Increase in invasive group A strep infections requires monitoring

WAILEA, Hawaii — A recent increase in invasive group A streptococcal infections in pediatric patients should be monitored and patients treated appropriately, according to a presentation at the Maui Derm meeting.

“The thing that’s interesting is these rates and new cases of strep are increasing not just in the United States, but in Britain and Australia,” Sheila Fallon Friedlander, MD, professor emeritus at UC San Diego School of Medicine and a pediatric dermatologist at Scripps Clinic San Diego, said during the presentation.

Friedlander cited a CDC warning about invasive strep infections that were found in Texas and Colorado, as well as other locations.

Strep tococcus pyrogens, or group A beta hemolytic strep, differs from Streptococcus pneumoniae and Streptococcus agalactiae, or group B streptococci. In addition to children, people aged older than 65 years, American Indian and Alaskan Native adults, residents of long-term care facilities, people with certain medical conditions, people with wounds or skin disease and people who inject drugs are also at risk.

Invasive strep results in 1,500 to 2,300 deaths per year and comes with cellulitis, abscess and necrotizing fasciitis. It also invades areas that are usually “sterile,” according to Friedlander.

The reason for the uptick in invasive strep cases is currently unknown, but could be connected to post-COVID activities.

“We were all in masks, so there were lots of things we weren’t getting. We weren’t getting COVID and other viruses, but we were probably not spreading bacterial infections as well either,” Friedlander said.

Additionally, with a surge of RSV, influenza and COVID, invasive strep is also surging.

“In the literature, it can be seen that after these viral infections, people seem to be more susceptible to group A strep. Is it because the anatomy has changed by the inflammation and disease that comes with the virus? We don’t know,” Friedlander said.

Group A strep does not react to Bactrim (trimethoprim/sulfamethoxazole, Sun Pharma), so that treatment should not be used for these patients. IV therapy and debridement may be necessary. For pediatric patients, amoxicillin is the best option, while adults can be treated with penicillin, Friedlander said.