Amidst a surge in incidents of streptococcal toxic shock syndrome, a formidable bacterial ailment renowned for its swift progression and formidable lethality, Japanese health authorities remain on vigilant alert. The documented occurrences of this uncommon yet grave malady peaked at 941 in Japan during 2023, as per reports by the National Institute of Infectious Diseases (NIID) and local media outlets.
This uptick in cases has been incessant, with 378 fresh instances documented as of February 25, constituting 40 percent of the total 2023 cases in merely under two months.
Originally, it was group A streptococcus bacteria that were responsible for the development of the overwhelming infection of the streptococcal shock syndrome (STSS) that was prevalent in Japan about 30 years ago, and with the present day population of about 125 million Japanese people, the average number of cases was around 100 to 200 every year.
The number, however, had been already going up before the pandemic, reaching 894 incidences last year (The Asahi Shimbun newspaper, 2019). The re-emergence of this disease has become now possible starting from the lifting of the pandemic cautionary.
STSS, colloquially dubbed as the “flesh-eating disease,” has the potential to induce necrosis of muscle tissues in severe cases. Although individuals of all age cohorts are susceptible to infection, it manifests more prevalently in individuals above the age of 30. Reports from Japanese media, citing NIID sources, indicate a mortality rate of 30 percent among afflicted individuals.
While the majority of individuals harboring streptococcus bacteria exhibit no discernible symptoms or merely present with a sore throat and dermatological manifestations, Japanese authorities highlighted by The Japan Times caution that if the bacteria disseminates to the bloodstream, muscles, or pulmonary system, symptoms can rapidly exacerbate, precipitating elevated blood pressure, organ malfunction, and in extreme scenarios, fatality. As of now, cases have been documented in 45 out of Japan’s 47 prefectures. In January, the Health Ministry urged regional administrations to procure specimens from patients diagnosed with this ailment to discern the various strains.
The Centers for Disease Control and Prevention (CDC) elucidate that any infection induced by group A streptococcus bacteria holds the potential to culminate in toxic shock syndrome. The onset of infection occurs when bacteria breach the body’s defenses through compromised barriers, such as dermal lesions or mucosal membranes. Subsequently, these bacteria disseminate to deeper tissues before infiltrating the circulatory system. The primary ingress points for streptococci fostering toxic shock syndrome encompass the pharynx, vaginal canal, mucous membranes, and integumentary/soft tissue.
Any form of dermal trauma or perforation, including surgical incisions, may serve as conduits for bacterial infiltration. “Regrettably, the mode of ingress remains obscure in up to 50 percent of cases,” as per the CDC. Treatment necessitates hospitalization, antimicrobial intervention, and eradication of the foci of infection, potentially through surgical intervention. The CDC approximates the mortality rate for STSS to range from 30 percent to 70 percent.
Preventative Measures
Japan’s Health Minister Keizo Takemi asserted in January that while the precise etiology of the surge remains nebulous, it likely correlates with the resurgence of respiratory ailments in the post-pandemic epoch now that Covid-19 bears semblance to seasonal influenza. With the relaxation of precautionary measures by the Japanese government, the health minister underscored the significance of stringent hygiene practices, as group A streptococcus propagates via respiratory droplets and surface transmission.
“We advocate preventive measures such as meticulous hand hygiene and adherence to proper respiratory etiquette,” Takemi imparted to The Japan Times.
As per The Asahi Shimbun, Takashi Nakano, a professor specializing in infectious diseases at Kawasaki Medical School, remarked, “There exist myriad unknown facets, such as the precipitating factors for the acute manifestation of the bacteria. To forestall infectious maladies, adopt rudimentary measures like hand hygiene and maintenance of wound sterility.” Nakano also advocated promptly seeking medical assistance if symptoms manifest with unusual severity.