Thursday 21 June 2018

Ask our GP: My four children have all come down with scarlet fever. Why is there a high volume of cases here?

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Nina Byrnes

My four children have all come down with scarlet fever. I had thought that was an old-fashioned disease that people didn't really get any more. Should I be worried? My GP says they are experiencing a high volume of cases in our area of north Dublin. Why is it so prevalent now? My dad had it as a child and spent a week in an isolation ward; why is it that doctors are not so worried about it today? Also, my children had the disease a year ago and I had thought that you could only get it once. Why does it recur and should I prepare to have this as a yearly event? At the same time, myself and my husband got searing sore throats, cold sores, and were coughing blood. Is this related to the scarlet fever bacteria?

Scarlet fever was indeed common in Victorian times and pre-antibiotics it was a serious and often deadly disease. It is still around today but thankfully, due to the availability of antibiotic treatment, it is rarely a serious condition once diagnosed and treated appropriately.

There has been a particularly high incidence of scarlet fever infection in the UK and Ireland in recent months.

It is caused by a bacterial infection due to streptococcus A. Symptoms include a very red, sore throat and fever (38˚C or above). The scarlet part refers to a red rash that often appears. It has a typical sandpaper feel. Skin may be bright red, especially in the creases of the underarm, elbow, and groin.

The tongue classically becomes red and swollen. There may be a whitish coating, which fades to show a red bumpy tongue often called a strawberry tongue, as it resembles the surface of this fruit. There may also be swollen glands in the neck. Other possible symptoms include headache and body aches with nausea, vomiting or abdominal pain.

Streptococcus tonsillar infection is usually quite obvious on physical examination. There can be swollen tonsils with large collections of pus. There is often a very distinctive smell off the breath called strep halitosis. If the infection is in doubt, your GP can take a throat swab.

Scarlet fever requires antibiotic treatment. Penicillin in its basic form is very effective but treatment is required for 10 days to fully eradicate the infection. It is important to take the antibiotic as prescribed. With appropriate antibiotic therapy, complications are thankfully rare, but they can occur and it is important to seek review if your child gets better and then worse again.

Rheumatic fever (an inflammatory disease that can affect the heart, joints, skin, and brain) is a rare but serious complication of scarlet fever. Post-infectious inflammation of the kidneys is another complication. This usually settles without long-term problems once treated early, avoiding more chronic kidney damage. Ear infections, pneumonia and skin infections are other possible complications.

It is important to stay home for the first 24 hours of antibiotic treatment to reduce the chance of passing the infection to others. Scarlet fever is highly contagious.

Infections often travel quickly through families, crèches and schools. Scarlet fever is most common in children aged five to 15 but it can also occur in adults. It can reoccur because it is a bacterial infection, so these can infect more than once. However, reinfection doesn't always occur so there is no need to be concerned this would be an annual event.

Your symptoms of severe sore throat may indeed have been scarlet fever. Some people with a throat or pharyngeal infection may cough up some blood due to severe irritation of the lining of the throat area but it is important to state that coughing up blood is never normal - you should talk to your GP about this.

Antibiotics treat the infection. Meanwhile the pain of scarlet fever may be eased by simple painkillers, gargling with salt and water and by drinking warm drinks or eating cooling foods such as yogurt and ice pops.

 

Q. My seven-year-old daughter is on her third course of antibiotics this winter. What should I do to counteract the side effects as I hear they destroy healthy gut bacteria and influence mood in children?

Dr Nina replies: The best way to avoid complications and side effects of antibiotics is to use them only when absolutely necessary. Most coughs, colds and sore throats occur due to viruses and antibiotics will not help in this case. There is a serious overuse of antibiotics worldwide. Our antibiotic use is amongst the highest in Europe.

Antibiotics are a group of medicines that kill bacteria. When used correctly, they can be lifesaving, because when the right antibiotic hits a certain bug it works quickly to kill it.

Antibiotics are usually very well tolerated and used appropriately are quite safe. There are possible side effects. Severe allergic reaction to antibiotics can be life threatening. Diarrhoea from antibiotics can cause dehydration and destroy healthy gut bacteria, which aid with digestion and well-being.

Antibiotics can interact with other medication, making them less effective. It is very important to only take antibiotics that have been prescribed for a specific illness by your doctor. However, if you have been prescribed an antibiotic it is really important that you take it as directed and complete the entire course, even if you feel better after a day or two.

Taking probiotics when you are taking an antibiotic may help reduce the chance of antibiotic related upset significantly. These bugs, commonly referred to as “good bacteria”, are live micro-organisms; either the same or similar to those found in the body, that scientific research has found to be beneficial to health. Probiotics are considered generally safe but may not be suitable for those with reduced immune systems or in the elderly and they may interact with some medication. Their production is unregulated so strength and purity of brands may differ.

If you have any health queries for Dr Nina Byrnes, please email drnina@independent.ie. Please note that Dr Nina cannot enter into individual correspondence

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