A 3-year-old girl from Landes died on November 28 from bacterial sore throat due to streptococcus A. What is it? How to recognize it? What to do ? Tips
A 3 year old girloriginally from Landesis deceased on November 28 as a result ofan invasive streptococcal A infection, reports France Blue. Two other children would also be infected with this bacterium and hospitalized in serious condition, including a member of the little girl’s siblings. This infection can manifest as angina or of scarlet fever. “In 99% of cases, there is no difficulty with angina“recalled Didier Couteaud, representative of the Landes Regional Health Agency. “However, in some cases, the disease can degenerate and can affect vital functions. This was the case.” On the 8 to 9 million cases of angina occurring each year in Francethe streptococcus A would be involved in about a quarter of cases (10 to 25% in adults25 to 40% in children over 3 years old), according to the Health Watch Institute in 2007 during an epidemic of scarlet fever and strep throat in the Hautes-Alpes and Bouches-du-Rhône. Streptococcal A strep throat occurs especially in cold weather such as Winter and at springwhich can epidemically affect communities such as schools.
Angina is an inflammation of the tonsils or even the entire pharynx in the throat. It is most often due to a virus, we then speak of angina “viral“. More rarely, it is caused by a bacterium, it is then “bacterial“. Among the bacteria responsible for angina, streptococci. There are many bacteria of the genus Streptococcus of which the Streptococcus pyogenes Where “Streptococcus A“.”Its habitat is the back of the throat, therefore the pharynx, and it has a rich pathogenic power“ explained to us the infectiologist Stéphane Gayet in a previous article. “Streptococci A secrete many toxic substances” reminded the Institute of Health Surveillance. Group A streptococcal (GAS) infections can manifest themselves in several forms, skin or ENT infections including erythematous angina (or “red angina”)the scarlet fever (angina with rash and raspberry tongue) and more rarely in the form of invasive infections. Infections are the more often benign but can degenerate into a serious infection.
“In children, about a third of anginas are due to group A streptococcus (SGA)” explain the French Society of Pediatrics. The SGA is considered “rare” before the age of 3 in the same way “post-streptococcal complications are exceptional”. It is therefore not systematically sought. In 2018, a study association of Dr Nicolas Nodet seeking to assess the prevalence of strep throat in children from 12 to 35 months showed that streptococcus A was responsible for 26% of acute angina of these children. For the doctor, the bacterium is not so rare and the generalization of the test diagnostic “would better manage the symptoms and pain of many children, while effectively preventing the occurrence of complications loco-regional”. In children, screening is currently recommended between the ages of 3 and 15.
Strep A strep throat is rarer in adults. It would represent 10 to 25% of angina. In adults, a Mac Isaac’s clinical score < 2 has a negative predictive value > 95% to eliminate the streptococcal origin of angina.
Strep A strep throat starts abruptly and is manifested by:
In children, no clinical sign or score has sufficient positive or negative predictive value to determine the streptococcal origin of angina. The doctor must carry out a rapid screening test (RDT) dedicated to angina to confirm streptococcal A angina. Today this test is not indicated for children under 3 years of age.
In the event of a positive test for group A strep throat, the doctor will prescribe antibiotics (amoxicillin is recommended by the High Authority of Health).
Group A strep throat may be responsible for complications rare but serious. Among them: the acute articular rheumatism (AAR, inflammatory disease which results in polyarthritis of the large joints (knees, elbows) and a high fever with possible heart damage)the acute glomerulonephritis (kidney infection) and Sydenham’s chorea (neurological damage).
Epidemic of scarlet fever and strep throat Hautes-Alpes and Bouches-du-Rhône, 2007. Health monitoring institute.
Angina, Marseille University Hospitals, AP-HM
Streptatest, BioSynex, URPS Pharmacists.
Prevalence of strep throat in children aged 12 to 35 months in pediatric emergencies: intermediate results of the Pasteur Nicolas Nodet study. OpenScience. 2018
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