SCARLET FEVER

also called scarlatina acute infectious disease caused by certain types of hemolytic (hemoglobin-liberating) streptococcal bacteria, typically Streptococcus pyogenes. The English physician Thomas Sydenham in 1676 gave a clear differentiation of scarlet fever, as follows: The skin is marked with small, red spots, more frequent, more diffuse, and more red than in measles. These last two or three days. They then disappear, leaving the skin covered with brawny squamulae , as if powdered with meal. The onset of the disease begins from two to seven days after exposure. The first symptoms are fever, sore throat, headache, and, in children, vomiting. From two to three days later the rash appears as a reddening of the skin that begins on the neck, in the armpits and groin, and upon the chest. The face is flushed, with a ring of pallor around the lips. The throat is inflamed, and red spots appear upon the palate. The tongue is coated, but the edges are deeply inflamed. After four days the coating on the tongue disappears, leaving a swollen, deeply injected surface with prominent papillae (strawberry tongue). The eruption and fever last for a week or more and in about one-third of the cases are followed by desquamation, or peeling off of portions of the skin. The glands of the body are usually swollen; those of the neck may be tender and painful to touch. Complications are frequent. The sinuses probably are always secondarily involved, frequently remain infected during convalescence, and constitute an important focus in which the organism remains to make the patient a carrier. Abscesses of the ear and mastoiditis occur. Infection of the glands of the neck frequently results in abscess formation. In certain instances the streptococcus enters the bloodstream and is carried to various parts of the body, where localized areas of infection develop. Among the late complications are nephritis (inflammation of the collecting tubules in the kidney, occurring in 0.5 to 1 percent of all cases), arthritis, and rheumatic fever. Penicillin, to which the streptococcus is highly sensitive, is the treatment of choice. Gamma globulin, prepared from human serum, is also effective. Treatment includes bed rest and consumption of adequate fluids. Since the mid-20th century, scarlet fever has become uncommon and very much milder than previously, especially in the United States and Great Britain. This decline may be the result of a change in the virulence of the streptococcus, or possibly of a change in host resistance; it has, in any case, occurred independently of the use of penicillin and sulfonamides. Diseases tend to rise and fall in incidence and severity over the centuries, and it may be that scarlet fever is dying out.