County of Los Angeles
Department of Public Health
Acute Communicable Disease Control
313 N. Figueroa Street, #212
Los Angeles, CA 90012
Phone: (213) 240-7941
Fax: (213) 482-4856
Email:acdc2@ph.lacounty.gov
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Acute Communicable Disease Control
Streptococcal Infections, Group A (IGAS) and Toxic Shock Syndrome (STSS)
Invasive Group A Streptococcal (IGAS) disease is caused by the group A beta-hemolytic Streptococcus
pyogenes bacterium. Transmission is by direct or, rarely, indirect contact. Illness manifests as
various overlapping clinical syndromes including bacteremia without focus, sepsis, cutaneous wound
or deep soft-tissue infection, septic arthritis, and pneumonia. It is the most common cause of
necrotizing fasciitis, commonly known as “flesh eating bacteria.” IGAS occurs in all age groups
but more frequently among the very old. Infection can result in severe illness, including death.
Streptococcal toxic shock syndrome (STSS) is a rare but extremely severe illness characterized
by rapid onset of hypotension (low blood pressure) and shock. Other symptoms can include renal
(kidney) impairment, coagulopathy (abnormality in the blood's ability to clot), adult acute
respiratory distress syndrome, rash and local tissue destruction. Death occurs in up to 70% of
people who develop streptococcal toxic shock syndrome.
For surveillance purposes in LAC, IGAS is defined as isolation of S. pyogenes from a normally
sterile body site (e.g., blood, cerebrospinal fluid, synovial fluid, or from tissue collected
during surgical procedures). Isolation can include a non-sterile site if associated with STSS
or necrotizing fasciitis (NF). IGAS cases are characterized as STSS if the diagnosis fulfills
the CDC or Council of State and Territorial Epidemiologists (CSTE) case definitions for this
syndrome; and as NF if the diagnosis was made by the treating physician.
Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.