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Tokyo Issues Warning As Rare But Deadly STSS Bacterial Infections Rise
The Tokyo Metropolitan Government has issued a warning as cases of a rare-yet-severe type of bacterial infection have exceeded more than half of last year's count — 88 in the capital — along with 517 infections nationwide.
Concerns over the spread of streptococcal toxic shock syndrome (STSS), often dubbed the "flesh-eating disease," have reportedly prompted North Korea to cancel a rare soccer match with Japan that was to take place in Pyongyang.
In serious cases, STSS — most often caused by the bacteria called group A streptococcus — can cause necrosis of the connective tissues that covers muscles, and had a mortality rate of around 30% of the infected individuals in 2023, which is "an extremely high fatality rate," according to the Tokyo Metropolitan Government.
Toxic Shock Syndrome
Toxic Shock Syndrome or TSS is a rare yet severe bacterial infection that might be life-threatening if left untreated. It is caused by the bacteria, Staphylococcus aureus, that normally thrives on the skin, mouth or nose harmlessly but releases harmful toxins when it comes in contact with the body's bloodstream. Although toxic shock syndrome mostly affects menstruating women who use tampons; postmenopausal women, men and children can also get affected by the bacterial toxin. Here are some key aspects about toxic shock syndrome which everyone should be aware of.
CausesToxic shock syndrome is mainly caused by a toxin produced by some strains of Staphylococcus aureus (and not all staphylococcus bacteria) and in some cases by Streptococcal bacteria. Apart from this, this disease can be caused by –
One of the common risk factor of toxic shock syndrome is use of tampon by women (for a long time) during their menstruation. However, there are few other factors that increase the risk of being infected with the bacterial toxin. These are –
A sudden high fever (body temperature of 102 degree F) is the initial symptom that signifies that a person might be suffering from toxic shock syndrome. The other symptoms gradually arise after few hours and include –
As of now, there is no single test to diagnose toxic shock syndrome. However, based on the symptoms (fever, low blood pressure and skin rash), your doctor will diagnose the condition and recommend treatment options. In some cases, your doctor might recommend organ function tests and blood cultures (S. Aureus) to confirm the condition.
Also, it is important to consult a doctor as soon as you notice any of these symptoms as this disease can be fatal.
TreatmentIt should be noted that toxic shock syndrome requires urgent clinical attention and any foreign materials such as tampons, nasal packing or vaginal sponges should be removed immediately, if used. Apart from this, surgical wounds (if any) have to be drained out to hinder bacterial growth. Depending upon the severity and cause of the disease, your treatment is initiated. It usually includes –
Antibiotics: These are given to inhibit the bacterial growth and thus, limit the production of toxins.
Dialysis: If the disease has affected the kidneys, then dialysis is done to remove toxins from the body.
Medications: Most people experience low blood pressure and hence, it is necessary to control your blood pressure with use of medications.
Intravenous fluids: Apart from this, blood transfusion and intravenous fluids are given to the patients to improve their condition and maintain electrolyte balance in the body.
In severe cases, use of a ventilator to temporarily improve your breathing process might also be required to stabilise the condition of the patient.
PrognosisThe mortality rate of toxic shock syndrome is around 50%, which means that around half of the people suffering from the condition die. Also, the chance of suffering from this disease again in their lifetime is very high.
ComplicationsIf left untreated, toxic shock syndrome might lead to severe organ dysfunction which in turn causes liver, kidney and heart failure. And in rare cases, it might cause death.
PreventionThe only effective measure to prevent toxic shock syndrome in women is to avoid using high-absorbent tampons during their periods. Also, maintaining proper hygiene and sanitation plays a key role in the prevention of the disease.
More From Toxic shock syndromeThe Rapid Spread Of A Serious Bacterial Infection Is Causing Concern In Japan
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.
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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