A Horrendous Ordeal For A Very Sick Patient
It was recently reported that a woman, who worked as a nurse, recently survived a five year battle with necrotizing fasciitis caused by a so-called “flesh eating bacteria.” However, the bacteria which almost took this woman’s life was the rather common Group A Streptococcus, an organism which can cause relatively mild infections. Group A Streptococcus is also the bacteria responsible for “Strep throat”, which requires antibiotic treatment. Though she suffer through a number of operations, and even a gut transplant, this woman survived her horrendous ordeal, and wants to go back to work as a nurse. Despite the unique severity of her case, Group A Streptococcus (also known as Streptococcus pyogenes) infections are much more common than most people realize.
How Many People Die of Group A Streptococcus Infection?
The CDC reports that there are approximately 10,000 cases of invasive Group A Streptococcus infection each year in the United States, which lead to approximately 1,000 to 1,800 deaths each year. These “invasive” Group A Streptococcus infections are much more serious than Strep throat and require hospitalization.
People who get these more serious cases of Group A Streptococcus may have immune dysfunction due to a disease such as diabetes, or they may have been infected with a more virulent strain of Group A Streptococcus. People who use steroid medication, who are alcoholic, or who have chronic diseases are also more prone to develop a serious infection, though many apparently “normal” people develop invasive Group A Streptococcus infections each year.
What Can I do to Prevent Group A Streptococcus Infection?
The woman mentioned at the beginning of this article recently had a surgical procedure performed, a Cesarean section, which likely was how she first became infected with Group A Streptococcus. Such operations, or even relatively minor cuts and injuries, provide an opportunity for bacteria to enter the body. If you have a cut you should watch for signs of infection, which include worsening redness, pain, swelling, discoloration and puss drainage. If you are concerned about a recent injury you should seek medical attention, especially if you feel sick or have a fever.
People with sore throats should make an appointment with their doctor to have a test for “Strep throat.” If positive, it means that you are infected with Group A Streptococcus, and need to take your full and complete course of antibiotics, even if you are feeling better. Untreated Strep throat can lead to a condition called rheumatic fever, which can produce heart disease, especially in children. This is why treatment of Strep throat with antibiotics is important.
Hand washing during food preparation can help to decrease the spread of Group A Streptococcus.
What other diseases are caused by Group A Streptococcus?
There are a lot of them, some mild and some life threatening. Listed below are some of the conditions which can be caused by Group A Streptococcus.
1. “Strep throat“, a sore throat (or “acute pharyngitis”) by infection with Group A Streptococcus, which mayuse acute rheumatic fever and rheumatic heart disease is not treated properly.
2. Impetigo, a skin infection, can be caused by Group A Streptococcus in addition to another type of bacteria called Staph aureus. Lesions are red and may have a crusted honey appearance to them.
3. Scarlet fever. This is a syndrome which occurs after Group A Streptococcus infection and causes sore throat, a skin rash which spares the face, a bright red “strawberry tongue” and fever. It can also progress to a number of life threatening Group A Streptococcus infections including Group A Streptococcus pneumonia and sepsis.
4. Pneumonia. In 2002, a group of 163 marines in San Diego came down with pneumonia. The culprit was found to be Group A Streptococcus for dozens of the men. The army had in the past considered using antibiotics to prevent Group A Streptococcus infection in newly arrived recruits, which is believed to be caused by many people sharing close quarters.
5. Necrotizing Fasciitis, the “flesh eating” condition described at the beginning of this article. Group A Streptococcus can also cause less serious wound infections occurring after surgery, which are treated aggressively to prevent the development of necrotizing fasciitis.
6. Middle ear infection, called “otitis media” by doctors.
7. Bacteremia. This is a serious condition in which bacteria invade and multiple in a person’s blood stream. This condition can progress to sepsis and even septic shock and death if not treated promptly with antibiotics.
8. Sinusitis. This is a bacterial infection of the sinuses.
9. Post-Streptococcal glomerulonephritis. This condition was first observed historically in patients recovering from Scarlet fever, and symptoms include blood in the urine, swelling, high blood pressure, and occasionally decreased urine output. Only certain strains of Group A Streptococcus produce this condition which is an immune reaction to recent infection with Group A Streptococcus.
10. Bone infections, called osteomyelitis, can be caused by Group A Streptococcus as well. Perhaps as many as 10% of cases of osteomyeltitis are casued by Group A Streptococcus.
11. Brain infections, and infections of the meninges surrounding the brain, called “meningitis” can be caused by Group A Streptococcus. Group A Streptococcus often colonizes the back of the mouth in adults, nonetheless only rarely does it cause meningitis. Spread of Group A Streptococcus from an inner ear infection, or from a sinus infection, can cause meningitis in rare cases.
12. Toxic Shock Syndrome. Toxic Shock Syndrome occurs when the human body’s immune system reacts to toxins produced by Group A Streptococcus, or another bacteria such as Staph aureus. An initiating reaction could be a gynecologic condition, or another Group A Streptococcus infection such as a skin infection. Toxic Shock Syndrome can be fatal, and symptoms include fever, rash, scaling of the skin, hypotension, and three symptoms affecting other bodily organs such as vomiting or diarrhea, muscle pains, kidney failure, changes in the level of conscious.
N Engl J Med 2004; 350:2093-2094May 13, 2004