Overview
Streptococcal Toxic Shock Syndrome (STSS) is a severe illness that has been gaining increasing attention due to a surge in cases worldwide, notably in Japan. This life-threatening condition, caused by Group A Streptococcus bacteria, has raised alarms among health experts and the general Public.
Introduction
An article in THE WEEK, dated June 30, highlighted a concerning trend reported by Japan’s National Institute of Infectious Diseases (NIID): a notable rise in cases of ‘flesh-eating bacterial infections’ across the country. By June 9, the preliminary count of Streptococcal Toxic Shock Syndrome cases this year had already reached 1,019.
STSS, which can result from Group A Streptococcus (GAS) infection, may lead to necrotizing fasciitis, commonly known as flesh-eating bacterial infections. This year has witnessed a significant spike in the incidence of this rare and severe bacterial infection.
In this blog post, we’ll delve into the critical dangers of STSS, its symptoms, treatment options, and the recent rise in cases. By the end, you’ll have a comprehensive understanding of this deadly bacterial infection that has prompted Manila urging travelers to wear face masks.
What is Streptococcal Toxic Shock Syndrome?
STSS is a severe form of infection caused by Group A Streptococcus bacteria. It is specifically caused by Streptococcus pyogenes, the bacteria that causes strep throat or impetigo. In some cases, they can lead to severe infections, including STSS.
Although rare, the condition is severe, occurring when the bacteria release toxins into the bloodstream, triggering a systemic inflammatory response and toxic shock. Life-threatening symptoms ensue, such as low blood pressure, leading to widespread organ failure, loss of consciousness and, if not treated promptly, death.
STSS is the most severe form of Strep A infection. While it primarily impacts children and the elderly, cases can occur across all age groups. Pregnant women, especially shortly after child birth, may also face a higher risk.
Symptoms of Streptococcal Toxic Shock Syndrome
In STSS, the bacteria produce a toxin that can trigger an excessive immune response in certain individuals. The illness can rapidly become life-threatening within hours and carries a high mortality rate━upto 40% of those affected by STSS may not survive. Early signs and symptoms of STSS can be challenging to distinguish from common viral illness, especially in children, complicating diagnosis. Common symptoms include:
- Fever and Chills: Sudden onset of high fever and chills.
- Hypotension: Extremely low blood pressure.
- Rash: A diffuse, red rash that can resemble a sunburn.
- Organ Failure: Signs of organ dysfunction, including difficulty breathing, kidney failure, and liver issues.
- Severe Pain: Intense pain at the infection site, often disproportionate to visible symptoms.
It is crucial to watch for signs of sepsis, which can indicate a more serious underlying condition. Symptoms of severe invasive group a streptococcal disease, including STSS, resemble those found in other bacterial causes of sepsis, such as meningococcal disease. These symptoms include lethargy (drowsiness), rapid breathing, muscle pain, and confusion.
Causes and Risk Factors
Streptococcal Toxic Shock Syndrome is primarily caused by the Group A Streptococcus bacteria, which can be transmitted through direct contact with an infected person or through contact with contaminated surfaces. Several factors increase the risk of developing STSS:
- Cuts or Injuries: Open wounds or injuries can be entry points for bacteria.
- Chronic Illness: Conditions like diabetes, or heart disease can weaken the immune system.
- Recent Viral Infections: Having a recent viral infection, such as influenza, can make the body more susceptible to bacterial infections.
- Use of NSAIDs: Nonsteroidal anti-inflammatory drugs may exacerbate the severity of the infection.
STSS can sometimes occur alongside necrotizing fasciitis, another condition caused by Strep A, known for its severe tissue damage, and often referred to as “flesh-eating” due to bacterial toxin-induced death of skin cells. The infection advances swiftly, resulting in tissue necrosis characterized by intense pain, skin discoloration and peeling.
Parents of young children should rely on their instincts. If you’re concerned that your child is more unwell than expected with a common illness, especially if they exhibit symptoms like cold limbs, a sunburn-like red rash, or decreased responsiveness, seek prompt medical attention at your nearest emergency department.
Individuals with diabetes or alcohol use disorder (formerly known as alcohol dependence or alcoholism) are at a higher risk of developing STSS.
The Rise of Streptococcal Toxic Shock Syndrome in Japan
Recently, Japan has seen a significant increase in STSS cases, prompting health experts to investigate the underlying causes. According to Healthline, the number of infections has been steadily rising, leading to increased public health concerns. The reasons behind this surge are still under investigation, but several factors could contribute to this trend.
- Increased Awareness and Reporting: Greater awareness among healthcare professionals and the public may lead to more reported cases.
- Environmental Changes: Changes in climate and environmental conditions could affect bacterial transmission.
- Population Density: High population density in urban areas may facilitate the spread of infectious diseases.
