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Group A streptococcal infections: guidance and data

• From: Public Health England
• Part of: Infectious diseases
• Published: 31 July 2014
• Last updated: 6 May 2016, see all updates

The characteristics, diagnosis and management of group A streptococci infections.

Group A Streptococcus (GAS; Streptococcus pyogenes) is a bacterium which can colonise the throat, skin and anogenital tract. It causes a diverse range of skin, soft tissue and respiratory tract infections, including:

• tonsillitis
• pharyngitis
• scarlet fever
• impetigo
• erysipelas
• cellulitis
• pneumonia

In rare cases, patients may go on to develop post-streptococcal complications, such as:

• rheumatic fever
• glomerulonephritis

GAS can occasionally cause infections that are extremely severe. Invasive GAS (iGAS) is an infection where the bacteria is isolated from a normally sterile body site, such as the blood. Any GAS manifestation can be associated with development of streptococcal toxic shock syndrome, although patients with necrotising fasciitis are at highest risk.

GAS is spread by close contact between individuals, through:

• respiratory droplets
• direct skin contact

It can also be transmitted environmentally, through:

• contact with contaminated objects, such as towels or bedding
• ingestion of food inoculated by a carrier

Invasive GAS (iGAS) infection and scarlet fever are both notifiable diseases: health professionals must inform local health protection teams of suspected cases. Guidelines are available for the public health management of iGAS cases in the community and healthcare settings and scarlet fever outbreaks in educational settings.

Diagnosis

GAS is usually diagnosed by microbiological culture of the affected site. Serology has specific clinical uses and can be discussed with a local infection specialist.

GAS isolates from patients with healthcare-associated infections should be stored locally for a minimum of 6 months.

1. RVPBRU: reference and diagnostic services

   • 1 August 2014
   • Guidance

Management

See risk information for close community contacts of cases of iGAS infection.

Read further guidance on prevention and control of group A streptococcal infection in acute healthcare and maternity settings in the UK. Guidance on the management of close community contacts is provided below.

1. Invasive group A streptococcal disease: managing close contacts

   • 19 March 2008
   • Guidance

2. Scarlet fever: managing outbreaks in schools and nurseries

   • 16 April 2014
   • Guidance

Epidemiology

1. Pyogenic and non-pyogenic streptococcal bacteraemia: annual data from voluntary surveillance

   • 28 November 2016
   • Research and analysis

2. Group A streptococcal infections: activity during the 2015 to 2016 season

   • 6 May 2016
   • Research and analysis

3. Group A streptococcal infections: activity during the 2014 to 2015 season

   • 3 July 2015
   • Research and analysis

4. Group A streptococcal infections: update on activity for the 2013 to 2014 season

   • 11 July 2014
   • Research and analysis

Document information

Published: 31 July 2014

Updated: 6 May 2016

+ full page history

1. 6 May 2016 Added report on activity during the 2014 to 2015 season under epidemiology.
2. 2 December 2014 Added 'Group A streptococcal infections: activity during the 2014 to 2015 season' to the collection.
3. 31 July 2014 First published.

From: Public Health England

Part of: Infectious diseases