Strep A (Invasive Streptococcus A): A Re-Emerging Global Threat?

Outbreaks of a deadly streptococcal infection that results in toxic shock and the rapid destruction of muscle and flesh have raised concern among scientists that a strain of strep A, the bacterium involved, is re-emerglng as a major health threat. According to the Centers for Disease Control and Prevention, the current wave of invasive strep A infections began in the late 1980s, and by 1990, about 10,000 to 15,000 cases were being reported in the United States each year. Although this is less common than other bacterial infections, it is of concern because of the rapidity with which strep A can maim and kill.

The strep organism multiplies rapidly, dividing every 45 minutes and producing progressively worse symptoms that include a rising fever and rash. By the third day, the patient's temperature may soar above 102°F (39°C). By the fourth day, 25 to 50 percent of patients begin to suffer tissue destruction because the bacterium, through a complex genetic process, produces toxin that rapidly kills muscle and other tissue. There may also be a severe drop in blood pressure and impaired circulation that causes further tissue death and gangrene. Although popularly dubbed "the flesh-eating" bacterium, tissue-killing is a more accurate description of what it does.

Sufferers have included Jim Henson, creator of the Muppets, who died within days of falling ill, despite massive antibiotic therapy. Survivors are often left disfigured or severely handicapped.

Contrary to media reports, strep A is not new, nor is it resistant to penicillin and other antibiotics. Populations of bacteria, like viruses and many other organisms, tend to wax and wane. The last major upsurge of invasive strep A was during World War II, but it seemed to die out, probably due to its natural life cycle. Researchers in the United States and abroad reported clusters of infections caused by "flesh-eating bacteria" in the 1980s. Since then, the number or cases has increased worldwide.

Strep A can be a complication of a skin rash, especially in children, During an epidemic of chickenpox in California in the early 1990s, 28 children developed invasive strep A when their skin blisters became infected with the organism. Five of these children died.

Fortunately, the infection does not appear to be as contagious as the more common strep strain that causes a strep throat. The invasive strep A bacterium typically infects the body through a minor cut and, rarely, via a sore throat. Initially, the patient may experience flulike symptoms -- muscle aches, a sore throat, lever, and swollen lymph nodes. The skin wound becomes increasingly painful and inflamed.

Diagnostic Studies and Procedures

A rapid rise in temperature occurring in the presence of even a trivial wound or sore throat should raise a suspicion of invasive strep A, which can be identified by a laboratory culture.

Medical Treatments

Penicillin or another broad-spectrum antibiotic administered during the first three days of a strep A infection cures most cases. Even if treatment is delayed until the toxin has already begun its tissue destruction, antibiotics are still the mainstay of therapy. In this situation, clindamycin may be the most effective antibiotic, because it appears to prevent the bacteria from producing toxin. Antibiotics may be given by injection or intravenously, along with intravenous fluids, electrolytes, and other medications used to raise and maintain blood pressure.

All dead flesh must be removed surgically. In severe cases, amputation of infected limbs or other body parts may be necessary. Otherwise, the dead tissue becomes an ideal refuge for the bacteria, providing a haven that cannot be reached by antibiotics.

Alternative Therapies

There is no effective alternative to the immediate use of antibiotics for overcoming a strep A infection; medical treatment is of primary importance. But alternative therapies may play a role in rehabilitation, especially after amputation or extensive muscle loss.

Physical and Occupational Therapy. These therapists can teach exercises to help the patient regain muscle strength and can provide practical pointers in overcoming physical handicaps to retain independence.

T'ai Chi. This structured regimen of gentle exercises can improve muscle tone and function while fostering an enhanced sense of well-being.

Self-Treatment

Prevention is the best approach for dealing with this deadly disease. You should always take care to treat even the most minor cut immediately by washing the wound thoroughly with soap and water, flushing it with an antiseptic solution such as hydrogen peroxide or alcohol, and then applying an antibiotic cream.

See a doctor right away should you develop such symptoms as fever, swollen lymph nodes, or other signs of an infection.

Other Causes of Tissue Death

Staphylococcal toxic shock syndrome can cause a drop in blood pressure, tissue destruction, gangrene, and death.

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13 Comments

  1. At what body temperature does strep arrest (stop working/die) in your body?

  2. My daughter was only 20..she passed away nine days before christmas 2012....she died from strep a...I am looking for answers

  3. I am 32 years old and it has been about 5 months since I got out of the hospital from having STREP A. It all happened from when I went rafting and hit my leg on the inside of my right thigh. When I got home my leg started hurting but I really didn't pay any attention to it. Then I was at a friends house and it started hurting more and more and not realizing it I hadn't urinated in like 2 days so my kidneys were shutting down. After my friends notced that I kept getting worse and I was starting to halucinate they kinda made me go to the hospital because I didn't want to go. So I remember getting to the ER but I don't remember nothing after that. When I got to the ER I only had 10% life left. They ended up transporting me from the ER in Longview, Washington to the ICU in Portland, Oregon. I was on life support for a month at the hospital in the ICU. They don't know how long I had had the infection in my body but they think it was for a long time and that it explains any weird things I had done or did because it was in my blood. They couldn't find a antibiotic that would start working against the infection so they were gonna amputate my leg or they were afraid it was going to get in my spine and I was gonna be paralized. So at the last minute an infeciouse disease doctor got on my case and finally found an antibiotic that started working so they only cut a 10 by 10 area and 2 inches deep out of the inside of my right thigh and removed the vein that goes on the inside of my right thigh. Then I came to and out of the coma about 5 days before the month was complete of me being in the hospital. I had a wound vac put on it so it would fill in so they could do a skin graph on it. So when it was filled in enough they did a skin graph and took the skin off of the inside of my left thigh and put it on the wound on my right thigh. It took a few months but both my legs are healed. Now I'm just putting vitamin E on both scars to fade the color. Thank god I'm alive today and I thank my friends because if it wasn't for them I would have never gone to the hospital and I wouldn't be alive and here today. So anybody that has any symptons of Strep A go to the hospital and get help before it's too late because life is too beautiful to not enjoy it.

