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Group A streptococci are bacteria commonly found in the throat and on the skin. The vast majority of Group A Strep infections are mild illnesses, such as strep throat and impetigo. Occasionally however, these bacteria can cause much more severe and even life-threatening diseases, such as necrotizing fasciitis (occasionally described by the media as "the flesh-eating bacteria") and Streptococcal Toxic Shock Syndrome (STSS). In addition, people may carry Group A Strep in the throat or on the skin and have no symptoms of disease. Invasive Group A Strep disease is a severe and sometimes life threatening infection in which the bacteria have invaded parts of the body where bacteria are not usually found, such as the blood, deep muscle and fat tissue, or the lungs. Two of the most severe, but less common, forms of invasive Group A Strep disease are called "necrotizing fasciitis" (a destructive infection of muscle and fat tissue) and "Streptococcal Toxic Shock Syndrome" (a rapidly progressing infection causing low blood pressure/shock and injury to organs such as the kidneys, liver, and lungs). Approximately 20% of patients with necrotizing fasciitis and 60% with toxic shock syndrome die. Only about 10-15% of patients with other forms of invasive Group A Strep disease die. Invasive GAS infections occur when the bacteria get past the defenses of the person who is infected. This may occur when a person has sores or other breaks in the skin that allow the bacteria to get into the tissue, or when the person’s ability to fight off the infection is decreased because of chronic illness or an illness that affects the immune system. Also, some virulent strains of GAS are more likely to cause severe disease than others.

Symptoms

Early signs and symptoms of necrotizing fasciitis; Fever Severe pain and swelling Redness at the wound site Early signs and symptoms of STSS; Fever Dizziness Confusion A flat red rash over large areas of the body Severe, sometimes life-threatening, GAS disease may occur when bacteria get into parts of the body where bacteria usually are not found, such as the blood, muscle, or the lungs. These infections are termed "invasive GAS disease." Two of the most severe, but least common, forms of invasive GAS disease are necrotizing fasciitis and Streptococcal Toxic Shock Syndrome. Necrotizing fasciitis (occasionally described by the media as "the flesh-eating bacteria") destroys muscles, fat, and skin tissue. Streptococcal toxic shock syndrome (STSS), causes blood pressure to drop rapidly and organs (e.g., kidney, liver, lungs) to fail. STSS is not the same as the "toxic shock syndrome" frequently associated with tampon usage. About 20% of patients with necrotizing fasciitis and more than half with STSS die. About 10%-15% of patients with other forms of invasive group A streptococcal disease die.

Transmission

These bacteria are spread through direct contact with mucus from the nose or throat of persons who are infected or through contact with infected wounds or sores on the skin. Ill persons, such as those who have strep throat or skin infections, are most likely to spread the infection. Persons who carry the bacteria but have no symptoms are much less contagious. Treating an infected person with an antibiotic for 24 hours or longer generally eliminates their ability to spread the bacteria. However, it is important to complete the entire course of antibiotics as prescribed. It is not likely that household items like plates, cups, or toys spread these bacteria.

Diagnosis

Culture and Sensitivity testing

Treatment

Group A Streptococcal diseases can be treated with common, inexpensive antibiotics. Penicillin is the drug of choice for both mild and severe diseases. For penicillin-allergic patients with mild illness, erythromycin or clindamycin can be used, although occasional resistance has been seen. In addition to antibiotics, supportive care in an intensive care unit and sometimes surgery are necessary. Early treatment may reduce the risk of death although, unfortunately, even appropriate therapy doesn't prevent death in every case For persons with necrotizing fasciitis, surgery often is needed to remove damaged tissue.

Prevention

The spread of all types of GAS infection can be reduced by good hand washing, especially after coughing and sneezing and before preparing foods or eating. Persons with sore throats should be seen by a doctor who can perform tests to find out whether the illness is strep throat. If the test result shows strep throat, the person should stay home from work, school, or day care until 24 hours after taking an antibiotic. All wounds should be kept clean and watched for possible signs of infection such as redness, swelling, drainage, and pain at the wound site. A person with signs of an infected wound, especially if fever occurs, should seek medical care. It is not necessary for all persons exposed to someone with an invasive group A strep infection (i.e. necrotizing fasciitis or strep toxic shock syndrome) to receive antibiotic therapy to prevent infection. However, in certain circumstances, antibiotic therapy may be appropriate. That decision should be made after consulting with your doctor.