Alok Patel, MD, discusses the new invasive strep A strain


Alok Patel, MD, shares what pediatric health care providers should know about a concerning new strain of group A streptococcus.

Alok Patel, MD, is a pediatric hospitalist and clinical assistant professor of Pediatrics at Stanford Medicine Children's Health in Palo Alto, California. Here he discusses a potentially serious new strain of group A streptococcus, its presentations, and what health care providers should do right now to manage this illness.

Transcript (edited for clarity):
Dr. Patel, thank you so much for joining us today. Let's just get right into it. There's a new, apparently serious invasive strain of strep A that was first noticed by the CDC in Colorado last month. Since then more states are reporting it and it looks like it's getting pretty scary. What can you tell us about this new strain?

Simply put, group A strep is a very common bacteria: we see millions of infections related to group A strep every single year, parents have heard of things like strep throat, skin infections. This is all group A strep. What is concerning, what is dangerous, potentially life threatening is when the bacteria moves from a place it normally is like your throat into a place it shouldn't be, like the blood deep muscles and your lungs. This is the transition from group A strep to invasive group A strep. And for parents out there who are seeing these headlines and freaking out, I totally get it. I'm also a parent. And what people want to be on the lookout for are infections or sicknesses that look particularly bad and worse than a common cold. Because invasive group A strep, when this bacteria is in a child's bloodstream, when it's causing something like necrotizing fasciitis, fancy term for flesh eating bacteria, when it actually causes rheumatic fever, scarlet fever, kids are going to look really sick. I'm talking really high fevers, muscle aches that are keeping kids up at night, warm, tender rashes on their body tender joints. These symptoms, this constellation should warn a parent to go and call a doctor immediately and not delay. We are also telling parents right now there is absolutely treatment for invasive group A strep in the form of antibiotics. But the most important thing is to not have a delay in care.

That makes total sense. Is there any relationship to this and what we've been hearing so much in the press about the triple endemic RSV and COVID and influenza. How does this connect with what's been talked about in those illnesses?

Several infectious disease experts in public health theorize that the rise of invasive group A strep right now is possibly related to what we're seeing with respiratory viruses. Because when anyone has a severe infection from a respiratory virus, whether it is RSV, COVID-19, or influenza, this makes the host, us, more susceptible to bacterial infections. This is why when parents look at the bottle of Tylenol or ibuprofen, it says contact a doctor after a certain amount of days of fever. This is because we worry about viral infections like influenza, RSV, or all the other cold viruses transitioning to bacterial. So this is one thought right now is it the fact that so many people out there are getting sick. This is why we're seeing a rise in invasive group A strep, but it's too early to kind of pinpoint what exactly is causing it.

So on top of all this, there have been reported shortages of over the counter medicines. Is this something that both parents and pediatricians need to worry about? Will this be addressed soon, do you think?

I think the concomitant shortage of basic antibiotics medications like amoxicillin, especially the oral suspension of amoxicillin that we give to young patients with these headlines about invasive group A strep is concerning because any pediatrician out there knows that amoxicillin is a frontline antibiotic to treat infections that are commonly caused by group A strep. It's really important that we have these. To open conversations with families, we help them find the medications, wherever they live, whatever pharmacy they're using, because what we don't want to see is a delay in care, because a family is scrambling to find a med, or because all of a sudden it's 6 pm, and the pharmacy next to them is closed. So what myself and a lot of my colleagues have been doing in the hospital setting is just making sure that that script is filled, and the family can access it before they get back to wherever they're going before they're traveling, wherever it may be, because we want to prevent those delays in care: even a delay in something like strep throat could be potentially serious if it transitions over and becomes invasive group A strep, and we can prevent it all with antibiotics. Right? It's also important that we educate our families about the difference between bacterial infections and viral infections. We've all had those patients who are a little bit resistant towards antibiotics and say, can I just get better on my own, and we're able to have that conversation, if we suspect it's a viral etiology for an illness. But if it's bacterial, it's super important to tell our families, this antibiotic is absolutely necessary. You have to take it, you have to take it for the full duration and not delay.

Right. So finally, what are the key takeaways would you say for pediatric health care providers who thinks they might be seeing this in their patients? What are the top things you suggest they do?

No physician out there is going to be surprised at a group A strep infection, but I think it's important for all of us just to revisit some of the signs and symptoms of invasive group A strep. I work as a hospitalist. I see kids with infections literally on a regular basis. And I myself just revisited some of the literature about scarlet fever, post strep glomerulonephritis, toxic shock syndrome, necrotizing fasciitis, just to make sure it's on my radar. And it's important that we give parents, we give patients, everyone out there, good preventive information about signs and symptoms to look out for: what to do if their children all of a sudden have a tender joint, or a really high fever or just appear slightly more sick than a routine cold. And we educate families about not delaying seeking medical care. We're kind of in this duality right now about telling people to avoid the ER or urgent care unless it's an emergency because hospitals are overrun, but then also telling parents, hey, don't delay. So I think we can find that happy medium right there and just tell parents, if there's any doubt, just call a doctor or clinic jump on a telehealth visit, because that small intervention could mean the difference between inpatient care for a child who has invasive group A strep and an outpatient antibiotic and everyone can have a happy holiday and be healthy.

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