A parent recently told me her primary school-aged child had been diagnosed with scarlet fever. She was a bit surprised. "Scarlet fever" sounded old-fashioned, something people nowadays shouldn't get.
But in reality, scarlet fever is nothing more than a strep throat with a rash. In some countries, strep throat is indeed rare. But not in New Zealand - rates here are among the highest in the developed world, 14 times the OECD (Organization for Economic Co-operation and Development) average, making scarlet fever not quite as uncommon as we might hope.
Strep infections are passed from person to person via droplets coughed into the air, or deposited on surfaces by unwashed hands. Our kids pick it up, or breathe it in, and a day or two later they're sick with a sore throat and fever, swollen neck glands and nasty-looking tonsils. The next day a fine red rash might appear on the chest then spreads to neck, abdomen, and elsewhere. It's red, extensive and feels different than most rashes: almost sandpapery to the touch. This is scarlet fever.
After several days, the fever wanes, the rash fades, the tongue turns red and pebbly like the surface of a strawberry, and then skin starts peeling just like it does after a mild sunburn.
For most, scarlet fever passes within a week without major problems. But in the old days, scarlet fever was a fearsome childhood killer, resulting in the deaths of nearly one in 1000 people in Victorian England. That all changed with the introduction of penicillin in the 1940s. Now it's easily treated if kids get taken to the doctor when they develop bad sore throats. Untreated, it occasionally results in lifelong heart damage, called rheumatic heart disease, which we still see in alarmingly high rates in Maori populations.
The bottom line: scarlet fever should be a disease relegated to the past, but isn't. At least, not yet.
Gary Payinda, MD, is an emergency physician and would like to hear your medical questions.
Email: drpayinda@gmail.com (This column provides general information and is not a substitute for the advice of your doctor.)
