The death of a 7-year-old boy from streptococcus in Imathia a few days ago has caused great concern – the 6th child to die from streptococcus in Greece in 2023.

On the occasion of this event, EODY informs the public about the streptococcus microbe with 10 questions and answers.

What is group A streptococcus?

Group A streptococcus, also known as pyogenic streptococcus or GAS (Group A Streptococcus) is a bacterium that can cause various infections in humans, usually mild but in rare cases very serious, even fatal if not treated properly. In a small percentage (1-5%) of people the bacterium is found in their throat or skin or in other places, without getting sick, i.e. these people are healthy carriers of the bacterium.

How is it transmitted?

Group A streptococcus is spread by:
• Contaminated droplets from patient secretions
• Contact with contaminated surfaces
• Contact with infected skin lesions of patients
• From healthy carriers of the bacterium
Group A streptococcus is much more easily transmitted by people who are symptomatic and ill than by healthy carriers of the bacterium.

How a strep infection can occur – Symptoms and complications

Group A strep usually causes infections such as strep throat, fever and a skin rash known as scarlet fever, skin infections such as impetigo and cellulitis, which is inflammation of the skin and subcutaneous fat.

In some cases, if the streptococcal infection is not treated with the appropriate antibiotics, it can lead to serious complications such as an attack on the kidneys (poststreptococcal glomerulonephritis) or the heart (rheumatic fever).

The symptoms that the affected person will present depend on the type of infection caused by the bacterium. For example pharyngotonsillitis is manifested by fever, angina (sore throat), dysphagia, swollen tonsils with a whitish coating, swollen lymph nodes and hemorrhagic spots (petechiae) on the palate. In rare cases, group A streptococcus can cause invasive disease in humans (iGAS-invasive Group A Streptococcus), i.e. a very serious infection that without appropriate and immediate treatment can lead to death. Forms of invasive bacterial disease are necrotizing fasciitis and streptococcal toxic shock syndrome.

Who are most vulnerable to getting sick?

Anyone can get a strep infection. However, the most vulnerable to the bacterium are young children, the elderly, the immunocompromised, people with chronic diseases and those who live in poor hygiene and overcrowded conditions. Streptococcus pyogenes is one of the most common causes of pharyngitis in school-aged children.

Is there a vaccine for group A strep?

There is currently no vaccine to prevent streptococcal infection from group A pyogenic strep. However, there are some vaccines under study against the bacterium.

What are the infection prevention measures?

Measures to prevent streptococcal infection from Streptococcus pyogenes include:
• Correct application of hygiene and hand hygiene rules
• Application of personal protection measures
• Avoiding condensation and proper ventilation of the premises
• Proper cleaning and disinfection of surfaces and frequently used objects, according to the instructions of the experts
• Confining sick people to home care, at least for a twenty-four hour period after starting their antibiotic treatment

How can a strep infection be diagnosed?

There are various tests to diagnose group A strep infection depending on the patient’s clinical presentation. For example, streptococcal tonsillitis can be quickly diagnosed with a throat swab culture as well as a rapid streptococcal antigen detection test known as a step test.

What is the treatment?

Group A streptococcal infection should be promptly treated with appropriate antibiotics, depending on the severity of the infection.

When should I seek help?

Persisting fever, severe angina, dysphagia, fever combined with a rash, severe diarrhea are symptoms that require immediate medical attention. Invasive streptococcal infection develops rapidly, so any suspected disease requires immediate medical evaluation.

Is invasive group A streptococcal infection monitored in Greece?

Invasive group A streptococcal infection is not monitored in Greece, as it is monitored in some other countries, such as France, Spain and England.

In recent months, an increase in specific cases (iGAS) has been reported in some countries in children under the age of ten, while fatal cases have also been reported. ECDC, WHO and CDC are closely monitoring epidemiological data and recommend vigilance by both relevant authorities and the public to seek immediate medical attention in case of suspected symptoms.

According to the ECDC, it is likely that the increase in invasive disease from group A streptococci is related to the recent increase in the circulation of several respiratory viruses, such as the influenza virus and the RSV virus, since coinfection with group A streptococcus viruses favors manifestation of invasive disease. For this reason, the implementation of the aforementioned preventive measures are the best shield in the prevention of infectious diseases.