Streptococcal infections are a type of bacteria caused by different species of Streptococcus. These bacterial strains thrive in the human body and can cause a wide range of illnesses, from minor to severe. Although streptococcal infections typically affect young children, anyone can get sick from these infections through breathing in bacteria that are exhaled into the air following a cough or sneeze of an infected person.¹

Based on their characteristics, streptococcal bacteria are categorised into groups. One popular classification is the Lancefield grouping system, which allocates letters such as Group A, B, C, and so on.² There are certain species and strains associated with each group that can result in a range of diseases. It is therefore important to detect streptococcal infections as early as possible to distinguish between these classifications and ensure an accurate diagnosis, appropriate treatment plan and prevention of long-term complications. 

Common early warning signs

It can be difficult to tell when your child is seriously unwell. However, as parents or guardians, trusting your instincts is the most important action you can take to ensure a swift diagnosis. Streptococcal infections tends to have symptoms that are “flu-like” including:

• Sore Throat: The throat is red and swollen (also referred to strep throat)
• Fever: A sudden fever of 38°C or more with associated body chills and/or aches
• Swollen Lymph Nodes: The lymph nodes around the neck are larger and tender 
• Redness or White Patches on Tonsils³

What are the other symptoms?

Headache and nausea

Alongside the common symptoms, some children may experience light headaches, as well as abdominal pain, feeling sick and vomiting.

Scarlet fever

Scarlet fever is described as a red sandpaper-like rash, which looks like a sunburn. It starts on the chest and stomach, and propagates throughout the body in red lines. This is often accompanied with a flushed face.⁴

Difficulty breathing or swallowing

One of the most typical signs of streptococcal infections, especially Group A strep throat, is a sore throat. Swallowing may become challenging due to soreness and scratchiness in the throat. The discomfort could range from mild to severe, sometimes with difficulty in breathing. 

If your child has trouble breathing, seek urgent medical attention. 

Ear pain

An ear infection can occasionally be brought on by bacteria from a streptococcal infection that enters the middle ear and eustachian tubes. This condition is referred to as acute otitis media, and causes ear pain in some individuals. In most cases, the individual will get better without the need for antibiotics.⁵

When to seek medical attention

You should see a doctor if your child has:

• A high fever for longer than two days, together with an earache or painful throat
• Your child’s condition is getting worse
• Your child is not eating or drinking as much as they usually would
• Your child is not urinating as much or has fewer wet nappies than normal
• Your child looks dehydrated 
• Your child is very agitated or tired

Call 999 or go to A&E if:

• Your child is having trouble breathing 
• There are pauses when your child breathes
• Your child’s skin, tongue or lips turn blue or grey 
• Your child is floppy, or has trouble waking up or staying awake⁶

Potential complications from a delayed diagnosis

Considering that streptococcal infections are easily treatable with antibiotics, incomplete treatment, delayed diagnosis or untreated infections may result in severe complications due to an abnormal immune response. This can lead to severe consequences, which may be life-threatening in certain individuals. 

Rheumatic fever

Rheumatic fever is a rare inflammatory condition which develops when strep throat or scarlet fever is not fully treated. It is caused by the Group A Streptococcus (GAS) infections, affecting multiple organ systems, including the brain, heart, and the muscles. Your child's immune system may target its own tissues if these illnesses are not treated, resulting in swelling and inflammation that could harm these specific organs.

Untreated rheumatic fever can also lead to long-term cardiac problems, including heart failure and heart valve complications. This condition can develop into chronic rheumatic heart disease, which is responsible for more than 275,000 fatalities worldwide.⁷

Some symptoms include: 

• Fever
• Joint discomfort or swelling (affecting the knees or arms)
• Pain in one joint, spreading to another
• Chest pain
• Fatigue
• Small lumps under the skin

Rheumatic fever patients often require lifetime medical care in order to maintain their health.

In terms of neurological complications, Sydenham chorea is a movement disorder that some individuals with rheumatic fever experience. It commonly affects children between the ages of 5 to 15 years.

The symptoms and signs include:

• Uncontrollably jerky motions of the body, usually affecting the hands, feet, and face
• Crying or inappropriate laughter fits
• Muscle weakness
• Not being able to speak clearly

Most children are able to make a full recovery between 3 to 6 months.⁸

Post-streptococcal glomerulonephritis

Post-streptococcal glomerulonephritis (PSGN), also referred to as acute proliferative glomerulonephritis, is a condition where the kidneys deteriorate following a streptococcal infection. Small blood vessels in the kidney and the glomeruli (which filter waste) are impacted by this condition. Children between the ages of 6 to 10 years commonly have PSGN one to two weeks following a sore throat or six weeks following an impetigo skin infection.

Some possible symptoms are:

• Reduced production of urine
• Oedema in several parts of the body
• Blood in the urine
• Joint discomfort 
• Joint stiffness or swelling⁹

Hypertension and other kidney-related issues may result, which can impair kidney function.

Spread of infection

When the bacteria enters organs like the blood, muscles, or lungs – where it is not typically present – invasive GAS illness develops.

Two of the most severe types of invasive GAS disease are: 

• Necrotising fasciitis, a deep tissue infection that causes tissue destruction and requires emergency surgery
• Streptococcal toxic shock syndrome, where bacteria flows through the bloodstream

Severe infection may be associated with:

• High fever
• Low blood pressure
• A rash similar to scarlet fever
• Vomiting and diarrhoea
• Breathing difficulties
• Damage to the liver or kidneys
• Problems with blood clotting¹⁰

Summary

A range of illnesses, from a sore throat to life-threatening infections, can be caused by streptococcal infections (bacteria belonging to the Streptococcus group). It is important to diagnose this infection as early as possible, to ensure prompt diagnosis and treatment, and to prevent long-term complications. In children, early signs to look out for are flu-like symptoms, such as a high temperature and a sore throat. Although these syndromes can be treated with antibiotics, streptococcal infections can be serious if they are neglected and can ultimately lead to the development of rheumatic fever, spreading of infection, and kidney problems (glomerulonephritis). If you are concerned about your child, seek early medical attention.