Recent Epidemiology of Group A Streptococcal Infections in North America and Abroad: An Overview

Abstract

Feared for centuries as a major cause of infection-associated morbidity and mortality among infants, children, and adults, infections caused by the Group A beta-hemolytic streptococcus (Streptococcus pyogenes) and the associated public health problems declined remarkably by the close of the decade of the 1960s. Rather than hospitals being filled with children and adults with rheumatic heart disease or with suppurative sequelae such as mastoiditis, serious Group A streptococcal infections and their sequelae declined to the point where they have almost been considered a "nuisance". There have been relatively rare instances of surgical infections and there have been infrequent epidemics of pharyngitis. However, in North America, Europe, and most of the industrialized countries of Asia, epidemics of serious Group A infections and their sequelae essentially are unheard of. These infections and their suppurative and nonsuppurative sequelae have been much more of a medical and public health problem in many of the developing countries of the world, where few significant changes in their epidemiologic patterns have been evident. The primary manifestations of Group A streptococcal infections have been pharyngitis and superficial skin infections (impetigo) for most industrialized countries. During the past 10 years, however, this has changed remarkably. Serious Group A infections and their suppurative and nonsuppurative sequelae have re-emerged as significant problems for physicians and for public health authorities. For example, mortality has been greater than 30% in some reported series. This fact has placed increasing pressure on primary care physicians to appropriately diagnose and treat these infections. Understanding the epidemiology can beneficially impact patient care and public health policies.