Strep A infections on the rise nationally, UMMC experts warn

By: Annie Oeth, aoeth@umc.edu

Streptococcus A infections can cause more than a simple sore throat, experts at the University of Mississippi Medical Center and Children’s of Mississippi say. Cases of Group A strep infections are rising in the U.S. and in countries including Canada and Great Britain.

Group A strep bacteria is extremely contagious and can cause everything from strep throat to severe infection. Infection from these common bacteria can cause rare invasive infections of areas of the body that are usually germ-free, resulting in serious and life-threatening conditions such as necrotizing facsciitis, a rare but rapidly progressing infection that destroys deep soft tissues, and streptococcal toxic shock syndrome, which can cause organ failure and death.

Strep A can also cause skin infections including cellulitis and impetigo in children and adults.

U.S. Centers for Disease Control and Prevention statistics show that there are about 500 to 1,500 cases of necrotizing fasciitis and about 2,000 to 3,000 cases of streptococcal toxic shock syndrome each year in the United States. In comparison, there are several million cases of strep throat each year in the U.S.

While severe illness from strep infections is rare, "I think it is vital that pediatricians maintain a high level of suspicion for acute Group A strep disease, simply because there is the chance of reducing serious complications with the oldest antibiotic in the book, penicillin,” said Dr. Charlotte Hobbs, professor of pediatric infectious diseases.

Spotting early signs of invasive disease, such as persistent fevers and change in behavior for children or development of rash is important as more aggressive treatment and antimicrobial therapy may be needed, she said. “Toxic shock syndrome or necrotizing fasciitis must be treated early and may even require surgical intervention to address the source of infection.”

Even a mild strep throat infection can become serious if it develops into rheumatic fever, which can result in permanent cardiac damage.

Rheumatic fever can result in fluid around the heart, an enlarged heart, heart failure from valve leakage or a heart murmur because of valve damage, said Dr. William Moskowitz, chief of UMMC’s Division of Pediatric Cardiology and co-director of the Children’s Heart Center.

A World Pediatric Project (WPP) volunteer for more than 20 years, Moskowitz developed a program during his WPP missions to screen children in the Eastern Caribbean for rheumatic heart disease as well as a public education program for rheumatic fever prevention.

“Timely and complete treatment for strep throat can keep a child’s healthy heart from the risk of becoming damaged,” Moskowitz said.

The rise in Group A strep infections mirrors the surges in respiratory viruses earlier in 2023, Hobbs said. “There is still a higher number of invasive Group A strep cases overall, although the respiratory viruses are abating. This increase is thought to be partly because, during peak COVID periods, people were being more careful in washing their hands and practicing good hygiene. Indeed, this is the best way to reduce GAS transmission.”

Though strep throat is often viewed as a childhood malady, anyone can catch it, so Dr. Bhagyashri Navalkele, associate professor and medical director of infectious diseases at the University of Mississippi Medical Center, recommends anyone with symptoms of strep to get medical care.

“A sore throat without respiratory symptoms such as congestion after close contact with an infected person is a strong indicator for getting a strep test,” she said. “A throat swab for strep is a rapid test, and if the result is negative, a culture is done to make sure the result is correct.”

Hobbs and Navalkele say the best ways to stem the spread of strep include simple health habits such as washing hands, covering the nose and mouth when coughing or sneezing, and staying home when sick.

“Practicing good hygiene and seeing medical care early for signs of strep infections reduce the chances for the infection to spread or become more serious,” Hobbs said.

"Fever and rash along with any signs of abnormal mental status should be taken very seriously in a child as they may be signs of serious invasive Group A strep infection, which can progress to fulminant disease very quickly,” she said.

Other ways to reduce the risk of Group A strep infections include keeping any injuries clean and disinfected and making sure adults and children are current with vaccinations for influenza and varicella, or chicken pox. Influenza and the lesions from chicken pox can make infection with Strep A more likely.

Children’s of Mississippi appointments can be made online or by calling (888) 815-2005.

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