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Scarlet Fever Is Milder and Rarer Today

Disease: The condition was riskier decades ago, before penicillin. Now it's 'basically strep throat with a rash,' a doctor says.


It's one of those notes sent home from school that causes shivers of alarm: a case of scarlet fever, a "highly contagious" disease that causes a telltale bright red sandpapery rash, has been reported in your child's classroom.

Even though scarlet fever conjures up visions of serious illness--which it was more than half a century ago, before penicillin was developed--today the illness is uncommon and, if treated, not serious.

"It's basically strep throat with a rash--that's all it is," said Margaret B. Rennels, a professor of pediatrics at the University of Maryland School of Medicine in Baltimore and a spokeswoman for the American Academy of Pediatrics. "In the bad old days, scarlet fever tended to be much more severe and, for reasons we don't really understand, much more common."

Like influenza, which varies in severity from year to year depending on the strain of the virus that predominates, strep throat varies in virulence annually. The illness is caused by group A streptococcus bacteria and is detected by a throat culture, a swab of the back of the throat.

While sore throats are common, most cases are caused by viruses rather than by strep. Antibiotics are not prescribed unless there is a bacterial infection, because antibiotics are useless against viruses.

Scarlet fever, which is named for the rash that usually appears on the chest or underarms, is often accompanied by the same symptoms that strep-throat sufferers exhibit: chills, fever, swollen lymph nodes or glands in the neck, a painfully sore throat and, in young children, abdominal pain.

While most strep responds to antibiotics within 24 to 48 hours, the rash from scarlet fever may last a week and resemble a sunburn, complete with peeling skin.

Contrary to the assertions of those well-intentioned notes from school, strep throat is not wildly contagious, Rennels said. It is transmitted by droplets from an infected person and can be passed by sharing eating utensils or drinking from the same cup as an infected person "or if a strep carrier coughs in somebody's face," Rennels said.

Most schools and day-care centers require that a child with strep throat or scarlet fever stay home until he or she has been on antibiotics for at least 24 hours and has no fever.

The real danger from scarlet fever or active cases of strep throat occurs when the illness is not treated with penicillin or another antibiotic. In these cases, strep can cause a serious kidney disorder or rheumatic fever, a potentially fatal illness that can damage heart valves.

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