Scarlet Fever


  • Age 2-6 years, peak incidence is 4years
  • 2-4 day incubation period, and then:
  • Fever
  • Malaise
  • Tonsillitis
  • "Strawberry tongue"
  • Rash

Strawberry Tongue

  • Tongue is covered in white coating
  • Through this white coating, red papillae may be seen
  • Then the white coating dissapears
  • This leaves the tongue with a beefy, red appearance


  • Typically starts on Torso
  • Fine Punctate Erythema ("Pinhead")
  • Then spreads to rest of the body
  • Rough "Sandpaper" texture
  • Desquamination occurs later in the illness – especially around fingers and toes
  • Often spares the face but they often have flushed appearance with perioral pallor.


  • made from throat swab (but don't wait for result – start Abx immediately)


  • Oral Phenoxymethylpenicillin – azithromycin if penicillin allergic
  • Children can return to school 24hours after starting antibiotics
  • Scarlet fever is a notifiable disease


  • Otitis media – this is the most common complication
  • Rheumatic fever: typically occurs 20 days after infection
  • Acute glomerulonephritis: typically occurs 10days after infection


  • Scarlet fever is a reaction to erythorogenic toxins produced by Group A hayemolytic streptococci (Usualy Strep Pyogenes)