8 - Scarlet fever epidemics of the nineteenth century: a case of evolved pathogenic virulence?

Summary

Introduction

Between approximately 1820 and 1880 there was a world pandemic of scarlet fever and several severe epidemics occurred in Europe and North America. It was also during this time that most physicians and those attending the sick were becoming well attuned to the diagnosis of scarlet fever, or scarlatina. They could differentiate the disease from diphtheria by the presence of the characteristic rash, or ‘exanthem,’ that accompanied the sore throat, fever, inflammation of lymph nodes and abscessing of the throat and tonsils.

Streptococci bacteria were probably first isolated by the Viennese surgeon Theodor Billroth in 1874, but the association of hemolytic streptococci with scarlet fever was not demonstrated until 1884, and the specifics not outlined until 1924 by George and Gladys Dick (Dowling 1977). Once there is the onset of symptoms such as sore throat and fever the course of the infection can progress very quickly and children in the nineteenth century epidemics were known to succumb within as few as 48 hours in some cases. Streptococci may be contracted through human contact, airborne droplets, or ingestion. A common source of the bacteria in historical outbreaks was unpasteurized milk handled by infected dairy workers.

When an outbreak occurs, symptoms can vary widely within the population, or even within the same family – ranging from asymptomatic individual carriers to acute rheumatic fever and severe tissue infections. For common strains the highest risk is for young children.