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