Strep infections in children that can result in ‘flesh-eating’ disease becoming a concern

A computer-generated image of a group of gram-positive bacteria group A Streptococcus. (Jennifer Oosthuizen/CDC)

Doctors should be on the lookout for a special type of invasive strep infection in children that can result in so-called “flesh-eating” disease and organ failure, according to health officials.

Just before Christmas, the US Centers for Disease Control and Prevention issued an advisory on the recent increase in pediatric invasive Group A streptococcal infections, otherwise known as iGAS.

It is too early to know for sure whether the increase in such infections is what would be typical of a pre-pandemic season. But cases of iGAS in children this season are above similar periods seen in the first two years of the COVID-19 pandemic. In any case, the number of iGAS infections nationally has been relatively low.

However, federal officials have investigated a possible increase in iGAS infections in children at a Colorado hospital, and possible increases have subsequently been reported elsewhere.

These bacterial infections can cause potentially fatal diseases such as necrotizing fasciitis — sometimes referred to as “flesh-eating bacteria” — as well as toxic shock syndrome that can cause organ failure and sepsis, an extreme and sometimes fatal body 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 immediately report cases of Group A Streptococcus, including cases of necrotizing fasciitis and streptococcal toxic shock syndrome.

Group A Streptococcus bacteria can cause milder but still painful illnesses – such as streptococcal pharyngitis, commonly known as strep throat. Symptoms may include a 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 can also have a skin rash, known as scarlet fever.

In contrast, more dangerous iGAS infections “are associated with high mortality rates and require prompt treatment, including appropriate antibiotic therapy,” the CDC said.

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Health authorities in Britain have tracked cases of iGAS, which remain rare even there. Authorities in early December reported five deaths recorded within a week of a diagnosis of iGAS in children younger than 10 in England. During the last season where Group A streptococcal infections were particularly high, there were four deaths in the same age group in the same time period.

Exposure to someone with strep throat puts them at greater risk for an iGAS infection, the CDC said. Strep throat is common among school-aged children ages 5 to 15 and usually peaks in the US from December to April. Cases of iGAS are especially high when flu levels are high, and this flu season is shaping up to be the worst in at least a decade.

People who are already sick or have recently had a viral infection such as the flu or chickenpox are at higher risk for iGAS, according to the CDC. The elderly, nursing home residents, people with chronic medical conditions, those with wounds or skin diseases, intravenous drug users, homeless people, and Native American populations are also considered to be at higher risk for iGAS.

The CDC is urging parents to familiarize themselves with the symptoms of iGAS and seek immediate medical attention. Here is a summary of the symptoms of the most dangerous complications:

Necrotizing fasciitis: Early symptoms include a red, warm or swollen area of ​​skin that spreads quickly, severe pain and fever. Later symptoms may include ulcers, blisters or black spots on the skin, change in skin color, pus or discharge from the infected area, dizziness, fatigue, nausea or diarrhea.

Streptococcal toxic shock syndrome: The disease begins with fever and chills, pain, nausea and vomiting. But within 24 to 48 hours, more serious symptoms develop, such as low blood pressure, a faster-than-normal heart rate, 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 a lot and their eyes can turn yellow.

Cellulitis: Symptoms appear as a red, swollen and painful area of ​​skin – usually on the legs and feet – 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 have fever and chills,” the CDC said.

To help reduce the chance of severe symptoms, health officials recommend vaccination against the flu and chickenpox, as viral infections of these diseases put people at higher risk for an iGAS infection.

An iGAS bacterial infection in someone who already has a viral infection of another disease may present in a patient as persistent or worsening symptoms after an initial improvement of the disease.

This story originally appeared in the Los Angeles Times.