Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Group A streptococcal (Streptococcus pyogenes) bacteremia in children

Dennis L Stevens, MD, PhD
Sheldon L Kaplan, MD
Section Editor
Morven S Edwards, MD
Deputy Editor
Carrie Armsby, MD, MPH


Group A streptococcus (GAS, eg, Streptococcus pyogenes) is an aerobic gram-positive coccus that is a common cause of acute bacterial pharyngitis and other cutaneous and invasive infections in children [1]. Invasive GAS infections are defined as bacteremia, pneumonia, osteomyelitis, septic arthritis, or any other infection associated with the isolation of GAS from a normally sterile body site [1]. Invasive infections also include necrotizing fasciitis and spontaneous gangrenous myositis.

The epidemiology, clinical manifestations, treatment, and prognosis of GAS bacteremia and/or invasive GAS infection in children will be reviewed here. GAS bacteremia in adults and issues related to specific manifestations of invasive GAS infections (toxic shock syndrome and necrotizing fasciitis) are discussed separately:

(See "Treatment of streptococcal toxic shock syndrome".)

(See "Necrotizing soft tissue infections".)

(See "Group A streptococcal (Streptococcus pyogenes) bacteremia in adults".)


Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Sep 2016. | This topic last updated: Feb 22, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
  1. Stevens DL. Invasive group A streptococcus infections. Clin Infect Dis 1992; 14:2.
  2. Megged O, Yinnon AM, Raveh D, et al. Group A streptococcus bacteraemia: comparison of adults and children in a single medical centre. Clin Microbiol Infect 2006; 12:156.
  3. Kiska DL, Thiede B, Caracciolo J, et al. Invasive group A streptococcal infections in North Carolina: epidemiology, clinical features, and genetic and serotype analysis of causative organisms. J Infect Dis 1997; 176:992.
  4. Demers B, Simor AE, Vellend H, et al. Severe invasive group A streptococcal infections in Ontario, Canada: 1987-1991. Clin Infect Dis 1993; 16:792.
  5. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2008. www.cdc.gov/abcs/reports-findings/survreports/gas08.html (Accessed on July 14, 2011).
  6. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2009. www.cdc.gov/abcs/reports-findings/survreports/gas09.html (Accessed on July 14, 2011).
  7. Centers for Disease Control and prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2010 www.cdc.gov/abcs/reports-findings/survreports/gas10.html (Accessed on May 15, 2012).
  8. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus. www.cdc.gov/abcs/reports-findings/survreports/gas11.pdf (Accessed on August 19, 2013).
  9. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2012. www.cdc.gov/abcs/reports-findings/survreports/gas12.html (Accessed on August 06, 2014).
  10. Laupland KB, Davies HD, Low DE, et al. Invasive group A streptococcal disease in children and association with varicella-zoster virus infection. Ontario Group A Streptococcal Study Group. Pediatrics 2000; 105:E60.
  11. Tapiainen T, Launonen S, Renko M, et al. Invasive Group A Streptococcal Infections in Children: A Nationwide Survey in Finland. Pediatr Infect Dis J 2016; 35:123.
  12. Lamagni TL, Neal S, Keshishian C, et al. Severe Streptococcus pyogenes infections, United Kingdom, 2003-2004. Emerg Infect Dis 2008; 14:202.
  13. Patel RA, Binns HJ, Shulman ST. Reduction in pediatric hospitalizations for varicella-related invasive group A streptococcal infections in the varicella vaccine era. J Pediatr 2004; 144:68.
  14. Gaworzewska E, Colman G. Changes in the pattern of infection caused by Streptococcus pyogenes. Epidemiol Infect 1988; 100:257.
  15. Martin PR, Høiby EA. Streptococcal serogroup A epidemic in Norway 1987-1988. Scand J Infect Dis 1990; 22:421.
  16. Schwartz B, Facklam RR, Breiman RF. Changing epidemiology of group A streptococcal infection in the USA. Lancet 1990; 336:1167.
  17. Holm SE, Norrby A, Bergholm AM, Norgren M. Aspects of pathogenesis of serious group A streptococcal infections in Sweden, 1988-1989. J Infect Dis 1992; 166:31.
  18. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2013. http://www.cdc.gov/abcs/reports-findings/survreports/gas13.html (Accessed on March 27, 2015).
  19. Stevens DL, Tanner MH, Winship J, et al. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med 1989; 321:1.
  20. Stevens DL, Salmi DB, McIndoo ER, Bryant AE. Molecular epidemiology of nga and NAD glycohydrolase/ADP-ribosyltransferase activity among Streptococcus pyogenes causing streptococcal toxic shock syndrome. J Infect Dis 2000; 182:1117.
  21. Gauguet S, Ahmed AA, Zhou J, et al. Group A streptococcal bacteremia without a source is associated with less severe disease in children. Pediatr Infect Dis J 2015; 34:447.
  22. Tyrrell GJ, Lovgren M, Kress B, Grimsrud K. Varicella-associated invasive group A streptococcal disease in Alberta, Canada--2000-2002. Clin Infect Dis 2005; 40:1055.
