Strep A: what is Strep pneumonia and why are cases rising?

What is strep pneumonia?

Group A streptococcus (GAS) are a type of bacteria often found in the throat and on the skin. GAS infections commonly cause sore throats or scarlet fever, which can be treated with antibiotics. However, invasive Group A strep - which occurs if these bacteria get into the bloodstream or other areas where they shouldn't be such as the muscles or lungs - it can cause serious illnesses such as pneumonia, meningitis and sepsis.

Bacterial pneumonia is swelling of the tissue in one or both lungs, caused by bacterial infection. If you have pneumonia, the clusters of tiny air sacs at the end of the breathing tubes in your lungs become filled with fluid.

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Aspiration pneumonia

Aspiration pneumonia is a lower respiratory tract (chest) infection caused by bacteria which have leaked into the lungs from fluid from the stomach or mouth. This can be as a result of vomiting or an inability to swallow properly. It causes symptoms of a lower respiratory tract infection (cough, fever, shortness of breath) and is usually treated with antibiotics.

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What are the symptoms of strep pneumonia?

The symptoms of bacterial pneumonia include a cough that produces green, yellow, or bloody mucus, high temperature, heavy sweating, loss of appetite, low energy and exhaustion, rapid breathing and pulse and chills. If there is not enough oxygen going around your body, your lips and nails may become blue. This is a medical emergency.

You may also experience sharp stabbing chest pains that get worse with deep breathing or coughing, or shortness of breath.

Invasive Group A strep

The signs and symptoms of invasive Group A strep can include a high fever, severe muscle aches, localised muscle tenderness or redness at the site of a wound - depending on the type of pneumococcal infection.

Urgent, early medical help is essential for iGAS. People rapidly become unwell between 12 and 24 hours after being infected. It is usually treated with antibiotics such as penicillin. However, how it is treated can depend on the severity of the illness and the complications such as a weakened immune system.

The UK Health Security Agency advises you to contact NHS 111 or your doctor if your child seems unwell and is getting worse. It's also important to seek medical help if your child is feeding or eating much less than normal, has had a dry nappy for 12 hours or more, or if your baby has a temperature of 38°C or higher.

How common is strep pneumonia?

In the UK, around 40,000 people a year are hospitalised with pneumonia caused by the strep A bacterium. Even with the use of antibiotics, pneumonia still causes death in up to 20% of cases. Worldwide, pneumonia is the leading cause of death in children¹.

Why has there been a spike in cases of strep pneumonia?

Although Group A strep infections are common in children, invasive Group A strep is rare. However, the lifting of COVID-19 restrictions means there are now a higher number of community-acquired pneumonia cases.

Dr Elizabeth Whittaker, honorary clinical senior lecturer at Imperial College London, says when there are high numbers of pneumonia infections, severe cases will also occur."

We are seeing more pneumonia than usual, most likely as Group A strep infections are coinciding with the peak in winter respiratory viruses which are typical for this time of year," she explains. "Severe invasive Group A strep is rare, but parents need to be aware when and how to seek medical attention."

How is strep pneumonia treated?

Antibiotics are used to treat bacterial pneumonia. Complications of pneumonia are more common in young children, the elderly and people with pre-existing health conditions. These complications can include pleurisy - where the linings between your lungs and ribcage become inflamed - lung abscesses, and blood poisoning.

Further reading

1. Oxford Vaccine Group: Pneumococcal disease.