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Scarlet fever, also known as Scarlatina, is an infectious disease caused by Streptococcus pyogenes a Group A streptococcus (GAS). The infection is a type of Group A streptococcal infection (Group A strep). It most commonly affects children between five and 15 years of age. The signs and symptoms include a sore throat, fever, headache, swollen lymph nodes, and a characteristic rash. The face is flushed and the rash is red and blanching. It typically feels like sandpaper and the tongue may be red and bumpy. The rash occurs as a result of capillary damage by exotoxins produced by S.pyogenes. On darker-pigmented skin the rash may be hard to discern. Scarlet fever develops in a small number of people who have strep throat or streptococcal skin infections. The bacteria are usually spread by people coughing or sneezing. It can also be spread when a person touches an object that has the bacteria on it and then touches their mouth or nose. The diagnosis is typically confirmed by culturing swabs of the throat. There is no vaccine for scarlet fever. Prevention is by frequent handwashing, not sharing personal items, and staying away from other people when sick. The disease is treatable with antibiotics, which reduce symptoms and spread, and prevent most complications. Outcomes with scarlet fever are typically good if treated. Long-term complications as a result of scarlet fever include kidney disease, rheumatic fever, and arthritis. In the early 20th century it was a leading cause of death in children, but even before the Second World War and the introduction of antibiotics, its severity was already declining, perhaps due to better living conditions, the introduction of better control measures, or a decline in the virulence of the bacteria. In recent years, there have been signs of antibiotic resistance; there was an outbreak in Hong Kong in 2011 and in the UK in 2014, and occurrence of the disease rose by 68% in the UK between 2014 and 2018. Research published in October 2020 showed that infection of the bacterium by three viruses has led to more virulent strains of the bacterium.
