For the second consecutive year, Japan is experiencing a record number of cases of a potentially fatal bacterial infection, streptococcal toxic shock syndrome (STSS). Health experts are investigating the causes behind this alarming increase, with some suggesting that the COVID-19 pandemic’s social distancing measures might be a factor.
According to the Japan Health Ministry, 977 cases of STSS were reported by June 2nd, surpassing last year’s record of 941 infections. The Japan Times reports that 77 individuals succumbed to the disease between January and March this year.
STSS is a severe and rare complication of Group A Streptococcus (GAS), specifically the Streptococcus pyogenes strain, which also causes strep throat. The condition is life-threatening, with a mortality rate exceeding 30%. It occurs when the bacteria enter the bloodstream, leading to a systemic inflammatory response and toxic shock, causing symptoms such as low blood pressure, organ failure, and loss of consciousness.
Additionally, GAS infections in Japan are linked to necrotizing fasciitis, a serious condition often referred to as “flesh-eating” disease. This infection rapidly destroys tissue and requires emergency surgery. While GAS infections don’t always lead to severe outcomes, they are highly transmissible among children and can manifest as sore throats, rashes, and swelling.
“GAS can be transmitted through close personal contact and can be asymptomatic, but it can also cause classical strep throat symptoms like throat inflammation and pus-filled tonsils,” explained Dr. William Schaffner, a Professor of Infectious Disease and Preventive Medicine at Vanderbilt University.
Consecutive Record Years
In the past two years, Japan has seen a significant rise in both the number of STSS cases and fatalities. An assessment by Japan’s National Institute of Infectious Diseases in March indicated an increase in cases, a trend that has continued.
“At the current infection rate, cases in Japan could reach 2,500 this year, with a 30% mortality rate,” warned Ken Kikuchi, a Professor of Infectious Diseases at Tokyo Women’s Medical University. Most deaths occur within the first 48 hours, he added.
“Patients presenting to emergency rooms are often critically ill, with multiple organ systems affected, requiring immediate intensive care,” noted Dr. Dean Winslow, an infectious disease expert at Stanford Medicine.
Investigating the Surge
The precise cause of the recent surge in GAS infections remains unclear. However, experts speculate that the rise in various infections post-pandemic could be a contributing factor. During the pandemic, quarantine measures led to a global reduction in respiratory infections, including a 25% drop in GAS infections, according to the Centers for Disease Control and Prevention.
“Now that social interactions have resumed, these infections are making a comeback. Group A strep has not only returned to pre-pandemic levels but has also surpassed them in many countries, including Japan,” said Dr. Schaffner.
Dr. Amesh Adalja, a Senior Scholar at the Johns Hopkins Center for Health Security, suggested that the lack of exposure to the bacteria during the pandemic created an “immunity debt,” leading to increased infections now.
Identifying and Treating STSS
Initial symptoms of a GAS infection include chills, fever, and headache. Strep throat symptoms include red, swollen tonsils and throat, white patches, pus, and red spots in the mouth and throat. Common GAS infections are treated with antibiotics like penicillin and amoxicillin.
However, if the infection progresses to STSS, emergency intensive care is necessary. Symptoms of STSS include a rapid heart rate, difficulty thinking, rapid breathing, absence of urine, bleeding, bruising, jaundice, and low blood pressure. Treatment involves the antibiotic clindamycin and additional care for shock, such as oxygen, intravenous fluids, and blood pressure medication. Surgery may be required to remove dead tissue.
Conclusion
Japan is grappling with an unprecedented rise in streptococcal toxic shock syndrome (STSS) cases. This severe complication of Group A Streptococcus has resulted in 77 deaths this year, with a mortality rate exceeding 30%. Experts are investigating the causes, with some attributing the surge to increased infections following the relaxation of pandemic restrictions.
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