Group A Streptococcal Infections

by National Institute of Health

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Transmission of impetigo

The infection is spread by direct contact with wounds or sores or nasal discharge from an infected person. Scratching may spread the lesions. From the time of infection until you show symptoms is usually 1 to 3 days. If your skin doesn't have breaks in it, you can't be infected by dried streptococci in the air.

Treatment for impetigo

Your health care provider will prescribe oral antibiotics, as with strep throat. This treatment may also include an antibiotic ointment to be used on your skin.

Cellulitis and erysipelas

Cellulitis is inflammation of the skin and deep underlying tissues. Erysipelas is an inflammatory disease of the upper layers of the skin. Group A strep germs are the most common cause of both conditions.

Symptoms of cellulitis and erysipelas

Symptoms of cellulitis may include fever and chills and swollen "glands" or lymph nodes. Your skin will be painful, red, and tender. Your skin may blister and then scab over. You may also have perianal (around the anus) cellulitis may with itching and painful bowel movements.

With erysipelas, a fiery red rash with raised borders may occur on your face, arms, or legs. Your skin will be hot, red, and have sharply defined raised areas. The infection may come back, causing chronic swelling of your arms or legs (lymphedema).

Transmission of cellulitis or erysipelas

Both cellulitis and erysipelas begin with a minor incident, such as a bruise. They can also begin at the site of a burn, surgical cut, or wound, and usually affect your arm or leg. When the rash appears on your trunk, arms, or legs, however, it is usually at the site of a surgical cut or wound. Even if you have no symptoms, you carry the germs on your skin or in your nasal passages and can transmit the disease to others.

Diagnosis and treatment of cellulitis and erysipelas

Your health care provider may take a sample or culture from your skin lesions to identify the bacteria causing infection. He or she may also recover the bacteria from your blood. Depending on how severe the infection is, treatment involves either oral or intravenous (through the vein) antibiotics.

Scarlet Fever

Scarlet fever is another form of group A strep disease that can follow strep throat. It is usually contagious and lasts for a specific length of time whether or not it is treated.

Symptoms of scarlet fever

In addition to the symptoms of strep throat, a red rash appears on the sides of your chest and abdomen. It may spread to cover most of your body. This rash appears as tiny, red pinpoints and has a rough texture like sandpaper. When pressed on, the rash loses color or turns white. There may also be dark red lines in the folds of skin. You may get a bright strawberry-red tongue and flushed (rosy) face, while the area around your mouth remains pale. The skin on the tips of your fingers and toes often peels after you get better. If you have a severe case, you may have a high fever, nausea, and vomiting.

Transmission of scarlet fever

You can get scarlet fever the same way as strep throat-through direct contact with throat mucus, nasal discharge, and saliva of an infected person.

Treatment for scarlet fever

Like strep throat, your health care provider will treat scarlet fever with antibiotics.

Severe Strep Infections

Some types of group A strep bacteria cause severe infections. These include bacteremia (blood stream infections), toxic shock syndrome (multi-organ infection), necrotizing fasciitis (flesh-eating disease).

In 2004, 3,833 cases of severe group A streptococcal disease were reported to the Centers for Disease Control and Prevention.

All severe group A strep infections may lead to shock, organ failure, and death. Health care providers must recognize and treat such infections quickly.

Health care providers diagnose these infections by looking at blood counts and doing urine tests as well as cultures of blood or fluid from a wound site.

Antibiotics used to treat these severe infections include penicillin, erythromycin, and clindamycin. If you have severe tissue damage, your health care provider may need to remove the tissue surgically or amputate the limb.

People at the greatest risk of getting a severe strep infection are children with chickenpox, people with suppressed immune systems, burn victims, elderly people with cellulitis, diabetes, blood vessel disease, or cancer people taking steroid treatments or chemotherapy, intravenous drug users.

Severe group A strep disease may also occur in healthy people who have no known risk factors.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.