Everything you need to know about Scarlet Fever

You are happily dropping your kids off to school and you hear that “Scarlet fever” is doing the rounds. Your heart sinks, and you feel a little worried, but there is no need to panic. I am going to explain exactly what scarlet fever is, and my top tips on helping you and your kids manage the symptoms.

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What is scarlet fever?

Scarlet fever, also known as Scarlatina, is a contagious Streptococcus pyogenes (strep-toe-KOK-us) bacterial infection that causes flu-like symptoms. Symptoms of Scarlet fever usually includes a sore throat and a high fever and is accompanied with a rash that feels rough like sandpaper It is most common in children aged 2 to 10. It can happen at any age, but most people develop immunity to the toxin that the bacteria produces by that age, and it is extremely rare that anyone gets it more than once.

The incubation period (the period between exposure to the infection and symptoms appearing) can vary from one to seven days, but symptoms usually develop between two to five days after infection.

It is super contagious and can be caught by breathing in airborne droplets from an infected person when they cough and sneeze, touching the skin of someone with a streptococcal skin infection, such as impetigo and by sharing items such as clothes, bed linen, crockery, and towels. You can also catch it from asymptomatic carriers, these are friends, family and classmates that carry the bacteria in their throat and skin, but don’t have any visible symptoms.

Scarlet fever is caused by the same type of bacteria that causes strep throat which is very painful and feels like you are “swallowing razorblades”. Streptococcus pyogenes is also known as Group A streptococcus or group A strep and can be mild, but in some cases can lead to serious complications and it is always important to seek medical advice if you suspect anyone in your family has been exposed to this.

How do you know if you have scarlet fever?

One of the main symptoms for scarlet fever is a rash; small, raised spots that when you touch, feel like sandpaper, and looks like sunburn. It will typically start on your child’s face or neck and then spread to their belly, back, arms and legs. When you push on the redden skin, it turns pale.

Another common symptom is ‘strawberry tongue’, this is where your child’s tongue generally looks red and bumpy, and it’s often covered with a white coating early in the disease.

However, initially your child might develop flu-like symptoms before the rash appears. The reason for the rash – the ‘scarlet’ of scarlet fever, is because the bacteria sometimes make a poisonous toxin and this causes the rough rash. After these more common symptoms have gone away, the skin affected by the rash often peels.

Other symptoms for scarlet fever include:

Very sore throat and difficulty swallowing
Fever of 38.0C or higher and accompanied with chills
Nausea and/or sickness
Tummy pain
Aching body
Headache
Enlarged glands in the neck (lymph nodes) that are tender to the touch

How to manage scarlet fever and Group Strep A infections

Get in touch with your GP if you suspect Scarlet Fever. Don’t just walk in, though. They won’t thank you as it is so contagious… they will probably prefer a phone consultation. Here is the NHS’s advice.

Years ago, scarlet fever was considered a serious childhood illness, however, antibiotics have made it much less scary. It is important for your child to take antibiotics when they have scarlet fever because of the complications that may occur with group strep A infections, which I will touch on shortly, and also to reduce contagiousness.

Antibiotics, such as penicillin or amoxicillin, are the usual treatment from GPs Also, be mindful that children are still very much infectious for at least 24 hours once the antibiotic treatment has begun, so you’ll need to keep them at home for that time. Without antibiotics, your child will probably be infectious for around 1-2 weeks from when their symptoms first occurred, so this is another reason to call your GP straight away.

As with most bacterial infections, there is always the small risk of the infection spreading to other parts of your child’s body such as ear infections, sinusitis and even pneumonia. Also, if scarlet fever is left untreated it can result in more serious conditions that can then go on to affect the kidneys, heart and other parts of the body. It is always important to respect how virulent and problematic Group Strep A infections can be for some people.

There is a concern that there has been an increase in antibiotic-resistance to Group Strep A infections which means the antibiotics are ineffective at fighting the infection. Another cause for concern is that Streptococcus pyogenes infections are also likely to be engulfed into biofilms. A biofilm is a matrix or community of bacteria and other infections that can build up on mucosal linings of the mouth, tonsils, throat as well as the gut in a hard glue-like formation which can sometimes render the antibiotics less effective. Plaque on teeth and tonsil stones are biofilms for instance. This is partly why there has been so much more research into natural and herbal remedies in recent years to help support overall immunity and to help breakdown these biofilms so that the more virulent strep infections can be controlled more effectively.

Other potential complications

Paediatric Autoimmune Neuropsychiatric Disorders Associated (PANDAS) with Streptococcal Infections is becoming more common in children and is thought to be a misdirected autoimmune inflammatory response to an infection, in particular group strep A infections.

