You may have heard in recent days about a “flesh-eating bacteria” spreading in Japan, referring to an illness that can occur with streptococcal toxic shock syndrome (STSS).
Media reports indicate that the country recorded more than 1,000 cases of STSS in the first six months of 2024, more than the total for all of 2023. However, these cases have not yet been published in journals peer-reviewed, it is therefore possible that the reports will not be published. Totally correct.
STSS is caused by Streptococcus pyogenic bacteria, or “Strep A”. These bacteria are quite common, but some strains can cause a more serious illness, called invasive group A streptococcal disease.
Since 2022, many countries, including Australia, the United States, and countries in Europe, have noted an increase in serious invasive group A streptococcal disease. This increase is part of an overall increase in Strep infections. HAS.
So, what is STSS, why is it increasing now and is it concerning?
Who benefits from the STSS?
At any given time, many people will be “colonized” with Strep A, meaning the bacteria lives harmlessly in their throat or on their skin.
Strep A also causes sore throat (“strep throat”) and skin infections. Sometimes, for reasons that aren’t entirely clear yet, Strep A causes invasive infections like pneumonia, nasty “flesh-eating” skin infections, and STSS. In this way, Streptococcus A is an important cause of sepsis, a term that broadly refers to a potentially fatal infection.
STSS is the most serious Strep A disease, although fortunately it is very rare. It mainly affects young children and the elderly, but cases occur at all ages. Pregnant people may also be at higher risk, including shortly after giving birth.
What are the symptoms?
In STSS, the bacteria produces a toxin that can cause an overwhelming immune response in some people.
The disease can progress to be life-threatening within hours and has a high mortality rate – up to 40 percent of people who develop STSS will die from it.
However, the early signs and symptoms of STSS may overlap with those of common viral illnesses, particularly in children, making their diagnosis difficult.
Symptoms are vague in early invasive group A streptococcal infections – such as fever, rash and nausea. But it’s important to watch out for signs of sepsis, which suggest something more serious could be happening.
Signs of more severe invasive group A streptococcal disease, including STSS, are similar to those seen in other bacterial causes of sepsis (such as meningococcal disease). These include lethargy (sleepiness), rapid breathing, a rapidly progressing rash, muscle pain, and confusion.
STSS sometimes coexists with a condition called necrotizing fasciitis, also caused by Strep A, which is the “flesh-eating” presentation of the infection. This is when skin cells die in response to toxins produced by bacteria.
Parents of young children should trust their instincts. If you are concerned that your child may be sicker than they usually would be with a common virus, and especially if they have cold limbs, a red rash (like sunburn), or are less responsive , seek medical attention promptly at the nearest emergency department.
Why now?
Studies suggest that some more virulent strains of Strep A may be part of the current STSS surge.
Additionally, in 2020-2021, at the height of the COVID pandemic, when there was less close contact between people, there was also less exposure to Strep A (and other bacteria and viruses ). For young children in particular, this meant that they had not developed the partial protection against bad Strep A infections that results from repeated exposure.
With more human contact starting in 2022, there has been more transmission of Strep A, with children more vulnerable to contracting more serious illnesses, including STSS.
This is not unique to Japan. Although rare, we have observed many cases of STSS in Australia and elsewhere.
How is STSS treated and can we prevent it?
Strep A can be killed by penicillin, one of the oldest and most widely available antibiotics. When STSS is diagnosed early, antibiotics usually prevent more serious complications.
Other medications, such as immunoglobulins, may be needed to curb an uncontrolled immune response, and patients often need support in an intensive care unit.
There is no vaccine to prevent STSS and other Strep A infections (unlike other bacteria such as meningococcus and pneumococcus, which are part of the national childhood immunization program).
Researchers in Australia and around the world are working hard to find a vaccine to prevent Strep A infections.
Serious Strep A infections like STSS often follow viral infections, particularly chickenpox and flu, so stay up to date with vaccines on the national schedule (which includes chickenpox) and make sure you get the flu vaccine seasonal reduces the risk.
Strep A can be spread through large respiratory droplets or through direct contact with infected people or carriers. Simple hygiene measures (such as washing hands and covering your cough) reduce the amount of Strep A circulating in the community.
Are you planning a trip to Japan? No need to cancel your vacation
STSS is a rare but serious complication of Strep A infections, which can occur anywhere in humans. So, unless you’re attending the South Pole alone, you’re at a very similar (and very low) risk of getting a serious infection.
Make sure you are up to date on your vaccinations, including the seasonal flu vaccine. Always practice good hand hygiene and remember the signs of serious bacterial infections that require urgent medical attention.
Phoebe Williams, pediatrician and infectious disease physician; Senior Lecturer and NHMRC Fellow, Faculty of Medicine, University of Sydney; Joshua Osowicki, Team Leader, Researcher, Pediatric Infectious Disease Physician, Murdoch Children’s Research Institute, and Yara-Natalie Abo, General Pediatrician and Pediatric Infectious Disease Physician, PhD Student, Head of Vaccine Clinical Trials, Institute children’s research | Murdoch
This article is republished from The Conversation under a Creative Commons license. Read the original article.