Queensland has recently seen an increase in serious infections caused by invasive group A Streptococcus (iGAS) following similar reports elsewhere in Australia, some European countries, and the UK.
The rise has prompted Queensland Health’s Communicable Diseases Branch (CDB) to issue a public health communique, alerting clinicians to the signs and symptoms of sepsis.
Group A Streptococcus can be a common infection causing mild illnesses such as tonsillitis, pharyngitis, impetigo and scarlet fever However iGAS can cause life-threatening conditions such as necrotizing fasciitis and sepsis including streptococcal toxic shock syndrome.
iGAS, and other serious infectious diseases such as meningococcal disease and invasive pneumococcal disease (IPD), are notifiable conditions in Queensland and are closely monitored by CDB.
The overall risk to the general population is low but some cohorts may be more at risk of severe invasive infection. These include Aboriginal and Torres Strait Islander people, the immunocompromised, people with a chronic disease, people who smoke, those institutionalised or living in overcrowded conditions, and the very young and very old.
There is also additional risk with iGAS for pregnant and post-partum women.
Signs and symptoms of sepsis in an adult include a patient with a suspected infection combined with any of the following:
- fever, chills, or low body temperature
- no or low urine output
- nausea, vomiting, or diarrhoea
- fatigue, confusion, or drowsiness
- a lot of pain or they ‘feel worse than ever’.
For paediatric patients, clinicians should consider sepsis in a child with suspected infection and any one of these signs and symptoms:
- parental concern
- a lot of unexplained pain or very restless
- cold extremities
- blotchy, blue, or pale skin or a non-blanching rash.
- altered behaviour such as drowsiness, confusion, irritability or floppiness
- working hard to breathe with tachypnoea and in infants: long pauses in breathing
- reduced urine output; fewer wet nappies than usual
- lactate >2.
Hypotension is also a late sign of sepsis in children.
Remember: trust your gut and just ask – could it be sepsis? Prompt recognition and management of sepsis saves lives.
For the management of suspected sepsis, clinicians should refer to the paediatric and adult sepsis pathways and urgently escalate concerns to a senior clinician for a prompt review. Treatment should involve blood culture sampling, early fluids and appropriate empiric antibiotics, as outlined in the antibiotic prescribing guidelines where these are included with the pathways.
To prevent invasive infection, patients should be encouraged to:
- Ensure they are up to date with vaccinations (IPD, meningococcal) where available and recommended in accordance with the Queensland Immunisation Schedule. Respiratory viral infections can be precursors to invasive bacterial infection, it is also important for patients, especially those most at risk, to be up to date with recommended vaccinations and boosters to protect against COVID-19 and influenza.
- Exercise good hand and respiratory hygiene and to stay home if they are sick.
- Optimise their management of any chronic medical conditions and quit smoking.