Strep A symptoms described

Strep A outbreak, what to look out for

The UK Health Security Agency (UKHSA) is currently reporting higher than expected cases of infection with a bacterium called Streptococcus pyogenes. Dr Sarah Pitt (pictured) gives an overview of the situation

Also known as Strep A, this is a fairly common infection, usually associated with mild symptoms such as throat infections and sometimes tonsillitis. In school age children, it can also cause scarlet fever.

The symptoms of Strep A infection include:

• a high temperature,
• sore throat,
• sandpaper rash
• strawberry tongue
• headache and sometimes
• feeling sick and vomiting.

Strep A can be treated with standard antibiotics if required.

Sandpaper rash and strawberry tongue

A characteristic rash can also develop within 1-2 days of infection – sometimes known as ‘sandpaper rash’ because it is rough to the touch and itchy. This rash generally starts on the chest and then spreads across the body. A child can then become very tired, with swollen glands in the neck, reddened cheeks and white coating on the tongue which peels off to leave it red and swollen (called ‘strawberry tongue’).

Spreading scarlet fever

Strep A lives in the mouth and nose so it is easily spread by coughing and sneezing; cases usually rise in the winter and stay high into the early spring. In the current Strep A 'season' since autumn 2022, over 6,000 cases of scarlet fever have been reported to the UKHSA. This is higher than would be expected, even in a season where there are a lot of cases.

The last time there were such high rates of scarlet fever infections in the UK was 5 years ago, though even then the total cases recorded between September and December in 2017 was just over 2,500. But though this year’s numbers are unusually high, most cases will still be relatively mild.

More serious effects - invasive Group A streptococcus (iGAS)

Occasionally, some strains of the Strep A bacterium can enter the blood stream and cause a more serious disease called invasive Group A streptococcus (iGAS). This is the particularly dangerous development for young children, elderly and clinically vulnerable people, and can be life-threatening if not treated.

To put things in context, since September 2022, just over 60 people have died from iGAS infection across England – including the sad deaths of at least 15 children, as currently being reported in the news. For comparison, in the whole of the previous season with unusually high levels of disease in 2017/2018, there were 355 deaths due to iGAS infection, 27 of which were in children under 18.

Fear of bugs

However, the media continue to sensationalise with many patients getting confused and asking their doctors if this is a new disease. Dr Amarjit Raindi for the GP Clinic London, says patients are telling him, " We thought that Strep A had been eradicated", and asking if this "is this a new disease?". The fact is that humans have been living in general harmony with bacteria including the different types of streptococci since humans evolved.

Streptococci are a very common type of bug and are found pretty well everywhere. According to the journal Nature, we are bugs. They are normally perfectly friendly, and indeed assist in normal healthy living. Indeed, people with a lower diversity of microbial organisms in their gut are more likely to get overweight. It is when the normal balance of nature is thrown, or when the balance of natural immunity is compromised that they can become pathogenic (disease causing), and lockdowns probably did not help.

Treatment 

Thankfully, there is no evidence at the moment that there is a different strain of iGAS circulating at present, which means that standard antibiotic treatments should be effective against all types of Strep A infection.

In some outbreak situations, children who have been in contact with someone diagnosed with iGAS are being prescribed antibiotics as a precaution. This is standard procedure and should help to stop the spread of the infection. However, the current high rates of Strep A infection are leading to some issues with supplies of penicillin and amoxicillin, which will need to be managed carefully.