Group A streptococcal (GAS) meningitis

On this page you’ll find an overview of meningitis caused by group A streptococcus bacteria, including symptoms, treatment and prevention.

  • Group A streptococcal (GAS) meningitis is a rare form of bacterial meningitis.
  • It’s a severe, potentially life-threatening infection that requires urgent treatment.
  • Most GAS infections are mild and cause things like sore throat, tonsilitis and scarlet fever. 
  • Some infections can be severe and life-threatening and these are known as invasive group A streptococcal (iGAS) disease. Less than 1% of invasive group A streptococcal (iGAS) disease will result in meningitis.
  • Currently, there’s no vaccine to prevent GAS meningitis.

What is group A streptococcal meningitis?

Group A streptococcal meningitis (GAS) is the swelling of the membranes, called meninges, that cover and protect the brain and spinal cord. The bacteria Streptococcus pyogenes cause group A streptococcal meningitis. Streptococcus pyogenes is also often referred to as group A streptococcus, group A strep or GAS.

GAS meningitis is a very serious condition and a high proportion of the people who are diagnosed with the disease sadly die.1

GAS meningitis occurs when GAS bacteria invade the body and enter the cerebrospinal fluid (CSF), which surrounds and cushions the brain and spinal cord. In the CSF, bacteria can rapidly multiply and release poisons, causing inflammation and swelling in the meninges. This increases pressure on the brain, producing symptoms of meningitis.

What are the symptoms of group A streptococcal meningitis?

The symptoms of GAS meningitis can progress rapidly. Early diagnosis and treatment will increase the chances of a full recovery.

Early symptoms of GAS meningitis can look like milder, more common infections.

Symptoms may include: 

  • Fever.
  • Vomiting.
  • Severe headache.
  • Stiff neck (less common in young children).
  • Dislike of bright lights.
  • Seizures (fits).
  • Confused / delirious.
  • Very sleepy / vacant /difficult to wake.

Symptoms in babies and very young children can be slightly different. Their symptoms may include: 

  • High temperature (warning: could be normal or low in babies under three months old).
  • Irritability.
  • Vomiting / refusing to feed.
  • A high-pitched cry.
  • A stiff body with jerky movements or else floppy and lifeless.
  • Very sleepy / staring expression / too sleepy to wake up.
  • Tense or bulging soft spot on the top of their head.

Not everyone with meningitis will get all these symptoms. 

GAS meningitis can occur with Streptococcal Toxic Shock Syndrome (STSS), which can be rapidly fatal.2 Early signs and symptoms of STSS include:

  • Fever.
  • Muscle aches.
  • Dizziness.
  • A raised skin rash that feels like sandpaper.
  • Flu-like symptoms.

People with GAS meningitis will get worse fast. Check regularly on someone who is unwell. Always trust your instincts and get medical help straight away if you or someone you know is seriously ill. 

Read more information about the symptoms of meningitis. 

How do you get group A streptococcal meningitis?

GAS bacteria can be found on the surface of the skin or inside the throat. Many people can carry the bacteria without any symptoms or illness. The bacteria are spread from person to person through coughing, sneezing or skin contact. Both people who are carrying GAS or who are unwell with a GAS infection can pass these bacteria on to others.

The bacteria that cause group A streptococcal meningitis are common, but they very rarely cause meningitis. Most GAS infections cause relatively mild illnesses (also known as non-invasive GAS) such as:

  • Sore throat (also known as strep throat).
  • Tonsillitis.
  • Scarlet fever.
  • Impetigo.
  • Cellulitis.
In rare cases, the bacteria move to other parts of your body, where they can cause serious and even life-threatening disease. These infections are called invasive group A streptococcal (iGAS) disease.

If the bacteria travel through the blood and invade the membranes and fluid surrounding the brain and spinal cord, it can cause meningitis. GAS meningitis remains rare and represents only 1%–4% of all invasive GAS cases detected worldwide.3,4,5,6,7,8

Other types of invasive disease caused by GAS include:

  • Sepsis (a life-threatening response to infection).
  • Pneumonia (infection of the lungs).
  • Puerperal sepsis (infection associated with childbirth).
  • Necrotising fasciitis (an infection of the deeper layers of skin more commonly known as flesh-eating disease).
  • Osteomyelitis (infection of the bone).
  • Streptococcal Toxic Shock Syndrome (STSS).

Who can get group A streptococcal meningitis?

Group A streptococcal meningitis can affect anyone. But there are some people that are at a higher risk than others. They include:

  • People who have recently had chicken pox (varicella infection).
  • People who have undergone surgery.
  • People who use non-steroidal anti-inflammatory drugs (NSAIDs).
  • People with medical conditions such as HIV, cardiac disease, cerebrospinal fluid leaks, diabetes, kidney disease or cancer.
  • Injecting drug users.
  • People with a recent head injury.

