See also

Sepsis
Skin and Soft Tissue Infections
Pleural Effusion and Empyema
Sore Throat
Osteomyelitis and Septic Arthritis

Key points

• Invasive Group A Streptococcal disease (iGAS) is associated with significant morbidity and mortality
• There is an increased risk of secondary cases of iGAS in household contacts of an index case
• Household contacts require education about this increased risk and chemoprophylaxis should be considered

Background

Group A streptococcus (GAS) (also known as Streptococcus pyogenes) commonly colonises the skin, nasopharynx or anogenital tract of children.
GAS causes a wide range of clinical disease in children, from mild illnesses such as pharyngitis and impetigo, to severe, life-threatening invasive infections. 

Invasive GAS Disease (iGAS)

iGAS is defined by the isolation of GAS from a normally sterile site. Manifestations include: 

• Bacteraemia/septicaemia
• Streptococcal Toxic Shock Syndrome (STSS)
• Necrotising fasciitis
• Pneumonia/ Empyema
• Retropharyngeal abscess
• Osteomyelitis / Septic arthritis
• Meningitis

Cellulitis and pharyngitis are not considered to be invasive disease.

Management of household contacts of a case of iGAS

Household contacts - those who have spent more than 24 hours in the same house as an index case in the 7 days prior to symptom onset.
They are at increased risk of iGAS compared with the general population.
Secondary cases usually occur within a month of the index case, and predominantly in the first 7 days.

Some experts and guidelines recommend antibiotic chemoprophylaxis to reduce the risk of iGAS in household contacts, although this has not been studied.

Regardless of whether chemoprophylaxis is prescribed, all household contacts should be educated about their increased risk of iGAS, and the early signs and symptoms of iGAS that require prompt medical evaluation. These include:

• High fevers
• Severe muscle aches
• Sore throat
• Cellulitis
• Diarrhoea or Vomiting
• Severe Headache

Assessment & Management


Notes