Skip to main content

Manifestations of GAS Other Than Pharyngitis

Manifestations of Group A Streptococcus Other Than Pharyngitis
The majority of GAS manifestations do NOT represent complications of GAS pharyngitis

Manifestations, Non-invasive

  •  Scarlet fever1
  • Peritonsillar abscess - more common in adolescents2
  • Retropharyngeal and parapharyngeal abscesses3
  • Cervical lymphadenitis
  • Otitis media
  • Sinusitis
  • Skin and soft tissue infections - impetigo/pyoderma, erysipelas, intertrigo, cellutitis, dactylitis.

Delayed Manifestations of Group A Streptococcal Pharyngitis:

    • Acute Rheumatic Fever (ARF)4
    • Acute glomerulonephritis5
    • Poststreptococcal arthritis (PSRA)

Manifestations, Invasive infections - most invasive GAS infections do not have pharyngitis as a source. Examples include:

  • Streptococcal toxic shock syndrome
  • Sepsis
  • Necrotizing fascitis
  • Mastoiditis
  • CNS infections - meningitis, orbital cellulitis/abscess, brain abscess, empyema
  • Pneumonia, empyema
  • Peritonitis
  • Osteomyelitis, suppurative arthritis, myositis
  • Surgical wound infections
  • Neonatal omphalitis

Footnotes:

  1. Rare in the United States and presents mostly in children aged 5-15 years of age. (Centers for Disease Control and Prevention, 2022).
  2. The incidence of peritonsillar abscess ranged is reported as 10-34 per 100,000 people (Slouka et al., 2020)
  3. Mostly affects children between 2 - 4 years of age but incidence is rare; 1-2 per 100,000 (Cleveland Clinic, 2022).
  4. The incidence of ARF in the United States is 0.5 cases per 100,000 in children and young adults (Centers for Disease Control and Prevention, 2022).
  5. Rare in the United States and typically associated with a skin infection (Rawla et al., 2022).

References

 

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

Evidence Based Practice Menu
Children's Mercy Kansas City   /    Health Care Providers   /    Evidence Based Practice / Clinical Pathways    /    Clinical Practice Guidelines, Care Process Models, and Enhanced Recovery After Surgery Pathways   /    Pharyngitis   /   Manifestations of GAS Other Than Pharyngitis