How is group A streptococcal meningitis treated?

GAS meningitis must always be treated urgently with antibiotics. 
 
Meningitis is a deadly disease that can progress very quickly and kill within hours. If you suspect that you have this disease you should seek immediate medical care. Prompt recognition and hospital treatment offer the best chance of a good recovery.

When you get to hospital the doctor may do a lumbar puncture (LP) to help diagnose meningitis. A lumbar puncture involves taking a sample of cerebrospinal fluid from the spinal canal (the space through the back bones which contains the spinal cord). A lumbar puncture is important to confirm the diagnosis of meningitis. It will also show which germ is causing the illness so doctors can choose the most appropriate treatment.

You may be given antibiotics intravenously (directly into the vein). Steroids may also be given to reduce swelling around the brain.

If you’re very unwell, you might be transferred to a special ward in the hospital where you can be regularly monitored by hospital staff. In the UK this is known as an Intensive Care Unit. Very severely ill patients may have a prolonged stay, for weeks or even months.

What are the after-effects of group A streptococcal meningitis?

With early treatment, many people with GAS meningitis will make a good recovery. But it can cause neurological damage and other serious after-effects.

After-effects that can be caused by GAS meningitis include:
 
  • Learning and intellectual disabilities such as memory loss, lack of concentration or issues with thinking and problem solving.
  • Clumsiness and co-ordination problems.
  • Headaches.
  • Deafness, hearing problems, tinnitus, dizziness or loss of balance.
  • Epilepsy or seizures.
  • Weakness, paralysis or spasms.
  • Loss of sight or vision problems.
  • Hydrocephalus (fluid on the brain).
  • Mental health issues and changes to personality or behaviour.
  • Difficulties with sleep.
  • Fatigue.
  • Anxiety and depression.
Woman in an office speaking on the phone

Physical and emotional recovery from meningitis and its impact can be different for everyone. Support is available if meningitis has affected you or someone you know.

If you are in the UK or Ireland, the Meningitis Research Foundation Support Services team are ready to answer your questions.

If you are outside the UK and Ireland, our member network is the Confederation of Meningitis Organisations (CoMO). CoMO is dedicated to reducing the impact of meningitis globally, with members across the world. It is a great resource for finding support where you live.

Find a CoMO member in your country.

Is there any follow-up care after recovery from group A streptococcal meningitis?

Ideally, you should be given information about what to expect during recovery before you leave the hospital. The follow-up care you receive will be different depending on where you are in the world, and the guidelines that your local doctors follow. You may have further treatment involving different teams of doctors and specialists.
 
In some countries (including the UK), doctors will arrange at least one follow-up appointment so they can check for longer-term after-effects. This is particularly important for children, as some long-term neurodevelopmental complications can't always be identified immediately after their illness.
 
Read more about the follow-up care after recovery from meningitis.

Can we prevent group A streptococcal meningitis?

Although it’s not possible to prevent group A streptococcal meningitis, there are things that may help to reduce the chance of developing the disease. This includes detection and early treatment of non-invasive GAS infections, such as throat and skin infections. This may help to prevent the development of invasive disease.

If you or your child have strep throat or another form of GAS infection, you should stay home from work, school or nursery for at least 24 hours after starting a course of antibiotics. This can help to prevent the spread of GAS bacteria and others becoming sick.

Practicing good hygiene is an important way to prevent spread and infection with GAS bacteria. This includes washing your hands, especially after coughing, sneezing and before preparing, eating or serving food. Wash, treat and cover breaks in the skin and wounds until they are healed.

Preventative antibiotics may be recommended for people exposed to GAS bacteria who are at a higher risk of developing iGAS disease. Antibiotics may also be given as a control measure to prevent the spread of infection if there has been an outbreak of GAS.

Can I get a vaccine to protect me against group A streptococcal meningitis?

There is currently no vaccine available to prevent against group A streptococcal meningitis.

Frequently asked questions about group A streptococcal meningitis

Why did many countries experience high rates of iGAS disease after the COVID-19 pandemic?

Higher than usual numbers of hospital admissions and deaths from invasive group A streptococcal disease were reported in several countries in Europe and some parts of the United States following the COVID-19 pandemic. The additional admissions mostly affected children under 10 years of age.9,10,11
 
It’s possible that during the pandemic, children were at home and not exposed to many respiratory viruses and as much GAS bacteria. Their immune systems then may not have been as good at fighting these infections when they started circulating again after COVID restrictions were lifted.
 
Co-infection with other viruses such as the one that causes chickenpox can also make people more susceptible to infection with GAS bacteria. This may have made the situation worse.
 
