Streptococcal A so-called “streptococcal” angina is a bacterial angina that can affect children and adults. Usually treated with antibiotics, it can be complicated when the streptococcus moves elsewhere than in the throat. Worrying cases, including 3 deaths, were reported in France in December.
[Mise à jour le 12 décembre 2022 à 16h05] On it 8 to 9 million tonsillitis occurs every year in Francethat streptococci A would be involved in approx a quarter of the cases (10 to 25% in adults25 more 40% in children over 3 years). Most often, angina, which is then considered “bacterial”, is mild and treated with antibiotics. In rare but serious cases, it can become complicated. More pediatric cases of invasive group A streptococcal disease “in larger numbers than usual” have been reported in various French regions (Occitanie, Auvergne-Rhône-Alpes, New Aquitaine) over the last 15 days, the Directorate-General for Health informs on 6 December, primarily in children under 10 years of age. These cases led to hospitalization in resuscitation of at least 8 children without identified risk factors, including 2 died. Three adult cases has been reported incl 1 died. Streptococcus A is detected by TROD test, usually from 3 years of age. Faced with the increase in serious cases observed in recent days, doctors must now routinely test every patient with angina, regardless of age and perform a throat swab in case of scarlet fever and negative TROD. “In 99% of cases, there are no problems with angina“, reassured Didier Couteaud, representative of the Landes Regional Health Agency quoted by France Bleu. A 3-year-old girl has died in the area. “In some cases, the disease can degenerate and can affect vital functions. There it was.” An epidemic of scarlet fever and strep throat in Hautes-Alpes and Bouches-du-Rhône was reported in 2007. Strep Throat occurs especially in cold weather as Winter and at springwhich can epidemically affect communities such as schools.
What is strep A strep throat?
Angina is one inflammation of the tonsils or even the entire pharynx. She is most often due to a virus, this is called “viral” angina. More rarely is she caused by a bacterium, it is then “bacterial”. Among the bacteria responsible for angina, streptococci. There is many bacteria of the genus Streptococcus which Streptococcus pyogenes or “Streptococcus A”. “Its habitat is the back of the pharynx, therefore the pharynx, and it has a rich pathogenic power” the infectious disease doctor Stéphane Gayet explained to us in a previous article. “Strep A remains one of the most common bacteria in childhood infections including angina-like there is no vaccine against this bacterium, unlike, for example, pneumococci” explains Dr. Andréas Werner, pediatrician and president of the French Association of Ambulatory Paediatrics (AFPA). That infection of streptococci A is essentially directly with air or skin from a sick person or a healthy carrier (carrier but asymptomatic).
What is the risk of strep throat in children?
“In children, approx a third of anginas are caused by group A streptococci (SGA)” explains the French Society of Pediatrics. “This is the germ found in bacterial angina in children. It concerns older children because bacterial angina occurs usually after 3 years, it is very rare that they appear before” continues Dr. Werner. Streptococcus A is not usually systematically searched for in the youngest.
What is the risk of Strep A sore throat in adults?
Strep throat is less common in adults. It would represent 10 to 25% of angina. In adults, a Mac Isaacs Clinical Score < 2 har en negativ prædiktiv værdi > 95% to eliminate the streptococcal origin of angina.
- Fever > 38°C +1
- No cough +1
- Sensitive cervical adenopathy +1
- Tonsil damage +1
- Age 15-44 years 0
- ≥ 45 years -1
What are the symptoms of strep A strep throat?
Strep A sore throat starts abruptly and is expressed by:
- severe pain when swallowing,
- high fever (over 38°c),
- intense pharyngeal erythema,
- painful glands,
- swollen tonsils
- no cough
- abdominal pains
But “there is nothing validated or significant enough to dispense with the test because bacterial angina cannot be seen” insists Dr. Werner.
