Scarlet Fever (cont.)

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What is the history of scarlet fever?

In the 19th century, scarlet fever, measles, roseola, impetigo, fifth disease, yellow fever, chickenpox, and rubella were among the many diseases that caused rash and fever in children. Scarlet fever was among the most common of these diseases, and the phrase scarlatina was used to describe the mildest form of the disease. Unfortunately, scarlet fever was often severe, and in the 19th century, it was a leading cause of death among children in the United States. Malnutrition, in either childhood or prenatally during pregnancy, was a risk factor for more severe disease. In the 1870s, streptococcal bacteria were first identified by Theodor Billroth and Louis Pasteur. However, it was not until the early 20th century that GAS was effectively identified in routine culture. In the 1920s, studies showed that GAS was the cause of scarlet fever and identified the fact that a toxin was associated with scarlet fever strains of the bacteria. With the advent of the antibiotic era, mortality rates from scarlet fever declined.

Outbreaks of scarlet fever continue to emerge periodically, although the disease is less common now than it was in the 19th century. This is due to many factors, including the widespread use of antibiotics and a decline in the strains of GAS that produce the toxin. People have also become more resistant to infection as nutrition has improved. Also, people who have been exposed to the toxin in the past may produce antibodies that protect them against scarlet fever.

What causes scarlet fever?

Scarlet fever is caused by the Gram-positive coccal-shaped bacterium Streptococcus pyogenes, also known as group A. streptococci (GAS). This is the same bacterium that causes ordinary strep throat and which is associated with other diseases such as rheumatic fever. However, in order to cause scarlet fever, the infecting strain of S. pyogenes must produce a specific protein toxin. This toxin that causes scarlet fever is known as "erythrogenic toxin" or "pyrogenic toxin." It causes a reaction in skin that leads to the typical rash.

Medically Reviewed by a Doctor on 12/20/2013

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