Flesh-eating bacteria spreads to the US

By Katie Robinson | Fact-checked by Hale Goetz
Published July 3, 2024

Key Takeaways

  • A 2024 case report described a patient in the US treated for Streptococcal toxic shock syndrome (STSS), a rare bacterial infection that can quickly develop into a life-threatening emergency.

  • STSS is on the rise in several countries, including the US, with death rates as high as 30% despite established treatment protocol.

  • Patients and healthcare providers can take several steps to help prevent and better manage STSS.

A recent case report in the journal Cureus describes a critically ill patient who underwent treatment in the US for Streptococcal toxic shock syndrome (STSS), a rare bacterial infection that can quickly develop into a life-threatening emergency.[]

In January 2024, the Japan Times reported a record high number of new cases of STSS over 2023. Japan has averaged 150 cases of STSS each year since the infection was first reported in the country in 1992. This number skyrocketed to 941 last year, and it appears that the infection, while not new, has now established a similarly firmer footing in the US.[]

What is STSS? 

STSS is caused by a severe bacterial infection called invasive group A Streptococcus (iGAS) that spreads throughout the body.[] While it is rare for STSS to spread among individuals,[] a less severe group A strep infection—which is contagious and causes mild illnesses such as tonsillitis, impetigo, cellulitis, and scarlet fever—can develop into STSS.[]

STSS occurs most commonly in adults aged 65 or older. Individuals with diabetes or alcohol use disorder are at increased risk, as are those with infections or injuries that break the skin, such as chickenpox. 

The first symptoms of STSS include fever and chills, nausea and vomiting, and muscle pain.[] Low blood pressure develops a day or two later, which is followed by a rapid health decline with organ failure, and rapid heart and breathing rates. Function may decline in the kidneys, liver, lungs, blood, skin, or soft tissues, and patients may develop necrotizing fasciitis or cellulitis. 

STSS is treated in the hospital with antibiotics, fluids, and other treatments for shock and organ failure. Surgery may be needed to remove infected tissue to control the infection. However, as many as 30% of people with STSS will die from the infection.

Since 2022 especially, many countries—including the US and those in Europe—have reported a rise in iGAS, partly due to an overall increase in strep A infections.[] The World Health Organization reported that at least five European countries showed an increase in cases of iGAS, with related deaths in some of these countries. Children younger than 10 years were most affected. 

According to preliminary 2023 data from the CDC, increased iGAS infections in older adults have been reported in some areas of the US, while infections remained high in children from December to April when group A strep infections are usually highest.[]

The case report 

In the 2024 Cureus case report, a 41-year-old patient with a history of asthma attended the emergency department with vomiting, diarrhea, and shortness of breath.[] Tests showed rapid heart and breathing rates and low blood pressure.

A chest X-ray showed fluid buildup in the left lung, and the patient was admitted to intensive care to treat respiratory failure. STSS was diagnosed based on a lung fluid culture that was positive for Streptococcus pyogenes, along with the presence of multi-organ failure.

Treatment included broad-spectrum antibiotics, vasopressors, intravenous immunoglobulin, and renal replacement therapy. However, the patient declined and developed blisters on the right foot and one of the toes turned black with necrosis. The patient’s health gradually improved after undergoing left-sided video-assisted thoracoscopic surgery (VATS).

“Management should involve a multidisciplinary approach, focusing on early, effective antibiotic coverage, source control with chest tube placement or VATS procedure, and early rehabilitation for patients who have experienced prolonged hospitalization,” the authors wrote.[]

How to stay safe

The CDC’s recommendations to prevent group A strep focus on three goals: limiting bacterial exposure and spread, treating group A strep infections, and using preventive antibiotics appropriately.[]

According to the CDC, infections can be prevented by washing hands often, caring for fungal infections, cleaning and protecting wounds, and covering coughs and sneezes. Individuals should also wash utensils and dinnerware after someone who is unwell uses them. Extra measures should be taken for those with impetigo, including washing often with soap and water, and daily laundering of clothes, linens, and towels.

For treatment of group A strep infection, antibiotics should be taken if prescribed to help prevent serious complications and infection spread. Preventive antibiotics may help protect people with rheumatic fever from getting reinfected. Close contacts of someone with a group A strep infection generally are not required to take antibiotics. However, healthcare providers may prescribe antibiotics to close contacts of someone with iGAS who are 65 years or older, or who have other factors that increase their risk of getting iGAS.[]

What this means for you

STSS can quickly develop into a life-threatening emergency. Cases are increasing in several countries, including the US, with death rates as high as 30%, despite treatment. Healthcare providers should educate patients on the signs and symptoms of iGAS, and consider it as a potential cause of severe illness. Patients with suspected infections should undergo blood, wound, and pleural fluid cultures.

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