Invasive Group A Streptococcal Infections

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Abstract
Davies et al. (Aug. 22 issue)1 identify an annual incidence of 1.5 cases of invasive group A streptococcal disease in Ontario, Canada, in 1992 and 1993. The mortality rate was 15 percent. This prospective study relies on identifications from hospital microbiology laboratories and from Ontario's largest private laboratory service. These statistics may be misleading; the real incidence is probably much higher and the mortality rate much lower. The problem is that most patients with invasive streptococcal infection will present to the family practitioner or community pediatrician with uncomplicated superficial cellulitis, erysipelas,2 or perianal cellulitis.3 Occasionally, blood cultures will be taken, but more often than not empirical treatment with antibiotics will be undertaken, resulting in an uncomplicated resolution of the infection. It would not be surprising if a substantial number of uncomplicated invasive group A streptococcal infections escape detection.