Group A Streptococcus : Invasive Group A Streptococcal Disease (iGAS)

"Group A Strep (GAS) is a common bacterium that causes infections including strep throat. If strep goes untreated or under-treated, it can lead to invasive group A strep. It gets more serious if it invades the blood or spinal fluid and can result in flesh-eating disease and toxic shock that sometimes leads to death." Among symptoms to be on the lookout for are:

• Skin becomes red, warm, swollen, or very painful soon after an injury or surgery
• Fever and chills, muscle aches, nausea, and vomiting, followed 24 to 48 hours later by low blood pressure, increased heart rate, or rapid breathing

Toxic shock can lead to organ failure and death, according to the Centers for Disease Control.

WebMD

Doctors are seeing an increase in the number of patients experiencing an invasive form of group A strep. The illness is common but can be serious when bacteria spreads to the blood or deep tissue, and needs to be treated quickly.   CBC

 

"Researchers also recently reported on 2022 surges in iGAS in France and Denmark, while the U.S. Centers for Disease Control and Prevention (CDC) said cases this year have 'remained high in children in some areas of the country even after respiratory viruses decreased in those areas'."

"The CDC noted an added wrinkle: An ongoing shortage of liquid amoxicillin, which is often prescribed to children to treat early, milder group A strep infections."

"That common antibiotic has also been on Health Canada's tier three shortage list since mid-November, which refers to shortages 'that have the greatest potential impact on Canada's drug supply and health-care system'."

"A spokesperson for Health Canada told CBC News that there are signals the supply is improving, though overall demand remains higher than normal, which could impact supply at some pharmacies."

CBC News

In Ontario four children died, infected with invasive group A streptococcal bacteria in the past 6 months given a spike in cases of the sometimes-deadly disease. The deaths of these four children alongside deaths of 92 adults in the same period is reflective of a trend around the world -- a rise in cases of Invasive Group A Streptococcal Disease (iGAS). Reported cases of iGAS increased by 52 percent during the recent fall and winter strep season.

Group A Streptococcus is a bacterium found commonly in the nose, throat and on the skin. Many people carry the bacterium without it ever becoming active. Once invasive, it has the potential to cause severe illnesses, including necrotizing fasciitis (flesh-eating disease), meningitis and streptococcal toxic shock syndrome. Countries around the globe have reported spikes in iGAS in recent months and now Ontario has joined them.

Between October 2022 and March 31 in comparison to the same period in the five years before the pandemic higher rates of iGAS infections among all age groups were reported in Ontario. People over 65 are the most severely affected. Cases among children are rising, but deaths have not exceeded past years'. Very young children, pregnant women, those with weakened immune systems and people over 60 are considered at the greatest risk of developing invasive group A strep.

 

The vast majority of cases of iGAS require hospitalization. Among children, those between ages one and four had a higher percentage of severe outcomes than before the pandemic. Children under one and over four years of age had fewer severe outcomes than before the pandemic. While rates of serious outcomes for those over age 65 was higher in the past six months than during the average pre-pandemic year.

 

Seniors who were hospitalized had a death rate of 22.1 percent in comparison to17.8 percent in a pre-pandemic year. Higher rates of iGAS in Ontario, across Canada and elsewhere in the world were reported during a period where viral illnesses, including influenza and respiratory syncytial virus (RSV) spiked, and COVID-19 continues to circulate. In addition, long-term health issues can plague people who survive iGAS. 

 

Fever, headaches, confusion and a decreased level of consciousness during a strep infection signal a shift to a more serious disease level. "Those constellations of symptoms usually should ring an alarm bell", cautioned Dr. Donald Vinh, an infectious disease specialist with McGill University. In rare instances, GAS infection can lead to invasive GAS, which can cause life-threatening conditions, such as necrotizing fasciitis, streptococcal toxic shock syndrome and other severe infections, as well as post-immune mediated diseases, such as poststreptococcal glomerulonephritis, acute rheumatic fever and rheumatic heart disease.

 

Woman checking her child's fever. Credit: MART PRODUCTION

"Streptococcus pyogenes, also known as Group A Streptococcus, is a group of Gram-positive bacteria which can be carried in human throats or skin; it is responsible for more than 500 000 deaths annually worldwide."

"Transmission occurs by close contact with an infected person and can be passed on through coughs, sneezes, or contact with a wound."

"GAS infection commonly causes mild illnesses such as tonsillitis, pharyngitis, impetigo, cellulitis and scarlet fever. GAS infections are easily treated with antibiotics, and a person with a mild illness stops being contagious after 24 hours of treatment."

"GAS is considered a common cause of bacterial pharyngitis in school-aged children and may also affect younger children. The incidence of GAS pharyngitis usually peaks during winter months and early spring. Outbreaks in kindergartens and schools are common. GAS pharyngitis is diagnosed by rapid antigen tests (Rapid Strep) or bacterial culture and is treated with antibiotics and supportive care. Good hand hygiene and general personal hygiene can help control transmission."

World Health Organization