Scarlet fever is an infection arising from toxin-producing strains of Group A Streptococcus (Streptococcus pyogenes), a bacterium exquisitely adapted to the human host and responsible for a range of clinical manifestations from asymptomatic colonization to invasive disease [1][2][3]. The condition is characterized as a pyrogenic exotoxin-mediated streptococcal illness within the broader spectrum of GAS infection [2][3].
Disease overview
Bacterial Evidence-backed information EN 5/7 applicable sections · ZH 5/7 applicable sections Updated Oct 23, 2026
Scarlet fever is an infection caused by toxin-producing strains of Streptococcus pyogenes, a pathogen highly adapted to humans and capable of causing a spectrum of disease including asymptomatic carriage, pharyngitis, and invasive illness [1][2][3]. Following a decline through the 20th century, the disease has re-emerged in several countries including the UK, with a notable post-COVID-19 pandemic increase in incidence, particularly across Europe [2][3]. It remains a globally consequential illness, with the causative organism implicated in over 500,000 deaths annually [2].
Read the full clinical and epidemiological profile 6
The illness typically begins with sore throat and high fever, followed by a characteristic sandpaper-like skin rash driven by superantigen-mediated overstimulation of the immune system [2]. Oral findings such as strawberry or raspberry tongue may be early indicators, sometimes first recognized by dental practitioners [2].
Historically, scarlet fever caused substantial morbidity and mortality during 18th- and 19th-century epidemics in Europe and the USA, then nearly vanished in the 20th century before re-emerging in countries such as the UK, though the basis for these outbreaks is unclear [3]. A significant post-COVID-19 pandemic rise in incidence has been observed, mainly in Europe [2]. Globally, the responsible organism contributes to more than 500,000 deaths each year [2].
Group A Streptococcus employs virulence determinants that facilitate colonization, within-host dissemination, and person-to-person transmission while evading innate and adaptive immune defenses [1]. The organism is adapted to the human host, supporting both asymptomatic carriage and symptomatic spread including scarlet fever [1][2].
The World Health Organization has outlined preferred vaccine characteristics and promoted a research roadmap, reflecting renewed efforts toward safe and effective GAS vaccines as a preventive strategy [1].
- 1 Brouwer S et al. Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nat Rev Microbiol. 2023 Jul. PMID: 36894668. doi: 10.1038/s41579-023-00865-7. PubMed: https://pubmed.ncbi.nlm.nih.gov/36894668/
- 2 Matsubara VH et al. Recrudescence of Scarlet Fever and Its Implications for Dental Professionals. Int Dent J. 2023 Jun. PMID: 37062653. doi: 10.1016/j.identj.2023.03.009. PubMed: https://pubmed.ncbi.nlm.nih.gov/37062653/
- 3 Managing scarlet fever. Drug Ther Bull. 2017 Sep. PMID: 28882851. doi: 10.1136/dtb.2017.8.0529. PubMed: https://pubmed.ncbi.nlm.nih.gov/28882851/
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Recent related research
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