Doctors should be on the lookout for a particular type of invasive strep infection in children that can lead to so-called “flesh-eating disease” and organ failure, health officials say.
Shortly before Christmas, the United States Centers for Disease Control and Prevention issued an advisory on the recent increase in pediatric invasive group A streptococcal infections, also known as iGAS.
It is too early to know for sure if the increase in these infections is what would be typical of a pre-pandemic season. But iGAS cases in children this season are higher than similar periods seen in the first two years of the COVID-19 pandemic. In any case, the number of iGAS infections nationwide has been relatively low.
However, federal officials investigated a possible increase in iGAS infections among children at a Colorado hospital, and potential increases were later reported elsewhere.
These bacterial infections can cause life-threatening diseases such as necrotizing fasciitis – sometimes called “flesh-eating bacteria” – as well as toxic shock syndrome which can cause organ failure and sepsis, an extreme and sometimes fatal bodily response to an infection. Another complication can be cellulitis, a bacterial skin infection that can lead to painful swelling.
The Los Angeles County Department of Public Health has asked local clinicians to promptly report cases of group A strep, including cases of necrotizing fasciitis and streptococcal toxic shock syndrome.
Group A Streptococcus bacteria can cause more benign but still painful illnesses, such as strep throat, commonly known as strep throat. Symptoms may include sore throat, pain when swallowing, fever, red and swollen tonsils, and swollen lymph nodes. Children may have symptoms that also include headache, stomach pain, nausea, and vomiting. People with strep throat may also have a rash, known as scarlet fever.
In contrast, more dangerous iGAS infections “are associated with high mortality rates and require immediate treatment, including appropriate antibiotic therapy,” the CDC said.
British health authorities have been monitoring cases of iGAS, which also remain rare there. In early December, authorities reported five deaths recorded within a week of an iGAS diagnosis in children under 10 in England. During the last season when group A streptococcal infections were particularly high, there were four deaths in the same age group during the same period.
Exposure to someone with strep throat puts them at increased risk for iGAS infection, the CDC said. Strep throat is common in school-aged children between the ages of 5 and 15 and typically peaks in the United States from December through April. iGAS cases are especially high when flu levels are high, and this flu season is shaping up to be the worst in at least a decade.
According to the CDC, people who have or have recently had a viral infection such as the flu or chickenpox are at higher risk for iGAS. Elderly people, nursing home residents, people with chronic illnesses, people with wounds or skin conditions, intravenous drug abusers, homeless people, and Native American populations are also considered to be more at risk of iSGA.
The CDC urges parents to familiarize themselves with the symptoms of iGAS and seek prompt medical attention. Here is an overview of the symptoms of the most dangerous complications:
Necrotizing fasciitis: Early symptoms include a rapidly spreading red, hot, or swollen area of skin, severe pain, and fever. Later symptoms may include ulcers, blisters or black spots on the skin, change in skin color, pus or oozing from the infected area, dizziness, fatigue, nausea or diarrhea.
Streptococcal toxic shock syndrome: The illness begins with fever and chills, body aches, nausea and vomiting. But within 24 to 48 hours, more serious symptoms develop, such as low blood pressure, faster than normal heartbeat, rapid breathing, and organ failure. Kidney failure, for example, can be detected if a person stops producing urine. Liver failure can be detected if they bleed or bruise heavily, and their eyes may turn yellow.
Cellulite: Symptoms appear as a red, swollen and painful area of skin – usually on the feet and legs – that is warm and tender to the touch. “The skin may look pitted, like the peel of an orange, or blisters may appear on the affected skin. Some people may also develop a fever and chills,” the CDC said.
To help reduce the risk of severe symptoms, health officials recommend getting the flu and chickenpox vaccines because viral infections from these illnesses put people at higher risk for iGAS infection.
A bacterial iSGA infection in a person who already has a viral infection from another disease may appear in a patient as persistent or worsening symptoms after an initial improvement in the disease.
This story originally appeared in the Los Angeles Times.