Confirmed case of invasive Group A Streptococcal Infection in Chapleau

Advisory Alert

February 1, 2015

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Dear Chapleau Area Colleagues:

Re: Confirmed Case of Invasive Group A Streptococcal Infection in Chapleau

I am writing today to inform you of a confirmed case of invasive Group A Streptococcal (iGAS) infection occurring in a resident of the Chapleau area. All close contacts have been provided with appropriate chemoprophylaxis in accordance with provincial guidelines. There is no concern of community risk, however, as you know, iGAS can cause anxiety and concern. It is in this context that I am sending this Advisory Alert and that I will be communicating with the school community in which the case occurred.

Please be advised that there are no specific recommendations at this time, however, as a precautionary measure, I am advising the school community to watch for signs and symptoms of GAS infections over the next two weeks.

This advisory alert provides information on the clinical management of suspected iGAS cases including laboratory testing and treatment recommendations.

Etiology and Epidemiology

Group A Streptococcal (iGAS) disease is caused by the gram-positive beta-hemolytic bacterium Streptococcus pyogenes (S. pyogenes). S. pyogenes may colonize the throat of individuals (carriers) without symptoms and may be passed from person to person through:

• Droplet spread when an infected individual coughs or sneezes
• Direct or indirect contact of oral or nasal mucous membranes or non-intact skin with infectious respiratory secretions or exudates from wounds or skin lesions
• Sharing of contaminated needles

The incubation period ranges from 1 to 3 days. In untreated uncomplicated cases the period of communicability ranges from 10 to 21 days, however untreated skin conditions with purulent discharges can remain infectious for weeks or months. Persons with untreated streptococcal pharyngitis may carry the organism for weeks or months, but infectivity decreases in 2 to 3 weeks after onset of infection. With adequate treatment, transmissibility generally ends within 24 hours.

The risk of invasive disease is associated with several underlying chronic conditions including HIV infection, cancer, heart disease, diabetes or lung disease. Factors that appear to increase the risk for invasive disease include Varicella infection, alcohol abuse and age (˂ 1 year or ˃ 65 years). Persons in institutions and pregnant women also appear to be at higher risk.

Over the last four years, reported cases of iGAS have ranged from 13 to 23 in the SDHU area. The SDHU catchment area includes the districts of Sudbury and Manitoulin and the City of Greater Sudbury.

Clinical Presentation

Group A Streptococcus causes a wide variety of disease in humans. It is the most common cause of acute pharyngitis and infections of the upper respiratory tract and the skin. It can also cause a wide variety of invasive systemic infections. The most common clinical presentations for invasive group A streptococci are skin or soft tissue infections (cellulitis), bacteremia with no septic focus, pneumonia, streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF).

Laboratory Testing

For the purpose of heightened surveillance for GAS infection, please collect specimens on persons presenting to you with symptoms suggestion of infection. Swabs of the nose or throat can be collected and placed in Amies charcoal transport medium (GC kit). Include on the requisition information pertaining to symptoms and onset date. The most current guidelines for laboratory testing can be found on the Public Health Ontario website.

Treatment

Treatment recommendations are dependent upon site of infection and are outlined in the current version of the Anti-infective Guidelines for Community-acquired Infections.

Reporting

Under the Health Protection and Promotion Act, both suspected and confirmed cases of iGAS must be reported to the Medical Officer of Health.

For all reporting, inquiries or comments, please contact:
Sudbury & District Health Unit at 705.522.9200, ext. 301.

Please contact my office should you have any questions or comments.

Sincerely,
Dr. Penny Sutcliffe,
Medical Officer of Health

This item was last modified on September 9, 2016