  23. Christie CD, Havens PL, Shapiro ED. Bacteremia with group A streptococci in childhood. Am J Dis Child 1988; 142:559.
  24. Wong VK, Wright HT Jr. Group A beta-hemolytic streptococci as a cause of bacteremia in children. Am J Dis Child 1988; 142:831.
  25. Givner LB, Abramson JS, Wasilauskas B. Apparent increase in the incidence of invasive group A beta-hemolytic streptococcal disease in children. J Pediatr 1991; 118:341.
  26. Wheeler MC, Roe MH, Kaplan EL, et al. Outbreak of group A streptococcus septicemia in children. Clinical, epidemiologic, and microbiological correlates. JAMA 1991; 266:533.
  27. Moses AE, Ziv A, Harari M, et al. Increased incidence and severity of Streptococcus pyogenes bacteremia in young children. Pediatr Infect Dis J 1995; 14:767.
  28. Frère J, Bidet P, Tapiéro B, et al. Clinical and Microbiological Characteristics of Invasive Group A Streptococcal Infections Before and After Implementation of a Universal Varicella Vaccine Program. Clin Infect Dis 2016; 62:75.
  29. Doctor A, Harper MB, Fleisher GR. Group A beta-hemolytic streptococcal bacteremia: historical overview, changing incidence, and recent association with varicella. Pediatrics 1995; 96:428.
  30. Wong KK, Jain S, Blanton L, et al. Influenza-associated pediatric deaths in the United States, 2004-2012. Pediatrics 2013; 132:796.
  31. Randolph AG, Vaughn F, Sullivan R, et al. Critically ill children during the 2009-2010 influenza pandemic in the United States. Pediatrics 2011; 128:e1450.
  32. Campbell JR, Arango CA, Garcia-Prats JA, Baker CJ. An outbreak of M serotype 1 group A Streptococcus in a neonatal intensive care unit. J Pediatr 1996; 129:396.
  33. Barg NL, Kish MA, Kauffman CA, Supena RB. Group A streptococcal bacteremia in intravenous drug abusers. Am J Med 1985; 78:569.
  34. Braunstein H. Characteristics of group A streptococcal bacteremia in patients at the San Bernardino County Medical Center. Rev Infect Dis 1991; 13:8.
  35. Passaro DJ, Smitht DS, Hett EC, et al. Invasive group A streptococcal infections in the San Francisco Bay area, 1989-99. Epidemiol Infect 2002; 129:471.
  36. Bernaldo de Quirós JC, Moreno S, Cercenado E, et al. Group A streptococcal bacteremia. A 10-year prospective study. Medicine (Baltimore) 1997; 76:238.
  37. Factor SH, Levine OS, Schwartz B, et al. Invasive group A streptococcal disease: risk factors for adults. Emerg Infect Dis 2003; 9:970.
  38. Sierra JM, Sánchez F, Castro P, et al. Group A streptococcal infections in injection drug users in Barcelona, Spain: epidemiologic, clinical, and microbiologic analysis of 3 clusters of cases from 2000 to 2003. Medicine (Baltimore) 2006; 85:139.
  39. Ampofo K, Herbener A, Blaschke AJ, et al. Association of 2009 pandemic influenza A (H1N1) infection and increased hospitalization with parapneumonic empyema in children in Utah. Pediatr Infect Dis J 2010; 29:905.
  40. Scaber J, Saeed S, Ihekweazu C, et al. Group A streptococcal infections during the seasonal influenza outbreak 2010/11 in South East England. Euro Surveill 2011; 16.
  41. Rathore MH, Barton LL, Kaplan EL. Suppurative group A beta-hemolytic streptococcal infections in children. Pediatrics 1992; 89:743.
  42. O'Brien KL, Beall B, Barrett NL, et al. Epidemiology of invasive group a streptococcus disease in the United States, 1995-1999. Clin Infect Dis 2002; 35:268.
  43. Ibia EO, Imoisili M, Pikis A. Group A beta-hemolytic streptococcal osteomyelitis in children. Pediatrics 2003; 112:e22.
  44. American Academy of Pediatrics. Group A streptococcal infections. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW, Brady MT, Jackson MA, Long SS. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.732.
  45. Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J 1999; 18:1096.
  46. Richter SS, Heilmann KP, Beekmann SE, et al. Macrolide-resistant Streptococcus pyogenes in the United States, 2002-2003. Clin Infect Dis 2005; 41:599.
  47. Jaggi P, Beall B, Rippe J, et al. Macrolide resistance and emm type distribution of invasive pediatric group A streptococcal isolates: three-year prospective surveillance from a children's hospital. Pediatr Infect Dis J 2007; 26:253.
  48. Stevens DL, Bryant AE, Yan S. Invasive group A streptococcal infection: New concepts in antibiotic treatment. Int J Antimicrob Agents 1994; 4:297.
  49. Carapetis JR, Jacoby P, Carville K, et al. Effectiveness of clindamycin and intravenous immunoglobulin, and risk of disease in contacts, in invasive group a streptococcal infections. Clin Infect Dis 2014; 59:358.
  50. Gooskens J, Neeling AJ, Willems RJ, et al. Streptococcal toxic shock syndrome by an iMLS resistant M type 77 Streptococcus pyogenes in the Netherlands. Scand J Infect Dis 2005; 37:85.
  51. Chen I, Kaufisi P, Erdem G. Emergence of erythromycin- and clindamycin-resistant Streptococcus pyogenes emm 90 strains in Hawaii. J Clin Microbiol 2011; 49:439.