April 2000
CINCINNATI - Health officials here reported an increase of invasive group A streptococcal (GAS) disease.
Twenty-five cases of invasive GAS disease have occurred in a three-county area of Southwestern Ohio between Jan. 1 and Feb. 25, and 77 cases have been reported statewide year-to-date.
Of the cases confined to Hamilton, Butler and Clermont Counties, seven (28%) led to streptococcal toxic shock syndrome (STSS) and two resulted in death. All cases occurred in adults with the exception of one 2-month-old.
"It looks like there were no more than four to seven cases for the months of January and February in previous years, and there were 25 this year, so there is an increased number. Even given that, the population of those three counties is large enough that it's still a rare disease," said Alicia Fry, MD, MPH, epidemic intelligence service officer, Centers for Disease Control and Prevention (CDC). The CDC worked with the Ohio Department of Health and the county health departments in this investigation.
No obvious epidemiological links have yet been established, but researchers are still reviewing the data.
"Right now we're focused on getting specimens in for laboratory testing to see what strains are circulating," said Randy Hertzer, public information officer at the state health department. "We're conducting case investigations and talking with family members to help provide insight on whether there are any commonalties among the cases. Demographics are not a priority at this point."
![[bar]](/art/gradred.gif){kind=small}
According to Fry, children rarely contract invasive GAS since it tends to effect the extremes in ages; however, children often serve as a reservoir. "A child with a sore throat needs to be evaluated for streptococcal pharyngitis, preferably not empirically treated, but actually tested and treated appropriately because children are transmitters of the bacteria in the community," said Fry.
STSS has characteristic presentations, but some of the cutaneous manifestations of invasive GAS can be vague. Physicians should be thinking about those presentations to catch them early to avoid rapid disease progression.
"That's really the public health message," said Fry. "We sent notices to all of the physicians in the Ohio area alerting them there was an increased number of cases and they should be aware of that when they're seeing patients. We talked about some of the different clinical syndromes of invasive GAS to refresh their memories."
According to the CDC, GAS infection can result in a range of symptoms from no illness, to mild illnesses like pharyngitis and impetigo, to severe illnesses. Necrotizing fasciitis and STSS are the most severe, but least common forms of invasive disease. About 10,000 cases of invasive GAS occurred nationwide in 1998.
Early signs and symptoms of necrotizing fasciitis include fever, severe pain and swelling or redness at the wound site. Early signs and symptoms of STSS include fever, dizziness, confusion or a flat, red rash over large areas of the body.
Treatment for patients with GAS-associated necrotizing fasciitis and/or myositis includes both b-lactam antibiotics and clindamycin, as well as surgical débridement, according to the CDC. Some studies suggest that treating patients with STSS with intravenous immune globulin therapy may improve their outcome.
You can
express your views on this article, or other relevant themes, in the
Infectious Diseases in Children
Specialty Forums.