Symptoms, treatments and how to identify them. Ministry of guidance

There is a surge in cases of scarlet fever in Italy. For months now, pediatricians have sounded the alarm, asserting that this phenomenon is also caused by Covid: the various restrictions necessary to contain the health emergency have also limited the circulation of other viruses and bacteria, such as scarlet fever, thus “restraining” the immune system, especially for the little ones.

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There has been an increase in group A streptococcal infection (GAS), which can cause mild forms of the disease such as tonsillitis, pharyngitis, as well as scarlet fever, in some European countries. A detailed picture of the situation in Italy was provided by a circular from the Ministry of Health. Where we can read that “Nationally there is an increase in scarlet fever cases from January 2023” and the most affected people are above all children under 15 years of age.

Group A streptococcus (GAS) is the most common cause of bacterial pharyngitis and tonsillitis in school-age children, but it can also affect younger children. “In rare cases, GAS bacteria can cause a serious infection known as invasive gas sickness (iGAS),” confirms the ministry stating that “children who have had viral infections such as chickenpox or the flu are at greater risk of developing iGAS infection».


Therefore, scarlet fever can be easily treated with antibiotics. The important thing is to notice the symptoms early so you can intervene. Here comes the Ministry of Health guide, which provided clues on how to recognize the symptoms, what treatments to follow and how to prevent infection.

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Scarlet fever is a disease caused by infection with group A beta-hemolytic streptococcus (Streptococcus pyogenes). The typical appearance of red spots on the body (rash), which is a typical disorder of the disease, is caused by the release of a toxin produced by bacteria. The disease mainly affects children between the ages of 2 and 8 and the period of greatest infection in Italy lasts from December to April. Transmission of scarlet fever occurs through contact with mucus and saliva. The incubation period for the bacteria is 2-5 days. Symptoms usually appear within a week of infection. The first signs are:

sore throat;
general malaise
Fever above 38°C with swollen lymph nodes in the neck.


The rash usually begins on the chest, back, and abdomen and then spreads to the extremities. It is easy to distinguish from chickenpox and measles because it consists of pink-red spots that can coalesce and disappear by pressing on them with a finger, only to reappear when removed. In skin folds (armpits or elbows), redness may be more noticeable and the skin feels rough to the touch. On the other hand, if the face is affected by the rash, it may become very red, after abundant sun exposure, except for the area around the mouth which remains pale. Sometimes, the tongue can be covered with a white coating that disappears after a few days leaving a red tongue with swollen papillae, which is commonly referred to as a “strawberry tongue”.


Scarlet fever can be easily treated with antibiotic treatment prescribed by the pediatrician which can be combined with administration of paracetamol (Tacibrina) or ibuprofen if a high fever develops.

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It is usually recommended to drink plenty of fluids and rest. So you should not be afraid if symptoms appear: scarlet fever is no longer dangerous, but it is important to treat it within 10 days of its appearance to avoid complications such as abscesses or immune reactions that can cause rheumatic diseases, carditis, glomerulonephritis and post-streptococcal arthritis.


Finally, the Department of Health has provided some helpful guidelines for preventing scarlet fever infection. Scarlet fever is contagious from the time symptoms appear until about 24 hours after starting antibiotic treatment, so it is advised to stay home until then without going to school or work. Furthermore, since infection occurs through the spread of small droplets that are expelled during coughing and sneezing, it is recommended to cover the nose and mouth when coughing and sneezing, and to dispose of tissues immediately afterwards. Furthermore, it is essential to provide proper ventilation of indoor environments and to follow good hand hygiene, to wash them frequently with soap and water, and not to share towels, sheets, utensils, and other personal items with people with scarlet fever. Finally, schools where GAS infection has been reported should clean and disinfect toys and frequently touched surfaces by pupils.

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Phil Schwartz

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