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Vol. 2, No. 3 June 1994 |
Flesh Eating Bugs - In Our Own Backyard?
Recently the British tabloids have taken some of their precious Princess Diana hounding time to report an apparent epidemic of flesh eating bugs. Should we be worried that this dangerous creature will see the Atlantic Ocean as a small barrier and soon be threatening the North American continent?
The identity of this flesh eater has not been clear in a number of the sensationalistic reports. In actuality, this invisible cannibal is a commonly encountered bacteria, Streptococcus pyogenes, also know as group A streptococcus(GAS). This is the agent responsible for "strep throat" and rheumatic fever. In addition to these classical disease states, GAS is capable of causing a wide variety of serious , invasive infections of the soft tissues including cellulitis and necrotizing fasciitis and toxic shock-like syndrome. Invasive GAS infection is a severe, rapidly progressive infection. The site of entry of infection may be a trivial scratch or the lungs; sometimes a site of entry not determined.
Patients with invasive disease require rapid institution of antibiotic therapy meticulous supportive care, and often surgical debridement of soft tissue infection. Even with optimal care, mortality is substantial. In Ontario, the reported mortality was 53 per cent1.
The frequency of severe GAS infections declined during this century as a result of adequate antibiotic treatment, improving sanitary conditions and better access to health care. Some have also postulated that the virulence of the organism also decreased at that time. Severe GAS continues to be a very rare disease, even though in the late 1980's, an apparent increase in the frequency of invasive disease was appreciated worldwide. Overall, the number of cases per year in Ontario is less than ten.
Health care workers are not considered at an increased risk of developing group A streptococcal infections. Patients with severe GAS disease are not routinely isolated. Those caring for them do not need to wear a mask, although body substance precaution is important as it is with the care of all patients.
The rapid course, high risk of death and the fact that severe GAS infections can affect people who were previously healthy, make the disease a perfect subject for the media. Although the seriousness of this disease should not be minimized, it must be considered in context. A single media report does not an epidemic make.
Guest writer: Dr. W. Wobeser
References:
- Demers, B., Simor, A.E., Vellend, H. et al. Severe invasivegroup A streptococcal infections in Ontario Canada: 1987-1991. Clin Inect Dis 1993; 16: 792-800.
- Nichols, M. Maurauding microbes: Is a deadly new disease sweeping the globe? Maclean's 1994: June 6:87
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