  4. I am a 59 year old man in reasonably good health. In April of 2011 I contracted the Strep A virus. For the first week I thought I had a bad case of the flu. However, during that week I was so wiped out that I had a head on car accident (incorrectly thinking I had the flu) and went to the doctor three times. I don't even remember the second doctor appointment. Finally I was unable to breathe so I was transported to a small hospital and then transported to a second hospital because hospital one could not get a breathing tube down my throat because my head and throat were so swollen. After being put into an induced coma a life support and tons of antibotics via a pick line in my arm and 15 days in the hospital I survived. I was lucky because the infection settled in my neck. A month latter I had surgery and had the infection and swelling removed from my neck. Three months latter I was able to return to work. I repeat that I was lucky because this virus most often settlles in the extremities; often leading to amputation. The doctors have yet to determine the cause of the virus. My prayers and best wishes go out to anyone afflicted by this horrific virus.

  5. I work in a ICU unit in a hospital. I am 5 months pregnant and I was just wondering if I should be taking special precautions going around a pt with this infection?

  6. I was just in the hospital the beginning of Feb. for 5 days on IV antibiotics because of Strep A. I started on Monday not feeling well, not bad, just not myself. By Tues., felt worse and started vomitting. Not able to keep anything down. On Wed., still vomitting, running a fever, chills, rash on my forhead. Went to Emurgent Care locally. They gave me IV fluids becaus I was dehydrated and Zofran to stop the vomitting. I asked about the rash on my face. They asked me if I got bit by something. I went home and continued to vomit and have the fever and chills. By Thursday, the right side of my face and head were swollen and my right eye was swollen shut. I was still vomitting and having a high fever and chills. Went back to Emurgent Care where they did a strep test that was positive and sent me to the ER. I don't know why they did not do a strep test on me the first day especially when they saw the rash on my face. After reading what could have happened, I am very lucky to be here right now. It has been a month since the incident. The side of my head, lymph nodes, are still swollen and my eye still gets puffy. I ended up losing the hair on the right side of my head due to the swelling and infection. I was the sickest I have ever been in my life. I don't wish this on anyone. At the first sign of strep, please don't hesitate, go directly to the ER or you primary Doctor.

  7. I have just survived a Strep A infection in my bloodstream, but the fever that accompanied it took the use of my legs with it. I still have them, though. The damage is to the muscle and tissue and it should be repairable over time. I was very lucky to not have lost my life as the bacteria takes 48 hours to culture and the first emergency room that I went to missed it and sent me home. I had no symptoms before hand, so there was no way to know that it was coming on and be treated any earlier. Karen, IDK where you are located, but in the central IL region there are two great infection control centers here. One inside St. Francis hospital and one inside Proctor hospital. I wish you and your husband all the blessings in the world, and hope that he is able to recover. It's a very deadly and ruthless illness. Not everyone is as lucky as I was, but there are other survivors out there. Keep faith!

  8. My father died very quickly of Streptococcol A infection/Pneumonia within 24hurs. He'd had a cold, bit of a fever, but otherwise gave no cause to believe that he was just coping with the flu. He was 71, but a very fit and healthy man. All he did have were ulcerated veins on his legs. He refused to have them operated on, but had them regularly cleaned and dressed. Could these veins have been the entry point for the strep A? The doctors saw his legs in hospital as he was in intensive care but didnt seem unduly concerned by them. He was coughing up blood, and his kidneys failed, and went onto a machine to operate his lungs for him. Eventually his heart stopped. It was the severity and the speedy onset of his death that we were most shocked by.

    • Geraldine, as a patient I would say that, almost certainly, the ulcers were the entry point. He died because the Strep A infection was not spotted early enough for the anti-biotic treatment to prevent toxic shock.

  9. My husband is currently in the hospital with the strep A toxic syndrome it has affected his han then eventually spread in the blood. Has there been any further updated research or any new drug and how is the survival rate or how are the surivors and if possible can get a hold of any of them.

    • Karen, I shared my story above. Good luck to you and your husband!

    • Karen, I am from the UK and spent three months in hospital in 2004 fighting to stay alive with Strep A. I did not walk with crutches for another year but I survived and got fit again. I was supposed to die the first weekend in the Intensive Care Unit but it was not my time. If you need help or advice contact me. It was the toughest experience of my life and I lost 52lbs of body mass during my illness. Tell your husband to tough it out even if it is very painful.

    • I just got out of the hospital after 5 weeks with Strep A. I'm 39 year old and the mother of two children. I had a rash on my lower stomach and did not feel very well for about 3 days before I just felt so sick I went to the ER and quickly fell into a coma. They operated on the rash and found the Strep. I don't know how I lived, but I guess I have more to do in this life. I'm home now with sever wounds from the surgery, but even with a temp of 107, yes, that's right, I'm here and must move on. Please know your not alone. I'm afraid, but will press on.

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