Invasive Strep Alert

 

This week, the Pennsylvania Department of Health issued a health advisory to medical providers, hospitals, and health systems regarding possible increases in invasive Group A Streptococcal infections that have been observed this fall in the United States.

Group A Streptococcus (GAS) causes a number of very common bacterial infections that are familiar to pediatricians: Strep throat, scarlet fever (strep throat + rash), and impetigo (skin infection).

Strep throat and scarlet fever occur most commonly in children between the ages of 5 and 15, usually during winter and spring. The CDC reviews the telltale signs and symptoms of strep throat, noting that the infection primarily involves the throat and lymph nodes and rarely produces cold symptoms, like runny nose and cough:

In general, strep throat is a mild infection, but it can be very painful. The most common symptoms of strep throat include:

• Sore throat that can start very quickly

• Pain when swallowing

• Fever

• Red and swollen tonsils, sometimes with white patches or streaks of pus

• Petechiae — pronounced pi-TEE-kee-eye — on the soft or hard palate (tiny, red spots on the roof of the mouth)

• Swollen lymph nodes in the front of the neck

• Other symptoms may include a headache, stomach pain, nausea, or vomiting — especially in children. Someone with strep throat may also have a rash; it is known as scarlet fever.

 

Unfortunately, Group A Strep bacteria can act much more aggressively. Invasive GAS (iGAS) refers to severe and potentially life-threatening cases of pneumonia, bacteremia/sepsis, streptococcal toxic shock syndrome (a rapidly progressing infection that causes plummeting blood pressure and organ failure), and necrotizing fasciitis (so-called “flesh eating” bacteria that quickly spread to flesh and muscle). Since iGAS can progress rapidly, and because it is a reportable disease in Pennsylvania, the PADOH advisory urges health providers to recognize these infections early, especially among people at higher risk for severe disease:

Individuals at higher risk for severe iGAS disease include elderly or immunocompromised persons, persons with medical conditions including cardiac disease and diabetes, those with skin disease, trauma, surgical wounds, and injection drug use. GAS infections can spread rapidly in congregate settings including long-term care facilities, shelters for people who are experiencing homelessness, and others.

 

According to the PADOH’s Invasive Strep Fact Sheet, around 11,000 to 13,000 cases of iGAS occur each year in the United States, resulting in 1,100 to 1,600 deaths. The department’s recent health advisory, transmitted via the PA Health Alert Network, states: “At this time, Pennsylvania has not identified a significant increase in pediatric or adult cases compared to previous years.”

PADOH provides the following guidance for medical providers, hospitals, EMS personnel, and long-term care facilities:

Healthcare providers should encourage parents to make sure their children are up to date with influenza and varicella vaccines, as these infections can increase risk for getting an iGAS infection.

Recognizing Group A Streptococcus (GAS) infections early can prevent further GAS transmission and disease among individuals at high risk for severe outcomes. Consider obtaining culture for suspected invasive infection (iGAS), including cultures of abscesses, other infected sites, and blood cultures as clinically indicated to determine cases early in the infection process. This allows for swift administration of treatment and implementation of Infection control and prevention strategies to prevent further transmission and infection.

There is a national shortage of amoxicillin suspensions that is anticipated to last several months. When choosing a pediatric treatment protocol for GAS infection consider the antibiotic availability when initiating treatment.

 

Read more about the nationwide “pink bubblegum” shortage (amoxicillin) on The PediaBlog here. The American Academy of Pediatrics reviews antibiotic alternatives for treating common pediatric bacterial infections here.

Read more about Group A Streptococcal infections from the CDC here.

 

source http://www.thepediablog.com/2022/12/21/invasive-strep-alert/