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The following text is from an archived Red Book® edition and may not reflect current recommendations or information. To view the current edition, click here.
Section 3. Summaries of Infectious Diseases
Group A Streptococcal Infections
Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
CLINICAL MANIFESTATIONS: The most common clinical illness produced by group A streptococcal (GAS) infection is acute pharyngotonsillitis. In some patients who usually are untreated, purulent complications, including otitis media, sinusitis, peritonsillar and retropharyngeal abscesses, and suppurative cervical adenitis, develop. The significance of streptococcal upper respiratory tract disease is related to acute morbidity and nonsuppurative sequelae (ie, acute rheumatic fever and acute glomerulonephritis). Scarlet fever occurs most commonly in association with pharyngitis and, rarely, with pyoderma or an infected wound. Scarlet fever has a characteristic confluent erythematous sandpaper-like rash, which is caused by one or more of several erythrogenic exotoxins produced by GAS strains. Severe scarlet fever with systemic toxic effects occurs rarely. Other than the occurrence of rash, the epidemiologic features, symptoms, sequelae, and treatment of scarlet fever are the same as those of streptococcal pharyngitis.
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Toddlers (1–3 years of age) with GAS respiratory tract infection initially may have serous rhinitis and develop a protracted illness with moderate fever, irritability, and anorexia (streptococcal fever). The classic clinical presentation of streptococcal upper respiratory tract infection as acute pharyngitis is uncommon in children younger than 3 years of age. Rheumatic fever also is uncommon in children younger than 3 years of age.
The second most common site of GAS infection is the skin. Streptococcal skin infections (ie, pyoderma or impetigo) can result in acute glomerulonephritis, which occasionally occurs in epidemics, but acute rheumatic fever is not a sequela of streptococcal skin infection.
Other GAS infections include erysipelas, perianal cellulitis, vaginitis, bacteremia (with or without identified focus), pneumonia, endocarditis, pericarditis, septic arthritis, cellulitis, necrotizing fasciitis, osteomyelitis, myositis, puerperal sepsis, surgical wound infection, and neonatal omphalitis. Necrotizing
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