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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.

The first 300 words of the full text of this section appear below.

Section 3. Summaries of Infectious Diseases

Group A Streptococcal Infections

Clinical Manifestations
Etiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures

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CLINICAL MANIFESTATIONS: The most common group A streptococcal (GAS) infection is acute pharyngotonsillitis. Purulent complications, including otitis media, sinusitis, peritonsillar and retropharyngeal abscesses, and suppurative cervical adenitis develop in some patients, usually people who are untreated. The significance of GAS upper respiratory tract disease is related to acute morbidity and to nonsuppurative sequelae (acute rheumatic fever and acute glomerulonephritis).

Scarlet fever occurs most often 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 occurs rarely. Other than the occurrence of rash, the epidemiologic features, symptoms, signs, sequelae, and treatment of scarlet fever are the same as those of streptococcal pharyngitis.

Toddlers (1–3 years of age) with GAS respiratory tract infection initially have serous rhinitis and develop a protracted illness with moderate fever, irritability, and anorexia (streptococcal fever). The classic presentation of streptococcal upper respiratory tract infection as acute pharyngitis is uncommon in children younger than 3 years of age. Rheumatic fever also is rare 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. Acute rheumatic fever is not a proven sequela of streptococcal skin infection.

Other GAS infections include erysipelas, perianal cellulitis, vaginitis, bacteremia, pneumonia, endocarditis, pericarditis, septic arthritis, cellulitis, necrotizing fasciitis, osteomyelitis, myositis, puerperal sepsis, surgical wound infection, and neonatal omphalitis. Necrotizing fasciitis and other invasive GAS infections in children can occur as complications of varicella. Invasive GAS . . . [Go to Full Text]


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