Invasive group A streptococcal infection in the Northern Territory, Australia: Case report and review of the literature

Abstract

The increasing incidence of invasive group A streptococcus has been well documented in the temperate climates of North America, Europe and the United Kingdom. Studies also suggest that there are high rates of invasive group A streptococcus infection within the indigenous population of Northern Australia. This review article presents the case of infant Aboriginal twins with invasive group A streptococcal infection complicated by streptococcal toxic shock syndrome, highlighting both the severity and high transmissibility of invasive group A streptococcal disease. We review the epidemiology of group A streptococcal infection and suggest a potential role for chemoprophylaxis of household contacts to reduce the burden of disease within the indigenous population of Northern Australia.

High burden of invasive group A streptococcal disease in the Northern Territory of Australia

“…Transmission occurred within a household between twin infants, clinical details of which have been reported previously [27]. Onset of illness was 2 days apart with the common emm type 207·1 identified.…”

QUESTION 1: Are household contacts of patients with invasive group A streptococcal disease at higher risk of secondary infection?

“…Further studies of the effectiveness of contact chemoprophylaxis are needed, although these will be challenging in light of the sample size required 2 22. There is also a need to establish the risk to household contacts in settings associated with a high burden of GAS disease 23. Overcrowding and poor sanitation may lead to increased transmission and an even greater risk of secondary cases of invasive GAS disease than in the population-based studies included in this review.

Clinical bottom line

Close household contacts have an increased risk of invasive group A streptococcal (GAS) disease, commensurate to that in meningococcal disease.

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Two young brothers with invasive group A streptococcal infection

“…1 One point that came out in the analysis was the greater willingness to consider not resuscitating a neonate if this was the parents' choice, even if resuscitation was perceived by the neonatologist to be in the baby's best interests. This contrasted with the examples of children aged 2 months and 7 years, respectively.…”

“…1 A similar debate was raised in a regional Queensland hospital after two young white brothers (aged 3 and 5 years) were both diagnosed with invasive group A streptococcal (iGAS) infections. The brothers, who were admitted within 24 h of each other, presented with a short history of fevers, lethargy and joint pains.…”

“…1 Canadian guidelines suggest chemoprophylaxis be offered to all close contacts of a confirmed case of iGAS, including those exposed from 7 days pre-onset of symptoms in the case to 24 h after the initiation of antimicrobial therapy. 2 Current UK guidelines also suggest if there are two or more cases of iGAS within a 30-day period, that household contacts should be issued chemoprophylaxis.…”