After COVID 19 a potentially deadly disease has recently spread in Japan known as Streptococcal Toxic Shock Syndrome or STSS. Doctors have also named the disease "flesh-eating bacteria". This disease is capable of killing an infected person within 48 hours, and is spread through person-to-person contact.
It is prompting questions about what causes it and how to prevent it.
Japan reports record spike in this potentially deadly bacterial infection.This infection is caused by Group A Streptococcus (Streptococcus pyogenes) bacteria on primary human neutrophil. Group A strep is one of the main causes of STSS.
Streptococcus pyogenes is a species of Gram-positive, aerotolerant bacteria in the genus Streptococcus. These bacteria are extracellular, and made up of non-motile and non-sporing cocci (round cells) that tend to link in chains. They are clinically important for humans, as they are an infrequent, but usually pathogenic, part of the skin microbiota that can cause Group A streptococcal infection. S. pyogenes is the predominant species harboring the Lancefield group A antigen, and is often called group A Streptococcus (GAS).
Cases of a dangerous and highly fatal bacterial infection have reached record levels in Japan, official figures show, with experts so far unable to pinpoint the reason for the rise.
Portal of entry in body:
The most common way to get necrotizing fasciitis is when bacteria invade your body through a cut in your skin, although it can happen if you have a trauma that doesn't break the skin. Ways that bacteria can enter your skin: Cuts, scrapes or burns, Insect bites. You can get necrotizing fasciitis when bacteria enter a wound, such as from an insect bite, a burn, or a cut. It is not as common, but you can also get it in: Wounds that come in contact with seawater or fresh water.or you can get it by eating contaminated oysters.
Number of Cases repoted:
A disease caused by a rare “flesh-eating bacteria” that can kill people within 48 hours is spreading rapidly in Japan after the country relaxed from COVID.
Number of Cases of STSS'
Japan's National Institute of Infectious Diseases issued a statement in March warning that STSS was increasing in the country
As of June 2, Japan’s Health Ministry had recorded 977 cases of streptococcal toxic shock syndrome (STSS), which has a mortality rate of up to 30%.(3 deaths out of 10 Cases)Some 77 people out of 977 cases have died from the infection.
lHealth authorities have reported over 1,090 cases of streptococcal toxic shock syndrome (STSS) as of early June 2024, higher than the record 941 cases reported for all of year 2023.This is second-highest number of fatalities in the past six years.At the current rate of infection, experts fear the number of cases in Japan could reach 2,500 this year.
Number of cases in USA:
The Centers for Disease Control (CDC) estimates there are 700 to 1,200 cases of necrotizing fasciitis per year in the U.S. Most people who get the disease have other health problems.
Sometimes people call necrotizing fasciitis “flesh-eating disease” because the infection spreads very quickly .
There are only 150 to 200 cases of Vibrio vulnificus in the U.S. each year, but the mortality rate is high, with 1 in 5 people succumbing to the infection.
Symptoms Of disease :
STSS (Streptococcal Toxic Shock Syndrome) is a rare but serious bacterial infection that can develop when bacteria spread into deep tissues and the bloodstream. Patients initially suffer from fever, muscle pain and vomiting but symptoms can quickly turn life threatening with low blood pressure, swelling, and multiple organ failure as the body goes into shock.
“Even with treatment, STSS can be deadly. Out of 10 people with STSS, as many as 3 people will die from the infection,” according to the US Centers for Disease Control and Prevention (CDC). Thus the mortality rate is 30%that is higher than COVID 19(2%) .
Streptococcal sore throat:
Strep throat is caused by infection with a bacterium known as Streptococcus pyogenes, also called group A streptococcus. or Strep A. Streptococcal bacteria are contagious. They can spread through droplets when someone with the infection coughs or sneezes, or through shared food or drinks.
Antibiotics for treatment: Penicillin and amoxicillin are common antibiotics healthcare providers use to treat strep throat. If you're allergic to penicillin, the provider can prescribe another antibiotic. A healthcare provider may give you an antibiotic shot, or they may prescribe an antibiotic in either pill or liquid form.
Pathogenicity:
Streptococcus pyogenes (group A strep) produces a variety of exotoxins, including the streptococcal pyrogenic exotoxins (SPEs; scarlet fever toxins) that have been implicated in severe invasivestreptococcal diseases such as streptococcal toxic shock syndrome (STSS) and scarlet fever.
Most STSS cases are caused by the group A streptococcus (GAS) bacteria, which mainly produces fever and sore throat infections in children known as "strep throat," In rare circumstances, Strep A bacteria can become invasive when bacterium produces a toxin that enables it to gain access to the bloodstream, causing serious illnesses such as toxic shock.
Some types of Group A Strep can lead to symptoms developing rapidly, including limb pain and swelling, fever, low blood pressure, that can be followed by necrosis, breathing problems, multiple organ failure and death. People over 50 are more prone to the disease. "Most of the deaths happen within 48 hours," said Ken Kikuchi, a professor in infectious diseases at Tokyo Women's Medical University. "As soon as a patient notices swelling in foot in the morning, it can expand to the knee by noon, and they can die within 48 hours."
