Japan is worried about the explosion in cases of the very serious streptococcal toxic shock syndrome (STSS) caused by group A streptococci (GAS or pyogenic streptococci). The National Institute of Infectious Diseases (NIID) identified 422 cases between January 1 and March 17. This compares with 941 in 2023. 27 of the 47 Japanese departments are on red alert for this infection, which has a mortality rate of over 30%.
The situation is all the more serious, since in the summer of 2023 (and for the first time in Japan), authorities discovered a Group A Streptococcus (GAS) of the M1UK lineage, more virulent and more transmissible (the British strain, the most common in Europe).
Sometimes dubbed the "flesh-eater", the bacterium – which many people carry without knowing it and without becoming ill – can lead to infection of subcutaneous tissue and necrotizing fasciitis, named after the fascia, the tissue covering the muscles.
This is followed by multi-organ failure, including acute renal failure, acute respiratory distress syndrome, and disseminated intravascular coagulation (DIC), a coagulation abnormality that can lead to hemorrhage and thrombosis. All at a rapid rate. "One-third of people who develop the disease can die within 48 hours," explained Ken Kikuchi, an infectious disease specialist at Tokyo Women's Medical University, who says he is "very concerned" about the increase in 2024.
Serious consequences
Patients who do not succumb to the disease can suffer severe consequences. In a report on January 22, TV Asahi cited the case of a man who felt pain in his leg after a day of playing basketball. His leg swelled, becoming purplish in places, and his temperature reached 40°C. He saw a doctor, who did not run blood tests but prescribed antibiotics and fever medication. "If the pain was too much, I also had painkillers," he said. A week later, he was rushed to hospital after fainting: "Sepsis due to 'flesh-eating bacteria' was diagnosed." His leg was amputated but he survived after a stay in intensive care.
GAS is transmitted by aerosols. But the US Centers for Disease Control and Prevention pointed out that "for nearly half of people with GAS, experts don't know how the bacteria got into the body. Sometimes they enter through openings, such as a wound or surgical incision. The bacteria can also enter through mucous membranes, inside the nose and throat."
The first symptoms of GAS are a sore throat, fever, diarrhea, vomiting, and severe fatigue. Risk factors include a weakened immune system and a chronic illness such as diabetes. "There are still many things we don't know, including why the bacterium becomes fulminant," added Takashi Nakano, an infectious disease expert at Kawasaki Medical School.
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