Japan’s Health Ministry has indicated that the easing of coronavirus restrictions might be a factor contributing to the rise in cases. Despite this spike, the ministry maintains that traveling to the country is still safe.
However, they advise travelers to take precautions such as frequent hand washing and proper wound care to reduce the risk of infections. Meanwhile, experts note that although STSS has existed for centuries, it remains relatively uncommon.
Treatment and Prevention of Streptococcal Toxic Shock Syndrome
Prompt medical attention is critical for treating STSS. Treatment typically involves:
- Antibiotics: High doses of intravenous antibiotics to combat the bacterial infection.
- Intravenous Fluids: To maintain blood pressure and hydration.
- Medication: To manage complications like shock and sepsis.
- Supportive Care: Intensive care support for organ function, including mechanical ventilation and dialysis if necessary.
- Surgical Intervention: In severe cases, surgery may be required to remove infected tissue.
Diagnosing necrotizing fasciitis requires a comprehensive approach including physical examination, blood tests, tissue biopsy, and imaging such as CT scans. The infection can also result in severe scarring and long-term disability. Serious complications may progress to septic shock, organ failure, amputation, and death. Timely and aggressive treatment is essential due to the rapid progression and life-threatening nature of this condition.
Preventing Streptococcal Toxic Shock Syndrome involves several strategies:
- Good Hygiene: Regular hand washing and maintaining personal hygiene.
- Wound Care: Properly cleaning and covering wounds to prevent bacterial entry.
- Avoiding Close Contact: Staying away from individuals with known infections.
- Vaccination: Keeping up-to-date with vaccinations to prevent viral infections that could lead to bacterial complications.
Currently, there is no vaccine available to prevent STSS. However, serious Strep A infections such as STSS frequently occur after viral infections, particularly chickenpox and influenza. Staying vaccinated, including receiving the chickenpox vaccine, and getting the seasonal influenza vaccine can help lower the risk of these infections.
Why You Should be Concerned
The rising cases of Streptococcal Toxic Shock Syndrome in Japan have highlighted the potential for this deadly infection to spread globally. The independent reports on the increasing prevalence of flesh-eating bacteria, which are often associated with severe complications like STSS. This underscores the importance of awareness and prevention measures to protect public health.
Final Thoughts
Streptococcal Toxic Shock Syndrome is a rare yet severe complication of Strep A infections that can occur worldwide. Japan is currently seeing an unprecedented rise in cases of this disease. This year, STSS has led to 77 fatalities, with a mortality rate exceeding 30% in affected individuals.
This surge in Japan has raised concerns with the medical community and serves as a stark reminder of the importance of awareness and prevention. Experts do not foresee the potential for the disease to spread to other regions in the near future. However, they advised vigilance and emphasized the importance of hygiene practices.
Ensure you stay aware with vaccinations, including the seasonal flu vaccine. Practice diligent hand hygiene at all times and remain aware of the signs of serious bacterial infections that necessitate immediate medical care. By understanding the symptoms, risk factors, and treatment options, you can take steps to protect yourself and your loved ones from this dangerous infection.
Stay informed, stay safe! Share this blog post with your friends and family to raise awareness about Streptococcal Toxic Shock Syndrome and help prevent its spread. Together, we can combat this deadly infection.
FAQs
Q1. What is the mortality of Streptococcal Toxic Shock Syndrome?
- The mortality rate of STSS is high, with estimates ranging from 30% to 70% depending on the timeliness and effectiveness of treatment.
Q2. How is STSS diagnosed?
- Diagnosis typically involves a combination of clinical evaluation, blood tests to detect the presence of Group A Streptococcus bacteria, and imaging studies to assess organ function.
Q3. Can STSS be prevented?
- While there is no vaccine specifically for STSS, preventive measures include good hygiene practice, proper wound care, and avoiding close contact with infected individuals.
Q4. What should I do if I suspect I have STSS?
- Seek immediate medical attention if you experience symptoms of STSS, especially if you have a recent injury or infection. Early treatment is crucial for improving outcomes.
Q5. Are there long-term effects of STSS?
- Survivors of STSS may experience long-term health issues, including organ damage, chronic pain, and psychological effects. Rehabilitation and ongoing medical care are often necessary.
Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.
References:
- CDC | About Streptococcal Toxic Shock Syndrome.
- CDC | Clinical Guidance for Streptococcal Toxic Shock Syndrome.
- Healthline | Cases of This Deadly Bacterial Infection are Rising in Japan, Experts Want to Know Why.
- The University of Sydney | What is streptococcal toxic shock syndrome?
- The Manila Times | NAIA travelers urged to wear face masks.
- Independent | What is STSS, the deadly flesh-eating bacteria on the rise in Japan?
- THE WEEK | Flesh-eating bacterial infections: Diagnosis and treatment protocols explained.