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Strep A: cases of rare fatal infection hit record levels in Japan – here’s what risk these bacteria pose to global health

There has been a sharp increase in the number of people in Japan suffering with the rare but dangerous bacterial condition, streptococcal toxic shock syndrome (STSS). According to reports, cases of this potentially fatal strep A illness have more than tripled in Tokyo compared with this time last year. While experts aren’t entirely certain why cases have risen so sharply to record levels, many believe it could be due to people being less vigilant about protecting themselves from infection after COVID measures were dropped. Many countries, including the UK, have seen a similar increase in illnesses caused by strep A bacteria in the post-lockdown period – highlighting the continued burden…

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 Mystery in Japan as dangerous streptococcal infections soar to record levels

Health officials racing to identify cause of rise in streptococcal toxic shock syndrome, which has a 30% fatality rate

Articles of Interest

Fulminant streptococcal toxic shock syndrome

Streptococcal toxic shock syndrome (STSS) is one of the complications of invasive streptococcal disease. It is caused by the liberation of cytokines after the stimulation of the immune system by streptococcal toxins and is defined as the isolation of group A Streptococcus from a normally sterile site in the setting of shock and multi-organ failure.

Streptococcal Toxic Shock Syndrome Associated with Necrotizing Fasciitis

Streptococcal toxic shock syndrome (strep TSS) with associated necrotizing fasciitis is a rapidly progressive process that kills 30–60% of patients in 72– 96 h. Violaceous bullae, hypotension, fever, and evidence of organ failure are late clinical manifestations. Thus, the challenge to clinicians is to make an early diagnosis and to intervene with aggressive fluid replacement, emergent surgical debridement, and general supportive measures.

Streptococcal Toxic Shock—like Syndrome

After decades marked by a decrease in the incidence and severity of scarlet fever and streptococcal soft-tissue infections, invasive infections with group A streptococci have reemerged as a global public health problem.

Toxic Shock from Strep: a 'Lightning Strike'

In rare cases, the bacteria responsible for causing strep throat -- group A Streptococcus -- can penetrate beyond the superficial surfaces of the body and lead to necrotizing fasciitis, toxic shock syndrome, and even death. The mortality rate can reach 60% or higher for patients who develop both necrotizing fasciitis and toxic shock syndrome, according to Shulman. Those who have toxic shock alone will die 15% to 20% of the time.

Children In The UK Are Dying Of Invasive Strep A Infections. Here’s What To Know

Experts speculate that the current surge in respiratory viruses like the flu and RSV may be to blame for the rise in invasive strep A cases. Viral infections compromise your immune system, giving bacteria either in your environment or body the opportunity to take over, which is known as a secondary infection.

Multi-Organ Failure from Cellulitis – Streptococcal Toxic Shock Syndrome (STSS)

Streptococcal toxic shock syndrome (STSS) is a severe illness associated with invasive or noninvasive group A streptococcal (Streptococcus pyogenes) infection. STSS may occur with infection at any site, but most often occurs in association with infection of a cutaneous lesion. Signs of toxicity and a rapidly progressive clinical course are characteristic. While the fatality rate of S. aureus-mediated TSS is around 5%, the fatality rate of streptococcal TSS exceeds 50% even with adequate treatment (4). These patient often have a rapid clinical decline with sudden onset of refractory hypotension. Traditional measures such as antibiotics and IV fluids often do not lead to significant clinical improvement.

Severe group A streptococcal toxic shock syndrome presenting as primary peritonitis: a case report and brief review of the literature

Streptococcal toxic shock syndrome (STSS) can be defined as a septic shock syndrome resulting from infection with toxin-producing group A streptococci (GAS). STSS can sporadically present as primary peritonitis in previously healthy persons. Signs of STSS are non-specific and patients generally present with flu-like symptoms and can develop a life-threatening toxic shock syndrome in just a few hours.

Streptococcal toxic shock syndrome

Early diagnosis remains a problem, and aggressive surgery often cannot be avoided. The continuing rates of mortality and morbidity indicate the need for novel approaches to diagnosis and treatment.

Toxic Shock Syndrome Due to Streptococcus pyogenes Presenting with Purpura Fulminans in an Older Adult

Purpura fulminans (PF) was first described in 1886 and is characterized as a rare syndrome with a rapidly progressive course of hemorrhagic infarction of the skin and soft tissue necrosis. It mainly occurs in children and rarely in adults. PF is a life-threatening disease that can be a clinical presentation of toxic shock syndrome (TSS). The most common infectious etiology is cocci, and routine use of antibiotics for this disease is well recognized. However, another etiology, influenza virus, is often neglected.

What is Strep A? And how is it related to toxic shock syndrome?

People often think of TSS as being a tampon-related condition, but actually, TSS is an iGAS, where group A strep bacteria releases a harmful toxin, which can make someone very ill very quickly. Causing symptoms like a fever, a sunburn-like rash, lowering their blood pressure and leading to end-organ damage. TSS can be due to non-menstrual reasons and can affect men, children and non-menstruating women, too. The important takeaway information here is to practice good hand and respiratory hygiene and make sure you’re monitoring how you feel if unwell.

Resources

CDC

STSS is caused by S. pyogenes, which are also called group A Streptococcus (group A strep). When production of bacterial exotoxins and virulence factors occur in the deep tissues and bloodstream, this can lead to the induction of the cytokine cascade. Massive cytokine cascades contribute to the development of shock or organ failure.

StatPearls

TSS is most commonly caused by a toxigenic strain of Staphylococcus aureus or Group A Strep (Streptococcus pyogenes). Other strains of streptococci also produce superantigens, which can lead to TSS. The disease occurs most often in the setting of menstruation despite the discontinuation of high absorbency tampons. However, TSS can also present in non-menstrual settings such as in soft tissue infections, post-surgical infections, burns, retained foreign bodies such as nasal packing, and dialysis catheters.