Strep A: When do normal symptoms become an emergency?

Dr Muiris Houston on the recent spike in respiratory infections in children and when to seek medical advice for them

The death of a child in Belfast from invasive Group A strep (GAS) infection and a possible link between the bug and a child who has died unexpectedly in the northeast of the country is worrying for parents.

GAS is caused by bacteria known as Group A (beta-haemolytic) streptococcus. There has been a marked increase in respiratory tract Group A strep infections in children over the past few weeks. The increase is most likely related to high amounts of circulating bacteria, as well as increased social mixing compared to previous years. There is no evidence that a new strain is circulating.

GAS is a common infection that can cause sore throats, scarlet fever and a skin condition called impetigo. These infections are usually mild and respond to treatment with antibiotics.

Standard streptococcal symptoms

Typical symptoms of a streptococcal sore throat include a sore, red throat with pus around the tonsils; a fever; and enlarged and tender lymph nodes in and around the neck.


The symptoms of scarlet fever include inflammation of the throat, a pink-red rash spreading across the abdomen and chest wall (the rash may feel like sandpaper when touched), and a bright-red tongue (known as “strawberry tongue”).

The symptoms of impetigo include blisters (typically around the nose and mouth and legs), fever and swollen lymph nodes in severe cases.

However there is a more serious (albeit rare) form of infection called invasive Group A Strep (iGAS) infection. This can occur when a person has breaches in their respiratory tract after a viral illness. The original throat infection passes into the retro-pharyngeal space behind the throat, causing swelling.

Advice for parents

The following signal the possibility of more serious infection and are reasons for parents to contact their GP:

  • Child is displaying the above symptoms and is getting worse
  • Child is feeding or eating much less than normal
  • Child has had a dry nappy for 12 hours or more or shows other signs of dehydration
  • Baby is under three months and has a temperature of 38 degrees, or is older than three months and has a temperature of 39 degrees or higher
  • Baby feels hotter than usual when you touch their back or chest, or feels sweaty
  • Child is very tired or irritable.

Bring the child to an emergency department or call an ambulance if:

  • They are having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
  • There are pauses when your child breathes
  • Your child’s skin, tongue or lips are blue
  • Your child is floppy and will not wake up or stay awake.
Muiris Houston

Dr Muiris Houston

Dr Muiris Houston is medical journalist, health analyst and Irish Times contributor