Severe manifestations of Streptococcus pyogenes: a narrative review

Streptococcus pyogenes is a pathogen capable of causing a wide spectrum of diseases, ranging from mild infections to severe invasive conditions. This narrative review focused on two of its most serious manifestations: meningitis and streptococcal toxic shock syndrome (STSS). A systematic search was conducted in PubMed, Scopus and ScienceDirect for articles published in recent years in both English and Spanish. Studies addressing severe presentations in the pediatric population were included. S. pyogenes meningitis, although a rare disease, carries a high mortality rate (up to 75%) if not treated early. STSS, on the other hand, constitutes a medical emergency with variable mortality rates ranging from 5% to 56%, influenced by factors such as the EMM genotype and the expression of superantigens. Both conditions often present nonspecific symptoms, complicating initial diagnosis. Diagnostic and therapeutic delays can be decisive in unfavorable outcomes. Invasive forms of S. pyogenes infection require early suspicion, prompt intervention and aggressive clinical strategies to reduce mortality. Initial underestimation can be fatal; therefore, continuous medical education and active surveillance are essential.