In the child, no clinical signs or scores have predictive value positive or negative sufficient to determine the streptococcal origin of angina. “The McIsaac score is not useful in pediatrics” says Dr. Werner. The doctor must perform a rapid screening test (RDT) dedicated to angina to confirm streptococcal angina. “We put the cotton swab in the back of the throat and we have the result in 3 minutes” explains Dr. Werner, who remembers it normally “Any angina requires a sample before prescribing antibiotics to check if it is bacterial”. Gold “currently, a majority of doctors do not order this free test from health insurance and prescribe antibiotics without taking the test“. This test is usually recommended from the age of 3 as “bacterial angina is rare before” reminds the pediatrician.
The lack of amoxicillin complicates the situation.
In 2018, a French study by Dr. Nicolas Note to rate incidence of strep throat in children 12-35 months showed that streptococcus A was responsible for 26% of angina acute of these children. For this doctor,a bacterium is not that rare and the generalization of the diagnostic test “would make it possible to better manage the symptoms and pain of many children, while effectively preventing the occurrence of loco-regional complications”. This generalization was registered on December 6, 2022 of DGS following the increase in severe cases in children under 10 years of age in France. Doctors currently have to perform a Streptococcus A Rapid Diagnostic Orientation Test (TROD) in cases of angina and a throat swab before a clinical picture of scarlet fever, in case of a negative TROD.
What are the treatments for strep A strep throat?
In case of a positive test for group A strep throat, the doctor will prescribe antibiotics: amoxicillin is recommended by the high health authority. This antibiotic is currently in short supply in France: “We don’t have many left, which makes the situation very special” witnesses Dr. Werner. On 12 December, DGS reminded the doctors of this “antibiotic treatment is recommended only in case of positive angina TROD”. It should not be automatic because angina is suspected.
What are the complications of strep throat?
Group A strep throat may be responsible rare but serious complications. Streptococcus can invade other areas of the body: “In classical angina, the streptococcus is found in the throat. When the infection is invasive, the same bacteria will be found everywhere and lead to meningitis, pneumonia, otitis…” explains Dr. Werner. Strep A sore throat can also be responsible kidney complications (acute glomerulonephritis), heart (acute articular arthritis (AAR)) or neurological (Sydenham’s chorea) “but these complications are less and less present in France as the virulence of the germ has decreased“. An invasive streptococcal A infection imposes a hospitalization.
“A child who has a systemic streptococcal A infection is very unwell”
What are the signs of angina complications?
“A child who has a systemic streptococcal A infection is a child who is really unwell” emphasizes Dr. Werner. “Any change in the child’s general condition should cause concern, when the child is very unwell, there is no improvement after the start of treatment, it is necessary to consult again” he explains. ThatStreptococcus A is a bacterium that is very sensitive to antibioticsit has little resistance. “The antibiotic works quickly after 24 to 36 hours, the child is no longer contagious and he feels better, there is a marked improvement in the pain” argues Dr. Werner.
What advice for prevention?
To limit the risk of transmission, it is advisable to use the same barrier measures used against winter viruses:
- Wearing a mask for people with respiratory infections,
- Sneeze or cough into the crook of your elbow
- Ventilate the room,
- Clean the child’s nose thoroughly regularly
- Avoid the community of fragile children
- Do the recommended vaccinations for children
- Avoid large surfaces for the smallest children.
Thanks to Dr. Andréas Werner, pediatrician, president of the French Association of Ambulatory Pediatricians (AFPA) and editor of the Mpedia site.
Resurgence of invasive streptococcal A infections, DGS, 6 December 2022
Invasive group A streptococcal infection (IISGA): update per 6 December 2022, Public Health France.
Epidemic of scarlet fever and strep throat Hautes-Alpes and Bouches-du-Rhône, 2007. Health surveillance institute.
Angina, University Hospitals of Marseille, AP-HM
Streptatest, BioSynex, URPS Pharmaceuticals.
Incidence of strep throat in children aged 12 to 35 months in pediatric emergencies: interim results of the Pasteur Nicolas Nodet study. OpenScience. 2018