South Australia (SA) has recently seen an increase in invasive group A streptococcal disease (iGAS). iGAS became a notifiable disease in SA in October 2021. In 2023 there have been 171 cases compared with 82 for 2022. An increase in cases has also been reported interstate and in Europe and the United Kingdom. Increased numbers of cases have been reported in all age groups in SA, but the biggest increase has been seen in children under the age of 10 years, with 36 cases for 2023 (compared with nine in 2022).
iGAS is caused by Group A streptococcus (GAS) which commonly causes skin and throat infections. Presentations may include bacteraemia, sepsis, empyema, osteomyelitis, septic arthritis, meningitis, puerperal sepsis, and other life-threatening conditions such as streptococcal toxic shock syndrome (STSS) and necrotising fasciitis.
Symptoms/signs - general
- Fever and chills
- Dyspnoea and chest pain
- Muscle pain, myalgias & muscle tenderness
- Rapidly spreading skin infection
- Redness or skin flushing (sunburn-like)
- Dizziness or light headedness
- Nausea, vomiting, abdominal pain, diarrhoea
- Peripartum women – bleeding or purulent vaginal discharge
Symptoms/signs in children
- Cold or mottled limbs
- Limb pain
- Not wanting to walk
- Poor feeding
- Lethargy
- Increased work of breathing
- Tachycardia
- Reduced urine output
People at increased risk of iGAS
- Infants and young children
- Adults 65 years and older
- Persons with recent diagnosis of impetigo, streptococcal pharyngitis, or scarlet fever
- Persons who have been in close contact with someone with GAS in the past 30 days
- Peripartum women
- Persons living in crowded households
- Aboriginal and/or Torres Strait Islander persons
- Persons who inject drugs
- Persons who are immunocompromised
Medical practitioners are advised to:
- Be Alert for iGAS infection particularly in those at increased risk of GAS, and in children or adolescents who are more unwell than expected for a viral illness.
- Undertake usual testing to exclude other causes of sepsis. Take blood for culture and PCR, and in suspected meningitis, CSF (at least 1 mL) for PCR and culture.
- Arrange urgent transfer of suspected cases of iGAS to an emergency department (ED), with clear communication of concerns about potential sepsis/iGAS.
- Provide early resuscitation and empiric antibiotics if required. Follow the applicable sepsis pathway for adults or children.
- If a decision is taken to discharge a patient, encourage patients/carers to urgently present to the Emergency Department of the closest hospital if symptoms worsen or progress rapidly. Deterioration may be sudden.
- Notify Communicable Disease Control Branch of confirmed cases of iGAS.
- Provide information to patients. See www.sahealth.sa.gov.au/YouveGotWhat
- Counsel household contacts of iGAS patients about their increased risk of iGAS. Consider chemoprophylaxis for household contacts: seek infectious diseases specialist advice.
- Promote routine vaccinations including varicella and influenza for eligible patients. iGAS may follow infections caused by other pathogens such as varicella or influenza.
