What is strep A and what are the symptoms?

Parents urged to watch out for possible signs of strep A infection

Parents have been urged to watch out for possible signs of Streptococcus A infection after health authorities confirmed they were investigating two separate childhood deaths which may be linked to the infection.

Strep A was on Tuesday being investigated by the HSE as one of the possible causes in the death of a four-year-old child in the northeast/north Dublin region.

Meanwhile, it was confirmed that a five-year-old child at a Belfast primary school that last week reported a severe case of strep A has died.

To date there have been 55 cases of strep A in Ireland, with two confirmed deaths caused by the infection - both elderly people. Of the 55 cases 16 were paediatric.


What is strep A?

Strep A is a common bug which can cause a range of different illnesses of the nose, throat and lungs. It is a type of bacterium found on the throat and on the skin. In large groups of people it doesn’t result in any symptoms, and for the majority of those who do become ill, a course of antibiotics will resolve it.

How does it spread?

While people carrying the bacteria may be without symptoms, they are just as likely to pass it on as those who have become ill.

People can catch it through close contact and from coughs and sneezes. Outbreaks can sometimes happen in places such as schools.

What are the symptoms?

Strep throat is different from a regular sore throat and the pain can come on very quickly. Symptoms include pain when swallowing, fever and red and swollen tonsils – sometimes with white patches or streaks of pus.

The first signs of scarlet fever can be flu-like symptoms, including a high temperature, a sore throat and swollen neck glands.

A rash appears 12 to 48 hours later that starts on the chest and stomach, then spreads. A white coating also appears on the tongue that peels, leaving the tongue red, swollen and covered in little bumps, which is often called “strawberry tongue”.

Impetigo is a skin infection which starts with red sores or blisters that then burst, leaving crusty, golden patches.

Very rarely, strep A can cause severe illness when the bacteria get into parts of the body that are usually free from bacteria. This is called invasive group A streptococcal disease (IGAS).

What is invasive group A streptococcal disease?

Invasive group A strep disease can become a life-threatening infection in which the bacteria have invaded parts of the body such as the lungs, blood or muscles.

Two of the most severe but rare forms of invasive disease are necrotising fasciitis and streptococcal toxic shock syndrome.

Necrotising fasciitis is also known as the “flesh-eating disease” and can occur if a wound gets infected. Signs of necrotising fasciitis include fever – a high temperature above 38C – severe pain and swelling, and redness at the wound site.

Streptococcal toxic shock syndrome is a rapidly progressing infection causing low blood pressure or shock, and damage to organs such as the kidneys, liver and lungs. Early signs and symptoms of toxic shock may include fever, dizziness, confusion, rash and abdominal pain.

What should parents watch out for?

Parents are advised to contact their GP if their child is getting worse or are very tired and irritable; if they are eating or feeding much less than normal; if they have a dry nappy for 12 hours or more or shows other signs of dehydration.

If the baby is under three months old and has a temperature of 38 degrees celsius, or is older than three months and has a temperature of 39 degrees celsius or higher the baby feels hotter than usual when you touch their back or chest they should also be seen by a GP.

Parents are advised to call 999 or present at a hospital emergency department if their child is having difficulty breathing; if there are pauses when the child breathes; if the child’s skin, tongue and lips are blue or if the child is floppy and will not wake up or stay awake.

How can strep A be treated?

Strep A infections such as scarlet fever and impetigo are treated with antibiotics. After a full 24 hours of treatment, people are generally thought to no longer be contagious.

Anyone thought to have invasive group A streptococcal disease should seek medical help immediately. Antibiotics, other drugs and intensive medical attention are likely to be needed. - Additional reporting Guardian Service