Group A Strep

Dr. Greene's Answer

You are describing Group A Beta Hemolytic Streptococci (called Beta Strep by many people). They are among the most common disease-causing bacteria found in children and can cause an astonishing variety of diseases. Although very sensitive to appropriate antibiotic therapy, if treatment is delayed or absent, very serious illness and even death can result.

Most Group A Streptococcal infections are of short duration and relatively mild, but sometimes they are rapidly progressing, even life-threatening infections. The seriousness of the infection depends on the underlying health of the child, the amount of bacteria involved, the location of the infection, and the virulence of the particular strain causing the infection. More than 100 different types of Group A Beta Strep have been identified.

Common strep infections include those in the upper respiratory tract (often strep throat); scarlet fever, (which includes skin involvement and can be very mild or extremely serious); strep pneumonia (which can also be quite serious — and is what is reported to have killed Muppets creator Jim Hensen); strep skin infections (such as impetigo); strep vaginitis in pre-pubertal girls; and strep bacteremia (or Strep in the bloodstream), which can then lead to meningitis, brain abscess, bone infections, joint infections, or even endocarditis (an infection of the valves of the heart).

Strep pharyngitis (commonly known as “strep throat “) is one of the most common strep infections. Strep throat is contagious until antibiotic therapy has been in place for at least 24 hours. It is spread by close contact, both via respiratory droplets and by touch.

The prevalence of severe Strep has waxed and waned over the years. In the past, scarlet fever was a terrible scourge. The 1980’s saw a resurgence of Strep-induced rheumatic fever. During the 1990’s there was a rise of severe invasive Group A Strep. Hospitalizations such as the one experienced by your friend’s daughter are becoming more common.

The diagnosis of a systemic Strep infection should at least be entertained when there is vomiting lasting longer than 24 hours, a high fever, and an elevated white blood count in an ill-appearing child.

The presence of strep infection can be confirmed by performing a culture of the suspected site. Depending on a child’s symptoms, a throat culture, wound culture, blood culture, and/or a blood test may be obtained to evaluate for strep infection.

In the case of strep throat, rapid strep tests can give almost immediate results in the doctor’s office but may miss 10 to 20% of infections. Throat cultures may take 1 to 2 days, but are able to detect infection 95% of the time.

Thankfully, although the diseases can be quite serious, most children respond briskly to appropriate therapy, and will be active and energetic again in just a few days.