Sore Throat
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Group A streptococcus is a bacterium often found in
the throat and on the skin. People may carry group A streptococci
in the throat or on the skin and have no symptoms of illness. Most
GAS infections are relatively mild illnesses such as "strep
throat," or impetigo. On rare occasions, these bacteria can cause
other severe and even life-threatening diseases
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These bacteria are spread through direct contact
with mucus from the nose or throat of persons who are infected or
through contact with infected wounds or sores on the skin. Ill
persons, such as those who have strep throat or skin infections,
are most likely to spread the infection. Persons who carry the
bacteria but have no symptoms are much less contagious. Treating
an infected person with an antibiotic for 24 hours or longer
generally eliminates their ability to spread the bacteria.
However, it is important to complete the entire course of
antibiotics as prescribed. It is not likely that household items
like plates, cups, or toys spread these bacteria.
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Infection with GAS can result in a range of symptoms:
- No illness
- Mild illness (strep throat or a skin infection such as
impetigo)
- Severe illness (necrotizing faciitis, streptococcal toxic
shock syndrome)
Severe, sometimes life-threatening, GAS disease may
occur when bacteria get into parts of the body where bacteria
usually are not found, such as the blood, muscle, or the lungs.
These infections are termed "invasive GAS disease." Two of the
most severe, but least common, forms of invasive GAS disease are
necrotizing fasciitis and Streptococcal Toxic Shock Syndrome.
Necrotizing fasciitis (occasionally described by the media as "the
flesh-eating bacteria") destroys muscles, fat, and skin tissue.
Streptococcal toxic shock syndrome (STSS), causes blood pressure
to drop rapidly and organs (e.g., kidney, liver, lungs) to fail.
STSS is not the same as the "toxic shock syndrome" frequently
associated with tampon usage. About 20% of patients with
necrotizing fasciitis and more than half with STSS die. About
10%-15% of patients with other forms of invasive group A
streptococcal disease die.
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About 9,400 cases of invasive GAS disease occurred
in the United States in 1999. Of these, about 300 were STSS and
600 were necrotizing fasciitis. In contrast, there are several
million cases of strep throat and impetigo each year.
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Invasive GAS infections occur when the bacteria get
past the defenses of the person who is infected. This may occur
when a person has sores or other breaks in the skin that allow the
bacteria to get into the tissue, or when the person’s ability to
fight off the infection is decreased because of chronic illness or
an illness that affects the immune system. Also, some virulent
strains of GAS are more likely to cause severe disease than
others.
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Few people who come in contact with GAS will develop
invasive GAS disease. Most people will have a throat or skin
infection, and some may have no symptoms at all. Although healthy
people can get invasive GAS disease, people with chronic illnesses
like cancer, diabetes, and kidney dialysis, and those who use
medications such as steroids have a higher risk.
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Early signs and symptoms of necrotizing fasciitis;
- Fever
- Severe pain and swelling
- Redness at the wound site
Early signs and symptoms of STSS;
- Fever
- Dizziness
- Confusion
- A flat red rash over large areas of the body
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GAS infections can be treated with many different
antibiotics. Early treatment may reduce the risk of death from
invasive group A streptococcal disease. However, even the best
medical care does not prevent death in every case. For those with
very severe illness, supportive care in an intensive care unit may
be needed. For persons with necrotizing fasciitis, surgery often
is needed to remove damaged tissue.
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The spread of all types of GAS infection can be
reduced by good hand washing, especially after coughing and
sneezing and before preparing foods or eating. Persons with sore
throats should be seen by a doctor who can perform tests to find
out whether the illness is strep throat. If the test result shows
strep throat, the person should stay home from work, school, or
day care until 24 hours after taking an antibiotic. All wounds
should be kept clean and watched for possible signs of infection
such as redness, swelling, drainage, and pain at the wound site. A
person with signs of an infected wound, especially if fever
occurs, should seek medical care. It is not necessary for all
persons exposed to someone with an invasive group A strep
infection (i.e. necrotizing fasciitis or strep toxic shock
syndrome) to receive antibiotic therapy to prevent infection.
However, in certain circumstances, antibiotic therapy may be
appropriate. That decision should be made after consulting with
your doctor.
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AAT Deficiency
