Group A Streptococcus: A Re-Emerging Pathogen? Two Autopsy Cases of Deadly Infections in Previously Undiagnosed Young Adult Males

Streptococcus pyogenes [group A strep (GAS)] is not a novel pathogen, but it is a newly emerging deadly threat. Recent data suggests that GAS, like many other contagions, saw a rise in infections in 2022, likely due to the withdrawal of COVID-19 precautions. GAS can present as a localized infection, namely tonsillopharyngitis, impetigo, cellulitis, and scarlet fever, or as an invasive infection such as meningitis, pneumonia, necrotizing fasciitis, and puerperal sepsis. Even though GAS tonsillopharyngitis is not typically fatal, it can be complicated by acute rheumatic fever if antibiotics are not administered promptly. Though the prevalence of acute rheumatic fever (ARF) and its sequelae, rheumatic heart disease (RHD), has declined over the last half-century in Europe and North America, ARF and RHD both remain some of the most significant contributors to cardiovascular morbidity and mortality among socially and economically disadvantaged populations globally. Here we present 2 cases of fatal invasive GAS infections in previously healthy young adult males, with diagnoses made postmortem due to a lack of clinical recognition prior to death.