The reemergence of Streptococcus pyogenes in skin and soft tissue infections: a review of epidemiology, pathogenesis, and management strategies.

PURPOSE OF REVIEW: To discuss skin and soft tissue infections (SSTIs) caused by group A Streptococcus (GAS) by focusing on their pathogenesis, clinical manifestations, and management strategies.

RECENT FINDINGS: GAS is responsible for a wide range of infections from mild disease to severe fatal invasive infections with high mortality rates. Invasive GAS (iGAS) infections affect both young and old individuals and account for 1.8 million cases worldwide, with a mortality rate of up to 20%. In addition, conditions resulting by immune responses triggered by GAS also contribute to GAS-associated morbidity, and should not be overlooked. GAS has the ability to produce a wide set of virulence factors which contribute to its pathogenicity and its ability to colonize different body site and subsequently cause invasive infections. Management of SSTIs caused by GAS is challenging due to the risk of rapid progression and the risk of developing complications.

SUMMARY: During the COVID-19 pandemic, a relevant increase in iGAS infections has been registered. A constantly updated knowledge of the clinical presentation of iGAS infections is thus necessary to reduce their high mortality rates. Proper recognition and treatment of iGAS infections remain crucial.