The spread of a new virulent strain of group A strep, called M1UK, may also have contributed to the high rates of iGAS after the COVID-19 pandemic. This potential connection is currently being studied.12

Am I at risk if I have been in contact with someone who has had an invasive GAS infection?

Contracting iGAS disease from a household member or close contact is very rare.
 
If you experience any symptoms of infection within 30 days of close contact with someone with GAS infection then contact your doctor. Symptoms might include sore throat, skin infection or fever. You may need antibiotics.
 
It’s also important to be aware of the symptoms of iGAS, which include:
 
  • High fever.
  • Severe muscle aches.
  • Localised muscle tenderness.
  • Increasing pain, swelling and redness at site of wound.
  • Unexplained diarrhoea or vomiting.
If you develop any of these symptoms, you should seek medical advice immediately. Tell the doctor that you’ve been in contact with someone recently diagnosed with iGAS disease, and that you have developed some symptoms that you’re worried about.
 
In the UK, cases of invasive GAS infection should be reported to a Public Health Doctor who will decide what needs to be done to protect the community. In most cases, close contacts of the person who had the illness won’t need to take preventative antibiotics. Doctors may prescribe antibiotics for close contacts if they’re pregnant (at least 37 weeks), elderly (75 years or older), have chickenpox, or are a newborn baby (under one month).13

What is the survival rate for group A streptococcal meningitis?

Estimates of the survival rate for group A streptococcal meningitis in adults vary. It was thought that there’s a only a low chance of death, between 5-10%, due to GAS meningitis.14,15 But a Danish study found that, although the incidence of meningitis caused by GAS is rare, there’s a much higher chance of (27%) chance of death due to the disease.16
 
It’s agreed that GAS meningitis in children is severe and sudden, with the chance of death estimated as high as 43%.17

Can other types of strep infection cause meningitis?

Yes, other types of Streptococcus bacteria can cause meningitis. The two most significant types of Streptococcus bacteria that can cause meningitis are:
 
  • Streptococcus pneumoniae (commonly known as pneumococcal bacteria). This is the most common cause of bacterial meningitis in some countries.
  • Streptococcus agalactiae (often referred to as Group B strep or GBS). This is a common cause of meningitis in newborns and young infants worldwide.
Other types of Streptococcus bacteria rarely cause meningitis in adults or children.
 
