Streptococcus group A infection (invasive) (Streptococcus pyogenes (blood, CSF or other normally sterile site))

Clinical criteria
Streptococcus group A infection (invasive) comprises three clinical syndromes:

a) Streptococcal Toxic Shock Syndrome (STSS), which is characterised by hypotension (fifth percentile of systolic blood pressure in children, or <90mmHg systolic pressure in adolescents and adults) and two or more of the following:

a. Renal impairment (creatinine greater than twice upper limit of normal for age)

b. Coagulopathy (platelets <100,000x106/L or evidence of disseminated intravascular coagulation)

c. Liver dysfunction (ALT, AST or bilirubin more than twice upper
Limit of normal for age)

d. Adult respiratory distress syndrome (puLmonary infiLtrates and hypoxaemia without cardiac failure or generalised oedema)

e. Generalised erythematous rash that may desquamate

f. Soft tissue necrosis (necrotising fasciitis, myositis, gangrene)

b) Necrotising fasciitis

c) Sepsis syndrome, or systemic inflammatory response syndrome, with or without an identifiable focus of infection (such as meningitis, pneumonia, cellulitis, peritonitis, puerperal sepsis, septic arthritis, myositis)

Laboratory criteria

  • Laboratory criteria for a confirmed case
    • Isolation of group A streptococcus, or detection of group A streptococcus nucleic acid, from a normally sterile site (blood, cerebrospinal fluid, pleural fluid, peritoneal fluid, pericardial fluid, joint aspirate, bone, or deep tissue or abscess at operation)
  • Laboratory criteria for a probable case (STSS or necrotising fasciitis only)
    • Isolation of group A streptococcus from a non-sterile site (e.g. throat, sputum, vagina)
  • Laboratory criteria for a possible case (STSS or necrotising fasciitis only)
    • Serological evidence of recent group A streptococcal infection
    • Presence of streptococci on Gram stain of tissue or pus (necrotising fasciitis only)

Epidemiological criteria
NA

Case classification
A. Possible case
Any person meeting the clinical criteria for STSS, or with necrotising fasciitis, and the laboratory criteria for a possible case
B. Probable case
Any person meeting the clinical criteria for STSS, or with necrotising fasciitis, and the laboratory criteria for a probable case
C. Confirmed case
Any person meeting the laboratory criteria for a confirmed case

Current as of: 28 May 2018