Mr. Monday started having seriously high fever on Sunday night. Mojuju nursed him throughout the night but his fever did not go down.

“He’s roasting like a pig!” Mojuju tried to dress him to nursery. “I don’t think he can go nursery like this.”

“I don’t wanna go school,” Mr. Monday was whining half asleep.

So for the past 2 days he has been at home with me. His fever was manageable on calpol and neurofen and he ate all his meals too. On Monday night I checked him for Kawasaki signs (more info here) , which reassured us as we went to bed. I was however increasingly concerned about his flushed face. It wasn’t just the red cheeks that bothered me, there was something odd about his appearance which now I realise; his entire face was red except around his lips!

As if one sick child wasn’t enough, Lil’ Tuesday started to have chicken pox symptoms on the day itself

Tuesday (the day, not the baby lol) was brutal. Mr. Monday was having high fever all day, while Lil’ Tuesday’s chicken pox was full blown. Poor girl had fluid filled rashes (like really full of water) all over her body AND genitals, AND FACE, AND LIMBS. She’s only 4 months and doesn’t know what itch means, or what scratching is. She was generally irritable, uncomfortable, wouldn’t settle.

At this point I felt like my hair was going to fall out.

Then at night (Tuesday night), Mojuju brought Mr. Monday to me and told me he was complaining of anal pain. This is a red herring, he has an anal fissure because he wipes his ass so clean that even his skin came off lol. While examining his butt and putting barrier cream for Monday, I felt the skin of his belly and back, then told him to show me his tongue. His tongue which had a thick white covering in the morning, is now fully red with small red bumps. Strawberry tongue, I thought to myself. I ran my hand up and down his back again. Sandpaper rash…exactly the same as the boy I once seen in my paediatric posting. I’ve only felt it once, but I could never forget the sensation of such tough skin texture.

“His fever is not going down even with neurofen,” Mojuju exclaimed.

“He has strawberry tongue and his skin feels like sandpaper,” I told him.

“What does that mean?” 

“I think he has scarlet fever. If he does, he needs antibiotics as soon as possible before he goes septic since it’s been 2 days. If it’s not scarlet fever, I’m scared that it could be kawasaki”.

“So I’ll bring him to A&E now—“

“But the skins on his hands aren’t peeling so I don’t think it’s Kawasa–”
Mr. Monday cried in the midst of our discussion, “I want to see doctor!”

So off Mr. Monday went with Mojuju to the paediatric hospital while I stayed home with Lil’ Tuesday who was struggling with chicken pox. It was 8 hours wait, they came home at 6.30 A.M.. Mojuju was furious. It appears Mr. Monday was triaged as viral fever and they had put him at the bottom of the list. Even children that came hours after Monday was seen earlier. I was just relieved that Monday was seen, and that he did not need any hospitalisation.

“I told them, ‘look, it’s either scarlet fever, or Kawasaki, choose one quick’,” Mojuju explained. His eyes were weary from being awake all night.
“So what was it?”

“It was scarlet fever. Monday got some antibiotics now”

Scarlet fever is a notifiable disease (which means doctors has to report any found infection to public health of England / CDC): and should not be taken lightly. It is caused by a highly infectious bacteria called Group A Streptococcus. It is the same bacteria that causes strep throat. Occasionally this bacteria can cause severe and life-threatening infection. The symptoms is actually a reaction to a toxin generated by GAS.

Scarlet fever however is incredibly easy to treat. All you need is a penicillin based antibiotics. Usually amoxicillin is used, unless there’s concern that it may be glandular fever. Scarlet fever used to be an epidemic, and had very high mortality. However due to its susceptibility to simple antibiotics, its was getting less and less common. It is however worth noting that scarlet fever (which we were once taught that it is ‘and illness of the past’) is now increasing in number and clusters. This is due to its highly contagious nature, but also due to increasing restriction in antibiotics prescribing.

Untreated scarlet fever can lead to rheumatic fever, as well as heart/kidney or liver damage.

Although increasing restriction in antibiotics prescribing by doctors is one of the reason why scarlet fever is making a comeback, it is however not a wrong thing to do. When penicillin was first found, it was the magic pill that cured numerous infection. It was prescribed for nearly everything, even viral infection that would have recovered without antibiotics. Hence why syphillis and scarlet fever appear to be disappearing; they were being treated before symptoms started showing.

HOWEVER, with every antibiotics prescribe, the chance of bacteria getting resistance to the antibiotic increases; hence why we have ‘superbugs’ these days. By reducing antibiotics prescribing, we are saving our precious antibiotics for real bacterial infection.

If we were to prescribe antibiotics like how we used to, in a year or so Scarlet fever may not be treatable with just a simple penicillin. In fact, while I was working in the hospital, we found a patient infected with a bacteria that was even resistant to colistin (one of the last resort)— we just watched him die of the infection, not being able to give anything. No antibiotics could save him, and nobody should go near him without proper PPE (yes just like COVID).

So next time, before you get upset that you’re not given antibiotics, ask yourself if you truly need it. Keep penicillin working; it’s one of the miracle antibiotics that cures plenty of infection in children.