Recently, both in Europe and in our country, there has been an increase in cases of Invasive Group A Streptococcus (iGAS), in children and adults. European countries recorded an increase in the number of cases, but also deaths from iGAS in children under the age of ten, especially from September of the year 2022 onwards, reports EODY.

In our country, iGAS infections are not included in the mandatory disease reporting system. Nevertheless, due to the increase in iGAS cases internationally, EODY requested the declaration of all cases from the beginning of 2023.

From the beginning of the year 2023 until 11/1/2024, 89 cases of iGAS have been reported to EODY, 40 in adults and 49 in children, most of them under ten years old.

The incidents included 22 deaths, 10 in children aged twelve months to eight years and 12 in adults, most of them with underlying diseases.

According to the EODY, parents of children and school staff must be aware of the suspected symptoms of GAS and iGAS infection and the importance of seeking medical advice in a timely manner from the first twenty-four hours of the onset of symptoms.

iGAS infection should be included in the differential diagnosis of children with severe respiratory infection, previous viral illness (including influenza and chickenpox), and in persons who are close contacts of a case of streptococcal tonsillitis or scarlet fever.

The timely recognition of iGAS infection and the immediate initiation of antimicrobial and supportive treatment for the children who are ill is extremely important for the favorable outcome of the disease, emphasizes EODY. Close contacts of iGAS cases should also be identified, assessed and treated according to guidelines.

What is the reason for the increase in cases?

The increase in cases in children may be related to the recent increased circulation of respiratory viruses, such as seasonal influenza virus and respiratory syncytial virus (RSV), as co-infection with group A virus and streptococcus may increase the risk of invasive disease from iGAS, EODY reports.

Group A streptococcus (GAS) is the most common cause of bacterial pharyngitis in school-aged children. The clinical picture includes a sore throat, fever, headache, and in some cases a confluent erythematous rash, which is due to one or more of the erythrogenic toxins (scarlet). GAS pharyngitis is diagnosed with a rapid antigen detection test (strep test) and throat swab culture and is treated with antibiotics.

In rare cases group A streptococcus can manifest as an invasive infection, initially with non-specific symptoms (fever, general fatigue, loss of appetite) and especially in children, it can rapidly progress to severe and life-threatening. The clinical picture of an iGAS case can present as bacteremia, pneumonia, skin and bone infection, meningitis, cellulitis, osteomyelitis, necrotizing fasciitis, streptococcal toxic shock, etc.