A.
  1. Subbarao, S., Ribeiro, S., Campbell, H., Okike, I., Ramsay, M. E., & Ladhani, S. N. (2023). Trends in laboratory-confirmed bacterial meningitis (2012-2019): National observational study, England. The Lancet Regional Health - Europe, 25, 100692.
  2. Plainvert, C., Doloy, A., Joubrel, C., Maataoui, N., Dmytruk, N., Touak, G., Collobert, G., Fouet, A., Poyart, C., & Loubinoux, J. (2016). Characterization of Streptococcus pyogenes isolates responsible for adult meningitis in France from 2003 to 2013. Diagnostic Microbiology and Infectious Disease, 84(4), 350-352.
  3. Imöhl, M., Reinert, R. R., Ocklenburg, C., & van der Linden, M. (2010). Epidemiology of invasive Streptococcus pyogenes disease in Germany during 2003–2007. FEMS Immunology & Medical Microbiology, 58(3), 389-396.
  4. Lamagni, T. L., Darenberg, J., Luca-Harari, B., Siljander, T., Efstratiou, A., Henriques-Normark, B., Vuopio-Varkila, J., Bouvet, A., Creti, R., Ekelund, K., Koliou, M., Reinert, R., Stathi, A., Strakova, L., Ungureanu, V., Schalén, C., & Jasir, A. (2008). Epidemiology of severe Streptococcus pyogenes disease in Europe. Journal of Clinical Microbiology, 46(7), 2359-2367.
  5. O'Loughlin, R. E., Roberson, A., Cieslak, P. R., Lynfield, R., Gershman, K., Craig, A., Albanese, B. A., Farley, M. M., Barrett, N. L., Spina, N. L., Beall, B., Harrison, L. H., Reingold, A., & Beneden, C. V. (2007). The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clinical Infectious Diseases, 45(7), 853-862.
  6. Lucas, M. J., Brouwer, M. C., Bovenkerk, S., Man, W. K., van der Ende, A., & van de Beek, D. (2015). Group A streptococcal meningitis in adults. Journal of Infection, 71(1), 37-42.
  7. Santos, M. S., Ribeiro, G. S., Oliveira, T. Q., Santos, R. C., Gouveia, E., Salgado, K., Takahashi, D., Fontes, C., Campos, L. C., Reis, M. G., Ko, A. I., & Reis, J. N. (2009). Burden of group A streptococcal meningitis in Salvador, Brazil: Report of 11 years of population-based surveillance. International Journal of Infectious Diseases, 13(4), 456-461.
  8. Nielsen, H., Storgaard, M., Helweg-Larsen, J., Larsen, L., Jepsen, M. P. G., Hansen, B. R., Wiese, L., & Bodilsen, J. (2023). Group A streptococcus meningitis in adults, Denmark. Emerging Infectious Diseases, 29(9), 1937-1939. https://doi.org/10.3201/eid2909.230127
  9. World Health Organization. (2022). Increase in invasive Group A streptococcal infections among children in Europe, including fatalities. Retrieved from https://www.who.int/europe/news/item/12-12-2022-increase-in-invasive-group-a-streptococcal-infections-among-children-in-europe--including-fatalities
  10. World Health Organization. (2022). Increased incidence of scarlet fever and invasive Group A Streptococcus infection—Multi-country. Retrieved from https://www.who.int/emergencies/disease-outbreak-news/item/2022-DON429
  11. Abo, Y. N., Oliver, J., McMinn, A., Osowicki, J., Baker, C., Clark, J. E., Blyth, C. C., Francis, J. R., Carr, J., Smeesters, P. R., Crawford, N. W., & Steer, A. C. (2023). Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges. The Lancet Regional Health - Western Pacific, 22, 100873. https://doi.org/10.1016/j.lanwpc.2023.100873
  12. Johannesen, T. B., Munkstrup, C., Edslev, S. M., Baig, S., Nielsen, S., Funk, T., Kristensen, D. K., Jacobsen, L. H., Ravn, S. F., Bindslev, N., Gubbels, S., Voldstedlund, M., Jokelainen, P., Hallstrøm, S., Rasmussen, A., Kristinsson, K. G., Fuglsang-Damgaard, D., Dessau, R. B., Olsén, A. B., Jensen, C. S., Skovby, A., Ellermann-Eriksen, S., Jensen, T. G., Dzajic, E., Østergaard, C., Lomborg Andersen, S., Hoffmann, S., Andersen, P. H., & Stegger, M. (2023). Increase in invasive group A streptococcal infections and emergence of novel, rapidly expanding sub-lineage of the virulent Streptococcus pyogenes M1 clone, Denmark, 2023. Eurosurveillance, 28(26). https://doi.org/10.2807/1560-7917.ES.2023.28.26.2300155
  13. UK Health Security Agency. (n.d.). UK guidelines for the management of contacts of invasive group A streptococcus (iGAS) infection in community settings. Retrieved from https://www.gov.uk/government/publications/invasive-group-a-streptococcal-disease-managing-close-contacts-in-community-settings
  14. Sommer, R., Rohner, P., Garbino, J., Auckenthaler, R., Malinverni, R., Lew, D., & Kaiser, L. (1999). Group A beta-hemolytic streptococcus meningitis: Clinical and microbiological features of nine cases. Clinical Infectious Diseases, 29(4), 929-931.
  15. Baraldés, M. A., Domingo, P., Mauri, A., Monmany, J., Castellanos, M., Pericas, R., & Vázquez, G. (1999). Group A streptococcal meningitis in the antibiotic era. European Journal of Clinical Microbiology & Infectious Diseases, 18(8), 572-578.
  16. van de Beek, D., de Gans, J., Spanjaard, L., Sela, S., Vermeulen, M., & Dankert, J. (2002). Group A streptococcal meningitis in adults: Report of 41 cases and a review of the literature. Clinical Infectious Diseases, 34(9), e32-e36.
  17. de Almeida Torres, R. S., Fedalto, L. E., de Almeida Torres, R. F., Steer, A. C., & Smeesters, P. R. (2013). Group A streptococcus meningitis in children. Pediatric Infectious Disease Journal, 32(2), 110-114.
Author: Meningitis Research Foundation.
Reviewed by: Dianne Spalding, Meningitis Research Foundation Ambassador; Hajime Takeuchi, the Japan Child Meningitis Organisation and CoMO member.
Published: 27 December 2024.

Meningitis in your words: real-life stories

Meningitis affects millions of people, in all regions of the world. Through the bravery of sharing personal stories, we bring together people from every region of the world to support one another, so they are empowered to live a life beyond meningitis.
Type - GAS (Group A streptococcal)
Age group - Toddler (1-3)
Outcome - Recovery with after effects

"This had to be one of the scariest times of our lives."
Type - GAS (Group A streptococcal)
Age group - Adult 25-59
Outcome - Bereavement

"It was such a shock as it was sudden. It was hard and still is."
Type - GAS (Group A streptococcal)
Age group - Baby 0-1
Outcome - Full recovery

"He truly is our little miracle boy."