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EMS BULLETIN
SUBJECT: STREPTOCOCCAL INFECTION
NUMBER:95-09
DATE: April 10, 1995
01 of 01

In response to numerous inquiries regarding the Invasive Group A Streptococcal Disease described by the media as " the Flesh Eating Bacteria, " The office of Medical Affairs is disseminating for your use the attached information which has been distributed by the New York City Department of Health based upon a bulletin from the Federal Centers for Disease Control.

If there are any further questions, please do not hesitate to contact the Office of Medical Affairs at 1-718-416-7333 during normal business hours, or the Medical Director on-call via the Tour Commander after business hours.

Lorraine M. Giordano, M.D.
Director of medical Affairs

NEW YORK CITY EMERGENCY MEDICAL SERVICE
HHC 661 (Jun 83)
New York City Department of Health April, 1995
Questions and Answers on Group A Streptococcus

What is Group A Streptococcus (GAS)?
Group A Streptococci are bacteria commonly found in the throat and on the skin. The vast majority of GAS infections are relatively mild illnesses such as strep throat and impetigo. Occasionally however, these bacteria can cause much more severe and even life threatening diseases such as necrotizing fasciitis (occasionally described by the media as "the flesh-eating bacteria") and Streptococcal Toxic Shock Syndrome (STSS). In addition, people may carry group A streptococci in the throat or on the skin and have no symptoms of disease.

How are Group A Streptococci Spread?
These bacteria are spread by direct contact with respiratory secretions (nose and throat discharges) of an infected individual or by contact with infected skin lesions. Communicability is greatest when an individual is ill, such as when people have "strep throat" or an infected wound. Individuals who carry the bacteria but have no symptoms are much less contagious. Treatment of an infected person with an appropriate antibiotic for 24 hours or longer eliminates contagiousness. However, it is important to complete the entire course of antibiotics as prescribed. Household items like plates, cups, toys etc., do not play a major role in disease transmission.

What is Invasive Group A Streptococcal Disease?
Invasive GAS disease is a severe and sometimes life threatening infection in which the bacteria have reached parts of the body were bacteria are not usually found, such as the blood, deep muscle and fat tissue, or the lungs. Two of the most severe, but least common, forms of invasive GAS disease are called "necrotizing fasciitis" (A destructive infection of muscle and fat tissue) and "Streptococcal Toxic Shock Syndrome" (a rapidly progressing infection causing low blood pressure/shock and injury to organs such as the kidneys, liver, and lungs). Approximately 20% of patients with necrotizing fasciitis and 60% with STSS die. Only about 10-15% of patients with other forms of invasive group A streptococcal disease die.

How Common in Invasive Group A Streptococcal Disease? 
It is estimated that approximately 10,000-15,000 cases of invasive GAS disease occur in the U.S. each year resulting in over 2,000 deaths. CDC estimates there are between 500-1,500 cases of necrotizing fasciitis and 2,000-3,000 cases of STSS each year in the United States. In contrast, there are several million cases of strep throat and impetigo annually.

Why Does Invasive Group A Streptococcal Disease Occur? 
Invasive group A streptococcal infections occur when the bacteria get past the defenses of the person who is infected. This may occur when a person has sores or other break in the skin that allows the bacteria to get into the tissue. Health conditions that decreases a person's immunity to infection also makes invasive disease more likely. In addition, there are certain strains of group A streptococci that are more likely to cause severe disease than others. Many of the most severe infections have been caused by strains designated M-1 and M-3. The reason why some strains will cause more severe illness is not totally clear but may involve the production of substances ("toxins") that cause shock and organ damage, and "proteases" that cause tissue destruction.

Who Is Most At Risk Of Invasive Group A Streptoccal Disease? 
Few people who come in contact with a virulent strain of GAS will develop invasive GAS disease, most will have a routine throat or skin infection and some may have no symptoms whatsoever. Although healthy people can get invasive GAS disease, people with chronic, diabetes, and kidney dialysis, and those who use medications such as steroids are at high risk. In addition, breaks in the skin, like cuts, surgical wounds, or chicken pox may provide an opportunity for the bacteria to enter the body.

Can Invasive Group A Streptococcal Disease Be Treated? 
Group A Streptococcal disease can be treated with common, inexpensive antibiotics. Penicillin is the drug of choice for both mild and severe disease. For penicillin-allergic patients with mild illness, erythromycin can be used, although occasional resistance has been seen. Clindamycin may be used to treat penicillin allergic patients with more severe illness and can be added to the treatment in cases of necrotizing fascitis or STSS. Certain other antibiotics are effective. In addition to antibiotics, supportive care in an intensive care unit and sometimes surgery are necessary with these diseases. Early treatment may reduce the risk of death although, unfortunately, even appropriate therapy doesn't prevent death in every case.

ToolBook (c) 1990 Asymetrix Corporation 

 

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