However, patients with this life-threatening infection can survive and be cured, the most common culprit behind necrotizing fasciitis. But the CDC's latest warning points to an additional suspect, a type of bacteria called Vibrio vulnificus.
These life-threatening infections affect the skin, muscles, and soft tissue and cause patches of tissue to die. It spreads quickly and aggressively in an infected person, causes tissue death at the infection site, and can be deadly if not treated right away.
The majority of cases have been reported in adults over 30, and the death rate is around 30 per cent. The disease is a response to Group A Streptococcus (GAS), the same bacteria that causes strep throat in children.
Symptoms of necrotizing fasciitis include fever, severe pain, and a red painful swelling of the infected area which spreads quickly (up to 3 cm an hour). Death can occur in 12 to 24 hours. Persons with “flesh-eating disease” usually have a lot of pain in the infected area—they know something is wrong.
The disease, caused by a 'flesh-eating bacteria,' has a mortality rate of 30% and can be fatal within 48 hours. Symptoms include fever, muscle aches, and organ failure.
Lab diagnosis:
If your healthcare provider thinks you have flesh-eating disease, they may order diagnostic tests, including: Blood tests, such as a complete blood count. Culture of specimens taken from deep tissue. Tissue biopsy.
The doctor will diagnose your infection based on how suddenly your symptoms started and how quickly the infection is spreading. The infected tissue may be tested for bacteria. You also may need X-rays, a CT scan, or an MRI to look for injury to your organs or to find out how much the infection has spread.
LRINEC scoring comprises C-reactive protein (CRP), white blood cell count, hemoglobin level, creatinine, sodium, and glucose. A score of six or more suggests a high probability of having necrotizing fasciitis and a score of less than six leads to lower chances of having NF.
Preventive measures:
Preventive measures include good hygiene and prompt treatment.
Remember, an important clue to this disease is very severe pain at the site of a wound. Always take good care of minor cuts to reduce the chance of the tissues under the skin getting infected.
The early stage of necrotizing fasciitis is characterized by symptoms of redness, swelling, and pain in the affected area. Blisters may be seen in the involved area of skin. Fever, nausea, vomiting, and other flu-like symptoms are common
Streptococcal toxic shock syndrome (STSS) is a rare, but serious bacterial infection. STSS can develop very quickly into a life-threatening emergency. People with STSS need immediate care in a hospital and antibiotics. Treatment focuses on managing low blood pressure and multiple organ failure.
It causes your body to release toxins that can cause organ failure or death. Once thought to be solely related to tampon use, we now know that anyone of any age can get toxic shock syndrome. The main symptoms of TSS are sudden fever, flu-like symptoms, diarrhea and low blood pressure.
Most people need several surgeries to control the infection. Removing limbs (amputation) or organs may be done to save the person's life, depending on how severe the infection is and where it has spread. Medicines (such as antibiotics).kill the bacteria causing the infection.
However, patients with this life-threatening infection can survive and be cured, particularly if the diagnosis is made early in the course of infection and the appropriate management strategies are implemented quickly
If left untreated, necrotizing fasciitis can be fatal, sometimes within 48 hours. The bacterial species group A strep, is the most common culprit behind necrotizing fasciitis. But the CDC's latest warning points to an additional suspect, a type of bacteria called Vibrio vulnificus.
These life-threatening infections affect the skin, muscles, and soft tissue and cause patches of tissue to die. It spreads quickly and aggressively in an infected person, causes tissue death at the infection site, and can be deadly if not treated right away.
The majority of cases have been reported in adults over 30, and the death rate is around 30 %. The disease is a response to Group A Strep the same bacteria that causes strep throat in children.
Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause necrosis of the muscle fascia and subcutaneous tissues. The infection typically travels along the fascial plane, which has a poor blood supply. Initially, the overlying tissues are unaffected, potentially delaying diagnosis and surgical intervention. The infectious process can rapidly spread, causing infection of the fascia and perifascial planes as well as secondary infection of the overlying and underlying skin, soft tissue, and muscle. This activity reviews the evaluation, treatment, and prognosis of necrotizing fasciitis and highlights the role of an interprofessional team in evaluating and improving care for patients with this condition.
Symptoms of necrotizing fasciitis include fever, severe pain, and a red painful swelling of the infected area which spreads quickly (up to 3 cm an hour). Death can occur in 12 to 24 hours. Persons with “flesh-eating disease” usually have a lot of pain in the infected area—they know something is wrong.
The disease, caused by a 'flesh-eating bacteria,' has a mortality rate of 30% and can be fatal within 48 hours. Symptoms include fever, muscle aches, and organ failure.
Preventive measures include good hygiene and prompt treatment.
Remember, an important clue to this disease is very severe pain at the site of a wound. Always take good care of minor cuts to reduces the chance of the tissues under the skin getting infected.
The cases of STSS are also reported in five European countries
The incidence of TSS in India is unknown and its occurrence is reported in a few isolated case reports. The delay in identification usually leads to poorer outcomes in such cases, hence awareness of the presentation and clinical course is necessary for early diagnosis and institution of appropriate therapy.
Information compiled by Dr. Bhairavsinh Raol