The child may or may not develop any of the classic symptoms of scarlet fever at the time, but after expose to streptococcus bacteria from a close family member or friend they may instead develop sudden onset anxiety, obsessions and compulsions (OCD), tics, day and/or night-time frequent urination and even a regression in schoolwork. The symptoms are usually dramatic, they happen “overnight and out of the blue”. They can persist for several months and years in some cases if the brain is inflamed. This PANDAS response can be identified through a streptococcus antibody blood test via your GP or a private paediatric immunologist and can be treated with antibiotics and ibuprofen. The underlying inflammation and autoimmunity can be supported by nutritional interventions.

Can I use probiotics?

When recovering from scarlet fever and other associated streptococcus infections it may be prudent to avoid yoghurts and some probiotics containing a specific strain called Streptococcus thermophilus (S. thermophilus). This is because occasionally this ordinarily beneficial bacteria can exacerbate symptoms. However, this effect is only anecdotal and has been reported in a few cases of PANDAS.

There is however a streptococcus-based probiotic called BlisK12 (S. salivarius K12) which is thought to displace the pro-inflammatory strep strains with beneficial ones and often helps to restore equilibrium without exacerbating a flare. There is a great deal of research that this beneficial strain of streptococcus can help with many types of upper respiratory tract infections.

Lactobacillus and Bifidobacterium strains also seem to be totally OK, and so does Kefir and these beneficial microbes may be somewhat helpful for rebuilding the gut microbiome after the antibiotics.

Other complementary support for scarlet fever and Group Strep A infections

Firstly, there are some simple things you can do to ease your child’s symptoms; give them cool fluids, homemade ice lollies, easy to swallow soft foods.

Then to help with overall immunity and resilience here are a few evidence based nutrients that you may want to consider. You may want to incorporate a few of the following whilst your child is unwell or recuperating. The first four can be given to all ages over 12 months and the others can be given in capsule form to children aged 12 plus.

Vitamin D – There is research to suggest that vitamin D deficiency is associated with enhanced risk of streptococcal infections, it also improves antibacterial defences, which are important for efficient killing of bacteria. This vitamin is super easy to top up! First and foremost, sun exposure is the best way to boost your vitamin D levels (20 minutes per day), I also encourage supplementation during the winter months or if a blood test has shown that your child is deficient.

Cranberry – Some data suggests that cranberry extract in mouthwash has a significant potential in reducing oral Streptococcus counts. Cranberry has been traditionally used to help control bacterial infections due to its antimicrobial properties. When extracts of Cranberry and Sumac (which is a popular Persian spice), this combination was found to provide some antibacterial action against Streptococcus pyogenes.

Propolis & Active Honey – Research shows that propolis is responsible for various bioactivity such as antibacterial, anti-inflammatory, antioxidant activities. Published research has indicated that propolis and its derivatives has many natural antimicrobial compounds with a broad spectrum against different types of bacteria and that it enhanced the efficacy of conventional antibiotics. Active honeys such as Manuka and Jarrah have been found to be helpful at soothing the sore throat and may help to breakdown Streptococcus pyogenes biofilms.

Erythritol and Xylitol – these are tooth-friendly sugars that are often added to sugar-free food supplements, chewing gums and sweets as well as low sugar foods. They are also sometimes used to help control streptococcus levels building up in the mouth and may specifically help to prevent tonsil abscesses caused by Streptococcus pyogenes. Research has found that xylitol bolsters the immune system and has a general effect of reducing ear and respiratory infections. Unlike table sugar it may actually help with glycaemic control.

Andrographis – Has been traditionally used in Indian and Chinese herbal medicine for cough, cold and influenza, suggesting it plays a role in respiratory tract infections, so may help with the flu-like symptoms that are associated with scarlet fever. This can be given to children from age 12 plus.

Thyme – research suggests that thymus vulgaris oil has antimicrobial activity and could be used in mouth rinse, toothpaste, or aromatherapy for prevention and treatment of related oral Streptococci infections.

Essential oils: orange, bergamot and clove – These oils contain antimicrobial agents and research suggests that they could be used as complementary therapies in the treatment of infectious diseases such as Streptococcus pyogenes and Staphylococcus aureus. Clove oil can be dabbed on sore spots in the mouth with a cotton bud. Orange and Bergamot can be infused.

As always NatureDoc therapists are here to support you and your children if you are struggling with the symptoms or longer lasting effects from scarlet fever or Group Strep A infections. Get in touch today and speak with one of my team.