Recent reports have highlighted an increase in severe invasive group A streptococcal disease, with more than 1,000 cases of Streptococcal toxic shock syndrome (STSS) in Japan in the first half of 2024, surpassing the total for all of 2023. While this surge has been noted in several countries since 2022, it is important to note that these cases have not yet been published in peer-reviewed journals, so the accuracy of these reports may be questionable. STSS is caused by a strain of Streptococcus pyogenes bacteria, also known as “Strep A”, which can result in life-threatening infections such as pneumonia, skin infections, and STSS.
STSS is the most severe form of Strep A disease, although it is relatively rare. This condition primarily affects young children and the elderly, with pregnant individuals also at higher risk. The toxin produced by the bacteria can trigger an overwhelming immune response, leading to a rapid progression of symptoms that can be fatal. The early signs of STSS can be misleading, resembling common viral illnesses, making it challenging to diagnose. Symptoms may include fever, rash, nausea, lethargy, fast breathing, muscle aches, and confusion, which can be easily mistaken for other bacterial infections causing sepsis.
Several factors have been identified as potential contributors to the increase in STSS cases, including the absence of close contact between individuals during the height of the COVID-19 pandemic in 2020-21. With reduced exposure to Strep A and other pathogens, particularly in younger children who build immunity through repeated exposure, the resurgence of infections was inevitable as human contact increased in subsequent years. While virulent strains of Strep A may play a role in the current surge, it is crucial to recognize that STSS is not unique to Japan and has been reported in other countries, including Australia.
While there is no vaccine currently available to prevent STSS and other Strep A infections, simple hygiene practices such as handwashing and covering coughs can help reduce the spread of the bacteria. Prompt diagnosis and treatment with antibiotics are essential in managing STSS, as early intervention can prevent serious complications. In some cases, additional medications like immunoglobulin may be necessary to control the immune response, requiring intensive care unit support. It is also advisable to stay up to date with immunizations, especially for viral infections like chickenpox and influenza, which can precede serious Strep A complications.
The surge of STSS cases in Japan and other countries underscores the importance of understanding the symptoms, risk factors, and preventive measures associated with invasive Strep A infections. While the current situation may be alarming, staying informed, practicing good hygiene, and seeking prompt medical attention when necessary can help mitigate the risks associated with this rare but severe condition. As research continues to develop potential vaccines and treatment options, vigilance in recognizing and addressing early signs of STSS remains crucial in protecting individuals from the serious consequences of Strep A infections.