected by the light.
- They cannot swallow their saliva, causing them to drool.
- They are having trouble breathing if you can see that their ribs are being drawn in, or they cannot talk or lie down flat because they are so out of breath.
The complications of scarlet fever include the following.
As was mentioned earlier, in addition to the rise in the number of children experiencing complications from scarlet fever, there has also been a rise in the incidence of invasive Group A streptococcus and pneumonia. Both of these can result in severe illness.
Advice that can be put into practice to alleviate a scratchy throat
Ice lollies are a great source of both fluids and energy. When you have a sore throat, they also act as a soothing agent for the throat.
Drink water frequently and in small sips; drinking too much water at once can make you feel nauseous, so try to avoid doing that.
Regarding food consumption, parents should let their children eat whatever they can and desire, even if it is something as simple as yogurt and white chocolate buttons, as is the case with my kid. When they are feeling better, they will be able to catch up on their nutrition.
It would help if you gave them paracetamol and ibuprofen to treat their fever and pain. Check the label to see the recommended dose, and ensure you don’t provide more. When it comes to parenting, it can be challenging to know when to worry and when to seek assistance.
The majority of the time, your child will have a sore throat because of a virus, or it could be strep throat, in which case your child may require antibiotics for the condition. Scarlet fever is still relatively uncommon. The purpose of the scarlet fever alert is to let primary care physicians and parents know that they should investigate further if a patient presents with a fever and a sore throat, and then they should act quickly when there is a possibility that the patient has scarlet fever or iGAS.