Streptococcal infections

Entering the heart of the winter season and with everyone’s attention focused on fears of getting influenza, another disease is being overlooked. 

溶連菌感染症 (Yorenkin-kansen-syou) known as Streptococcal infection in English (the more commonly known form of the disease is the Strep throat”) is hitting Japan right now, with doctors saying they are seeing many patients with the disease right now.

Group A Streptococcus is a bacterium often found in the throat and on the skin. People may carry group A streptococci in the throat or on the skin and have no symptoms of illness. Most GAS infections are relatively mild illnesses such as “strep throat,” or impetigo. (Other forms include infections of the bloodstream, nose, tonsils, skin and muscle, meningitis, and more see link

Occasionally these bacteria can cause severe and even life-threatening diseases known as “invasive GAS diseases” which occur when the bacteria get past the defenses of the person who is infected.  Severe, sometimes life-threatening, GAS disease may occur when bacteria get into parts of the body where bacteria usually are not found, such as the blood, muscle, or the lungs. It may happen when a person has sores or other breaks in the skin that allow the bacteria to get into the tissue, or when the person’s ability to fight off the infection is decreased because of chronic illness or an illness that affects the immune system. Also, some virulent strains of GAS are more likely to cause severe disease than others.
Two of the most severe, but least common, forms of invasive GAS disease are necrotizing fasciitis and Streptococcal Toxic Shock Syndrome. Necrotizing fasciitis (occasionally described by the media as “the flesh-eating bacteria”) destroys muscles, fat, and skin tissue. Streptococcal toxic shock syndrome (STSS), causes blood pressure to drop rapidly and organs (e.g., kidney, liver, lungs) to fail. STSS is not the same as the “toxic shock syndrome” frequently associated with tampon usage. About 20% of patients with necrotizing fasciitis and more than half with STSS die. About 10%-15% of patients with other forms of invasive group A streptococcal disease die.
A range of symptoms may be seen: No illness – Mild illness (strep throat or a skin infection such as impetigo) – Severe illness (necrotizing faciitis, streptococcal toxic shock syndrome) 
How it spreads: These bacteria are spread through direct contact with mucus from the nose or throat of persons who are infected or through contact with infected wounds or sores on the skin. Ill persons, such as those who have strep throat or skin infections, are most likely to spread the infection. Persons who carry the bacteria but have no symptoms are much less contagious.

Treatment: Treating an infected person with an antibiotic for 24 hours or longer generally eliminates their ability to spread the bacteria. However, it is important to complete the entire course of antibiotics as prescribed. It is not likely that household items like plates, cups, or toys spread these bacteria.

Take these precautions: The spread of all types of GAS infection can be reduced by good hand washing, especially after coughing and sneezing and before preparing foods or eating. Persons with sore throats should be seen by a doctor who can perform tests to find out whether the illness is strep throat. If the test result shows strep throat, the person should stay home from work, school, or day care until 24 hours after taking an antibiotic. All wounds should be kept clean and watched for possible signs of infection such as redness, swelling, drainage, and pain at the wound site. A person with signs of an infected wound, especially if fever occurs, should immediately seek medical care. Sometimes, the symptoms resemble those of the influenza B strain, so if you suspect you have a strep throat or the flu, you should ask to be tested for both the strep throat and the flu. To detect the disease, doctors will have to do a cheek and throat swab test for 3 antibodies, i.e.. ASO, ASK and ADN-B at a time. Early recognition and treatment of the disease is critical because all severe GAS infections may lead to shock, multisystem organ failure, and death.

GAS infections can be treated with many different antibiotics. Of you come down with a strep infection, do ensure proper treatment and complete the course of medicines until fully recovered to avoid complications such as rheumatic fever, and PSNG (inflammation of the kidneys).


Sources: National Center for Immunization and Respiratory Diseases; Strep A infection Wikipedia;  
See also Group B Strep infections for newborns

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