• The clinical manifestations of patients with group A β-hemolytic streptococcal (GAS) bacteremia presenting to an urban children's hospital were reviewed. Group A β-hemolytic streptococci were isolated from blood cultures from 17 children over a three-year period. Systemic Illnesses that may have predisposed these children to GAS bacteremia were identified in seven patients: preceding varicella infection (four patients) or malignant neoplasm/immunosuppressive therapy (three patients). Possible sources of GAS included compromised integument (seven patients), the oropharynx (six patients), or the lower respiratory tract (two patients). The clinical manifestations of GAS sepsis included the following: fever (15 patients); arthritis or arthralgias (four patients); cellulitis (three patients); maculopapular eruption (one patient); petechial or pustular exanthems (three patients); osteomyelitis (two patients); cervical adenitis (one patient); empyema (one patient); and meningitis with multiple brain abscesses (one patient). Two patients died of apparent overwhelming GAS sepsis while at home. Group A β hemolytic streptococcal bacteremia can present with a wide range of clinical manifestations and cause mild to fulminant disease In children.