A systematic review of asymptomatic colonisation with Group A Streptococcus in lower- and middle-income countries

We follow on from Locke et al.'s recent publication (1) with a paired systematic review of Streptococcus pyogenes (GAS) colonisation in lower and middle income countries (LMICs).Like S. aureus, GAS causes a spectrum of presentations from asymptomatic colonisation to skin and pharyngeal infections, and potentially fatal invasive disease.Furthermore, GAS causes post-infectious immunological sequelae including rheumatic fever and rheumatic heart disease (RHD), particularly in LMICs.There is increasing evidence that colonisation contributes to the spread of infections (2) and is not immunologically silent (3).