Could this be scarlet fever?

Dear Dr Ombeva,

My son developed a fever and rash last week. His voice was nearly lost and his cries weak. We went to hospital and they gave some injections. The doctor said this could be scarlet fever. What exactly is scarlet fever, and what can I do to ensure it does not happen again to my son or his younger sister?

Audrey

Dear Audrey,

Scarlet fever is a disease that often begins with a throat infection, caused by bacteria in the throat. These bacteria produce a poison called a toxin, which causes a rash that is scarlet-coloured, from which the name of the disease is derived.

There are many bacteria normally residing in the throat, and not all produce toxins. Not all children are sensitive to the toxin when it is produced, so some children in a family may get the rash while their siblings don’t, even if they both get the sore throat infection. The rash is the most striking feature of scarlet fever.

Usually, it begins like a severe sunburn with tiny bumps, almost measles-like rash, and may be very itchy. The rash appears first on the neck and face of the child, leaving a clear unaffected area around the mouth. It then spreads to the chest and back, then to the rest of the body.

In some creases - like under the arms and elbows - the rash may form red streaks. The areas of rash usually turn white when you press on them. The rash often fades by the sixth day, though the affected skin may begin to peel. The child usually has a sore throat, very high fever and swollen neck glands.

Sometimes the doctor may see swollen tonsils and back of the throat covered with a whitish coating, or appearing red, and swollen, or dotted with whitish or yellowish areas of pus. Sometimes chills, tiredness, body aches, nausea, vomiting, and poor or loss of appetite may occur.

While the doctor prescribes antibiotics for 10 days for the infection, it may take a few weeks for the tonsils and swollen glands to return to normal. The bacterial infection that causes scarlet fever is easily spread, from child to child, sneezing and coughing or contact with infected skin. Good hygiene and prompt treatment may help reduce likelihood of spread of infection.

- Dr Ombeva Malande is a paediatrics and child health expert