Cases from aggressive strains of strep, which spiked among children worldwide last fall, seem to be leveling out in Tarrant County, said Dr. Nicholas Rister, an infectious diseases physician with Cook Children’s Health Care System. 

The uptick mirrored a surge in respiratory viruses that cause the flu, COVID-19 and RSV, along with a dearth in amoxicillin, an antibiotic commonly used to treat strep. 

Formally called invasive group A strep, the bacterial infection is a progressive form of strep that infects parts of the body that are normally free from germs. While a typical strep infection might cause a sore throat or scarlet fever, invasive strep can lead to life-threatening illnesses like sepsis, streptococcal toxic shock syndrome or flesh-eating disease

What is strep throat?

Strep throat is an infection from a bacteria called group A streptococcus, or strep. The bacteria is highly contagious — people pass it along via respiratory droplets or direct contact. Common symptoms include fever, sore throat and swollen lymph nodes.

Source: U.S. Centers for Disease Control and Prevention

In a normal year, Rister said he sees one severe case every few months. The pandemic offered a reprieve, but as COVID-19 restrictions eased and respiratory viruses circulated freely, Cook Children’s started seeing at least one case a month. “These are still rare,” Rister remembers thinking, “But they’re alarming.”

Strep bacteria are common and highly contagious. Often, they live in the nose and throat without causing illness, he said. But COVID-19, the flu and other diseases offer a doorway, allowing the strep bacteria to infect a person’s tissues.

Although the worst seems to have passed, Rister encourages parents of sick children to keep an eye out for more severe symptoms, like an inability to swallow or difficulty moving the neck. Early signs of flesh-eating disease include an area of skin that’s red, warm or swollen and spreads quickly. Severe pain may accompany the site and beyond. These warrant immediate medical attention, he said. 

A course of antibiotics like amoxicillin typically stave off these more serious infections. While Rister and his colleagues struggled to access the drug in some forms last fall, he said, strep responds to a variety of antibiotics and no one went without treatment. Their supply is growing again, he said.

Routine vaccines for COVID-19 and flu, even chicken pox, can help prevent not only those diseases but also strep, because of the latter’s tendency to “piggyback,” Rister said. 

He doesn’t want parents and other caregivers to lose sleep over invasive strep. Still, he said, he wants them empowered to know the signs.

 “Strep is a common disease that can have some very serious outcomes,” he said.

Alexis Allison is the health reporter at the Fort Worth Report. Contact her at or via Twitter.

Her position is supported by a grant from Texas Health Resources. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.

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Alexis AllisonHealth Reporter

Alexis Allison covers health for the Fort Worth Report. When she can, she'll slip in an illustration or two. Allison is a former high school English teacher and hopes her journalism is likewise educational....