It's just a run-of-the-mill case of strep, that soreness that's gripping your throat. You could be right. After all, group A Streptococcus (GAS) is a bacterium that many of us carry in our throats or on our skin without any ill effects.
If we do feel anything, chances are we'll be hit by a mild case of strep throat or impetigo.
But sometimes, the effects can be far nastier. If the bacteria get into parts of the body where bacteria usually are not found — like blood, muscle and the lungs — the results can be devastating. Even fatal.
Two of the most serious illnesses caused by group A streptococcal infection are streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis, or flesh eating disease.
Streptococcal toxic shock syndrome will cause your blood pressure to drop rapidly and organs like your kidneys, liver or lungs to fail.
Necrotizing fasciitis, or flesh-eating disease, is a fast-spreading infection that works its way rapidly through the layers of tissue (the fascia) that surrounds muscles.
Health Canada says while both conditions are very rare, there are several hundred cases a year. About 20 to 30 per cent of them are fatal.
A new strain of streptococcal bacteria has been linked to the deaths of 14 people in northwestern Ontario over the past year-and-a-half. The EMM-59 strain has been moving east from British Columbia since 2006. It has been linked to 90 cases in the Thunder Bay area since August 2007.
What are the early symptoms of streptococcal toxic shock syndrome and necrotizing fasciitis?
The early signs and symptoms of STSS include:
- Abrupt onset of generalized or localized severe pain, often in an arm or leg.
- Flu-like symptoms.
- A flat red rash over large parts of the body, in about 10 per cent of cases.
In the early stages of necrotizing fasciitis, you may experience:
- Severe pain and swelling.
- Redness at the site of a wound.
For both illnesses, the infection sometimes starts at the site of a minor injury, such as a cut or bruise, but sometimes there is no obvious source of infection.
What is the risk?
Scientists don't know why streptococcus bacteria causes only minor infections in some people but poses a serious threat to others.
According to Health Canada, some of the risk factors that have been identified include:
- A weakened immune system, which could be caused by such factors as disease (HIV infection, AIDS), cancer treatments (radiation and chemotherapy), or by anti-rejection drugs taken following a bone marrow or organ transplant.
- Chronic diseases, including heart, lung and liver disease.
- Recent close contact with someone who has flesh-eating disease that was caused by group A streptococcus (GAS) bacteria.
- Chickenpox infection. (It should be noted that while flesh-eating disease can be a complication of chickenpox in children, such occurrences are very rare.)
Should you be concerned about more serious illnesses if you contract strep throat?
No. Millions of people in North America get strep throat every year, but less than one in a million will actually develop flesh-eating disease or streptococcal toxic shock syndrome. The vast majority of group A streptococcal cases arise from skin and soft tissue disease, not from strep throat.
Can you get flesh-eating disease from someone else?
There is some evidence that people in close contact (more than four hours a day) with someone infected with flesh-eating disease are at increased risk of developing the condition. Although this risk is still low, most health authorities in Canada suggest also treating family members to decrease the risk.
How is invasive group A streptococcal disease treated?
Because the necrotizing fasciitis progresses so rapidly (the infection destroys tissue so quickly that it can cause death within 12 to 24 hours), treatment usually involves antibiotics to fight the infection and surgery to remove the infected tissue. There is no vaccine to prevent flesh-eating disease.
High doses of penicillin and clindamycin are used to treat both necrotizing fasciitis and STSS.
The key is to start treatment as early as possible.