Barbara Fiorillo
Scarlet fever is a contagious exanthematous disease triggered by group A streptococcus (GAS), the most common cause of bacterial tonsillitis in school children. The bacterium produces a pyrogenic toxin (poison) which passes into the bloodstream and causes a scarlet-colored rash, from which the disease takes its name. It is transmitted by air with droplets of saliva, for example through coughing and sneezing, from a sick child or a carrier (without symptoms) of the bacterium which is normally located in the pharynx.
Although the incidence of GAS pharyngotonsillitis peaks in Europe in the winter months (when outbreaks are often reported in kindergartens and schools), the European Center for Disease Prevention and Control (ECDC) and the World of Health (WHO) have recorded, since the beginning of January, an increase in cases, even serious ones, among children under the age of 15 in all European countries (including Italy). An anomalous phenomenon that alerted the health authorities. What is going on? Today he takes stock with Vincenzo Tipo, head of the emergency department of the Santobono children’s hospital in Naples.
Dr. Tipo, why this increase in scarlet fever cases in Italy?
“The health measures adopted to prevent Sars-CoV-2 infection have significantly reduced social interactions and, at the same time, favored the use of tools capable of avoiding the spread of infections such as accurate hand hygiene and use of the mask. These tools have helped to keep the spread of many pediatric infections, both viral and bacterial, low, leading, however, to a reduced immune stimulation, due to the lower circulation of microbial agents, with a general decline in individual and group immunity. With the resumption of social contacts, and the decreased use of preventive health means, there has been an increased number of cases of scarlet fever, as well as more aggressive viral forms on average”.
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How to recognize the symptoms?
“Scarlet fever is a disease caused by bacteria of the group A beta-haemolytic Streptococci (SBEA) family, causing fairly trivial infections that are generally localized to the pharynx or skin. Transmission occurs by human-to-human contact through droplets of saliva or mucus and is favored in all those closed environments that our children usually attend, such as schools. The first symptoms appear about 1-3 days after infection and are generally high fever (38°C-40°C) and sore throat. About 24 hours after the onset of these symptoms, a widespread rash begins to appear on the face, trunk and limbs. It is a characteristic rash that pediatricians know very well and is the first sign of suspicion. You can remain contagious from 24 hours before the onset of symptoms up to 24-48 hours after starting antibiotic therapy”.
What to do if symptoms appear?
“If a child, generally between the ages of 5 and 15, has fever, sore throat and rash, it is useful to contact the family pediatrician who, with the visit, will be able to promptly recognize the symptoms. To confirm the clinical suspicion, the pediatrician can also make use of an easy-to-use tool which is the pharyngeal swab for Streptococcus research. The Throat Swab is a very easy test that is performed by “touching” the child’s tonsils and throat with a special swab similar to a long cotton swab. There is also the rapid pharyngeal swab, a reliable test for Streptococcus research, which gives an answer in a few minutes and which can also be carried out in your family pediatrician’s surgery or in many pharmacies that offer this service. Once the diagnosis has been made, the therapy is simple and is a therapy based on antibiotics which, of course, must be prescribed by the pediatrician. However, I want to clarify one aspect: in a totally asymptomatic child, even if with a positive swab, a wait-and-see attitude must be used without antibiotic therapy. As I often repeat: diseases are treated, not analyses”.
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What are the dangers of scarlet fever?
“Scarlet fever, if adequately treated, is almost never dangerous, and possible complications are given by the characteristics of the bacteria that cause it. Rarely, an SBEA infection can cause, in the acute phase, local complications such as abscesses or lymphadenitis, and, a few days after the acute phase, late complications such as rheumatic disease and/or glomerulonephritis (diseases affecting the heart and kidneys ). All these complications are easily preventable by promptly starting antibiotic therapy as prescribed by your pediatrician”.
WHO and ECDC have estimated the risk of iGAS to be low for the general population. What does it mean?
“In rare cases bacteria such as strep can cause a serious infection called ‘invasive GAS disease’ (iGAS) which can present with severe symptoms such as spread of the bacterium into the bloodstream, pneumonia, infection of soft tissue and bone and the dreaded streptococcal toxic shock syndrome. At European level, the patients most affected are children under the age of 10 and people over the age of 65. WHO and ECDC have estimated the risk of iGAS for the general population to be low, despite the increase in scarlet fever cases, considering that the current increase in reported cases in some European countries is moderate. It is also important to let people know that the presence of new strains of streptococci has not been reported and, above all, a developed resistance to antibiotics has not been reported: the disease is therefore easily treatable with the antibiotics we know”.
How to prevent the risk of infection in children?
“To prevent scarlet fever and above all the outbreak of the epidemics that we are verifying in the school population, it is useful to remember as always the hygiene rules that accompanied us even during the Sars-CoV2 season, i.e. adequate hand and airways, as well as good internal ventilation of the school complexes. Schools and other educational settings where infections are reported should also follow guidelines for cleaning and disinfecting toys and frequently touched surfaces. When the child is diagnosed with scarlet fever, it is always recommended to follow the therapy prescribed by your pediatrician”.