State transitions across the Strep A disease spectrum: scoping review and evidence gaps

Abstract

Abstract The spectrum of disease caused by Streptococcus pyogenes (Strep A) ranges from superficial to serious life-threatening invasive infections. We conducted a scoping review of published articles between 1980 and 2021 to synthesize evidence of state transitions across the Strep A disease spectrum. We identified 175 articles reporting 262 distinct GAS disease state transitions. Transition in the invasive and toxin-mediated disease category was highest (46%), while it was lowest (2.8%) in the locally invasive category. Transitions from well to any other state was most frequently reported (49%) whereas a relatively higher number of studies (n=71) reported transition from invasive disease to death. Transitions from any disease state to locally invasive, GAS Pharyngitis to invasive disease, and chronic kidney disease to death were lacking. Transitions related to severe invasive diseases were more frequently reported than superficial ones. Most evidence originated from high-income countries and there is a critical need for new studies in low- and middle-income countries to infer the state transitions across the Strep A disease spectrum in these high-burden settings.