[Infection with group A Streptococcus]

In the last 8-10 years, the prevalence of severe group A streptococcus (GAS) infections such as bacteremia, erysipelas, necrotizing fasciitis and puerperal fever has increased significantly in industrialized countries. Shock, acute respiratory distress syndrome and multiorgan failure have been common features, and the attributable mortality has been as high as 30 per cent. The majority of infections have occurred in otherwise healthy adolescents and adults, and the GAS strains have been predominantly M types 1 and 3, which produce pyrogenic exotoxins, indicating an increased virulence of these strains. The article reports on the prevalence, pathogenesis, clinical features and treatment of severe GAS infections.