Invasive Group A Streptococcus (Necrotizing Fasciitis)

About This Disease

Group A Streptococcus is a bacterium often found in the throat or on the skin. People may carry GAS bacteria and have no symptoms of illness. Most GAS infections are relatively mild illnesses such as “strep throat,” or impetigo. On rare occasions, these bacteria can cause other severe and even life-threatening diseases such as septicemia and necrotizing fasciitis.

Signs and Symptoms

Early signs and symptoms of NF are fever, severe pain and swelling, and occasionally redness at the wound site. Any wound that becomes very painful, swollen, or red requires immediate medical attention.

The symptoms of STSS are fever, vomiting, diarrhea, muscle aches and rash. As the name suggests, STSS can cause shock, which can be life threatening.


These bacteria are spread through direct contact with droplets from the nose or throat of persons who are infected or through contact with infected sores on the skin. It is not likely that household items like plates, cups, or toys spread these bacteria.

Invasive GAS disease occurs when the bacteria invade blood, or deeper tissues that are normally bacteria free. The most severe forms of invasive GAS are necrotizing fasciitis (NF), also called “flesh-eating bacteria, and Streptococcal Toxic Shock Syndrome (STSS).


Diagnosis of Groups A streptococcal infections is made by a physician who collects appropriate clinical specimens and has them culture in a clinical laboratory.


A doctor can prescribe medications to treat GAS infections. In severe NF cases, surgery may be needed to remove damaged tissue. For STSS, the symptoms of shock must be treated, which may require hospitalization.

Risk in Hawaii

Group A streptococcus are ubiquitous bacteria; they occur all over the world. Few people who come in contact with GAS will develop serious invasive infections. While healthy people can become infected, people with chronic illnesses like cancer, diabetes, and kidney dialysis, and those who use medications such as steroids have a higher risk.


The risk for all types of GAS infection can be reduced by good hand washing, especially after coughing and sneezing and before preparing foods or eating. All wounds should be kept clean and watched for possible signs of infection such as redness, swelling, drainage, and pain at the wound site. A person with signs of an infected wound, especially if fever occurs, should seek medical care. It is not necessary for all persons exposed to someone with NF or STSS to receive antibiotic therapy to prevent infection.