2024-03-26 07:50:00
Streptococcus pyogenes (Source: Public Health Image Library)
On March 20th, JoongAng Ilbo, a leading South Korean newspaper, stated, “As the number of Korean tourists visiting Japan has increased, caution is needed as an infectious disease with a mortality rate of up to 30% has recently spread rapidly in various parts of Japan. ” published an article. From January to February 2024, a total of 378 cases of fulminant hemolytic streptococcal disease (STSS) were reported, and infections were confirmed in all but two of the 47 prefectures. The content was that it had been done.
STSS, also known as the “flesh-eating bacteria,” is a terrifying infection that can rapidly cause gangrene in muscles and skin tissue. And it is true that the number of infected people is increasing every year. The first case of infection was reported in the United States in 1987, and it was first detected in Japan in 1992. According to preliminary data from the National Institute of Infectious Diseases’ IDWR (Infectious Disease Trends Research Weekly Report), the number of cases reported in Japan in 2023 is 941, an increase of 209 from the previous year (preliminary figures). Although the number of cases has been decreasing in recent years, perhaps due to the spread of the coronavirus pandemic, the number of cases has been decreasing since 1999, when the survey began in 1999.This number exceeds the highest ever recorded in 2019 (894 people).
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Yasutaka Mizuno, an infectious disease physician and director of the Global Healthcare Clinic, who has experience in treating STSS patients, explains the pathogen and its symptoms as follows.
“The mechanism by which STSS develops is not completely understood, but there is a type of hemolytic streptococcus (hemolytic streptococcus) that is found everywhere that produces a strong toxin and is said to cause the fulminant form. There are several types of bacteria, but they are generally known as the causative bacteria (group A streptococcus) that causes children’s tinnitus.It has a red toxin and is the cause of scarlet fever and impetigo. I will do it.”
What is strange is that streptococcal infections, which are normally more common in children, are more common in adults over the age of 30 when it comes to STSS. In Mizuno’s view, it is rare for bacteria to enter the bloodstream from things like childhood epileptic seizures, and that “in most cases, wounds caused by trauma are the gateway to entry.”
In fact, this was the case in the case that Mizuno first examined more than 20 years ago. The patient, an 8-year-old child, was injured during basketball practice and came to the hospital with a high fever of 40 degrees Celsius and his feet swollen.
“He said he suffered a sprain, but there was an existing wound and bacteria may have gotten into it.At that time, STSS cases were not as reported as they are now, but at that time, My boss suggested this possibility, and I started treatment right away, which saved my life.
The symptoms progress quickly. Cases of swelling of the extremities accompanied by high fever include cellulitis, but Mizuno says that currently, “STSS is the first suspect.”
“The initial symptoms are high fever and pain in the extremities. Strong pain and swelling appear in the area where the bacteria has gathered.Then, the disease progresses rapidly over several hours and necrosis of the muscle and skin tissue occurs. You become dizzy and confused. If treatment is delayed, there are many cases where shock and multiple organ failure develop, leading to death.”
Additionally, as pointed out by JoongAng Ilbo, this disease is characterized by an incredibly high mortality rate. The mortality rate for group A streptococcus is said to be about 30%, but for different types of streptococcus, the mortality rate can reach 70%. Mizuno also believes that the numbers will change depending on “what kind of diagnosis is made first.”
“If you suspect STSS, you can’t just wait and see. It progresses while you wait, so if you don’t take action accordingly, it will be irreversible. It may make a difference whether a doctor examines you or not.”
So, what kind of treatment is given for STSS? Mizuno says, “The only solution is to administer large doses of antibiotics that have a strong effect on streptococcus.”
“The first thing to do is to stop the progression of the infection by giving antibiotics through an intravenous drip without hesitation, but if tissue necrosis (necrotizing fasciitis) has progressed, it is necessary to stop the spread of the infection as soon as possible. Therefore, surgery to remove necrotic tissue may be performed at the same time.If diagnosed early and appropriate treatment initiated, this is an infectious disease that can save lives.”
However, as mentioned above, in the two months up to February 25th, the number of domestic patients was 378, which is already more than 40% of the number of patients in last year. The pace of the outbreak is such that on January 17th, the Ministry of Health, Labor and Welfare issued an emergency notice to local governments across the country, calling for vigilance. At the same time, the Ministry of Health, Labor and Welfare is proceeding with the analysis of strep bacteria collected from patients.
“STSS is a Class 5 infectious disease and all cases are subject to reporting. The doctor who diagnosed it must report it to the public health center within seven days. In recent years, the media has frequently reported on the increase in the number of STSS infections, Furthermore, since the end of last year, there has been an outbreak of pharyngitis caused by streptococcus, and it appears that the causative bacteria are more present in the environment than ever before.
If you get injured while exercising, there is a risk of infection. If you experience pain and swelling in your arms or legs along with a high fever after an injury, it’s best to rush to an infectious disease department as soon as possible.
Written by Ryusuke Suzuki
( SmartFLASH
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