Reports from the UK state that twelve children have so far died because of a strep A infection. While the families are rightfully heartbroken, the medical community is left wondering how it could be that a germ that leads to such a common infection can cause such a high number of deaths in a brief period of time and so early in the winter. The first thing that we need to understand is what exactly is strep A.
Strep A refers to a number of about 120 strains of bacteria from the Streptococcus group A, with the most frequent one being Streptococcus pyogenes. While it is the most common cause of strep throat, it is no secret that it can cause more serious complications, like scarlet fever, rheumatic fever or kidney disease as long-term complications if left untreated, and even invasive forms of streptococcal infections that can lead to sepsis and death. It is worth noting that cases like these are rare and are most often associated with pre-existing conditions that lower the immunity. Scientists are trying to asses if that is what’s currently happening with the deaths in the UK.
What are the symptoms of strep infection?
The most common manifestation of group A Streptococcus infection is strep throat. This can present itself as a sore throat accompanied by high fever, but without the common symptoms that suggest a viral infection, like cough, sneezing or a runny nose. More often that not, the sore throat and the fever can be the only symptoms, which is a very useful sign in guiding the diagnosis process towards strep throat. At a clinical examination, patients have tonsils that are red and swollen, with white spots on them. This is another sign that is very suggestive for a streptococcal infection.
Strep throat is not the only manifestation of group A Streptococcus. Some patients with strep throat develop a skin condition that is called scarlet fever, which leads to a generalized rash on the entire surface of the body known as sandpaper skin because of the way it feels to touch. Another sign of scarlet fever is called “strawberry tongue”, because of the aspect of the tongue, which looks red and bumpy. While scarlet fever used to be considered a critical condition before the use of antibiotics, it can now be both prevented through proper treatment of strep throat, and successfully treated.
Transmission, diagnosis and treatment of strep infections
The transmission is mostly airborne, through coughing and sneezing, which means that proper hygiene is efficient when it comes to preventing the condition. Diagnosing a streptococcal infection is a multi-step process, starting with the patient’s history, the clinical presentation, all the way to confirming it with a throat swab, from which a culture can be performed that will identify the germ. As for the treatment, seeing as the infection is bacterial in nature, a course of antibiotics is not only necessary, but mandatory and vital.
What’s different about the Strep A in UK at the moment?
Specialists still do not currently have all the answers as to why so many children have died in such short time because of an infection that usually tends to have a predictable, uncomplicated outcome. Strep throat affects millions of children worldwide every single year and the evolution is more often than not mild. So what’s happening this winter?
What we know so far is that, while group A Streptococcus tends to affect children between the ages of 5 and 15, there have been reported cases of an increased incidence of streptococcal infections, even invasive ones, in adults, which is less common that in the previous years. Another atypical occurrence is that so many cases of infection evolve towards an invasive form of the disease.
What is invasive strep?
An invasive form of the disease refers to the eventuality that, while the infection is firstly localized in the throat, it can spread to nearby tissues and from there, further into the body going as far as to enter the bloodstream and lead to sepsis. The invasive form of the disease can have several ways of manifestation. One of them is called necrotizing fasciitis, commonly known as “flesh-eating bacteria”, and it’s what happens when the streptococcus starts attacking large areas of muscle tissue, leading to severe ulcers and painful tissue necrosis.
From there, the bacteria are one step closer to causing sepsis, which means the infection has reached the bloodstream. This stage is particularly dangerous and life-threatening and needs aggressive antibiotic therapy.
Another invasive form is called Streptococcal Toxic Shock Syndrome and it’s what happens when, in the process of bacteria being destroyed by the immune system, they release toxins into the bloodstream that can also lead to sepsis, as well as multi-system organ failure.
What could cause this?
There are many unknown variables at hand at the moment. Doctors are currently doing their best to better understand why it’s happening, the mechanisms of it, and how to prevent it and treat it efficiently.
Theories are blaming the surge in respiratory infections recently, particularly in the pediatric population, possibly due to a decrease in immunity. It has been suggested that the pandemic and the precautions taken against COVID have weakened the defense mechanisms that the body is relying on in order to properly fight off infection, by lowering the exposure to threats. Particularly in children, who already have an immature immunity that’s incompletely developed, it is believed that this has left them more vulnerable.
At the same time, another theory states that, seeing as we don’t fully understand the long-lasting effects of COVID-19, this can be a side effect of it that targets the efficiency of the immune system.
A fraction of the medical society also believes that this new, more aggressive strain of strep A can be a consequence of the antibiotic resistance phenomenon and of the practice of incorrect antibiotic overuse that can lead to bacteria that develop better defenses against the weapons we have in our arsenal.
One thing is for sure. No matter the cause of it, prevention is key. At the moment, doctor advise treating every respiratory threat as if it were life-threatening, in the sense of taking the right precautions against respiratory infections, practicing proper hygiene, and seeking medical attention if your child is sick. More measures will be released to the public once specialists learn more about this threat.
This content is accurate and true to the best of the author’s knowledge and does not substitute for diagnosis, prognosis, treatment, prescription, and/or dietary advice from a licensed health professional. Drugs, supplements, and natural remedies may have dangerous side effects. If pregnant or nursing, consult with a qualified provider on an individual basis. Seek immediate help if you are experiencing a medical emergency.