Invasive strep A is on the rise and affecting kids in unusual ways

On Dec 21, 2022

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The seven kids with oddball symptoms arrived at Children’s Mercy Kansas City Hospital in Missouri in quick succession this past month. One complained of an eye that was “stuck.” Another had a lump behind one ear. A third had trouble swallowing, and then began drooling.

There was no reason to think these and four other cases, all in children younger than 10, might be related, recalled Angela Myers, the director of infectious diseases. But when the lab tests came back, they all pointed to the same culprit.

It was a potentially lethal form of strep A.

“We were very surprised,” Myers said. “We just don’t see this many together in such a short time.”

Infection with Streptococcus pyogenes — or group A strep, for short — typically produces mild symptoms, such as rash, fever or swollen tonsils leading to the eponymous strep throat. But in recent months, cases related to a rare invasive form of the common bacteria have been popping up across the United States, as well as Europe, often in connection with sometimes confusing symptoms, including skin rashes, fever, a racing heart and unexplained swelling.

The first confirmed pediatric deaths in this country, in two young children in the Denver area, were reported last week. At least 16 children have died of it in the United Kingdom, seven in the Netherlands and two in France.

The rise of invasive strep A is one of a number of unusual ways pathogens have been interacting with us — and each other — amid the end of coronavirus-era social distancing and masking this year. Both the World Health Organization and the U.S. Centers for Disease Control and Prevention said they are investigating the cases, including whether the viral storm that has been keeping many people sick may be at least partially to blame.

Why a ‘tripledemic’ is keeping some people sick for weeks, even months

Viral infections tend to create disorder in a person’s immune system, making it easier for a secondary bacterial infection to take hold and intensify its effects in some cases.

Minnesota health officials said they had seen 46 cases of invasive strep A in all ages in November, more than double the average 20 cases in previous months. Colorado reported that it was investigating not only a rise in invasive strep A cases, but also a possible increase in other severe or invasive bacterial infections in children.

Texas Children’s Hospital said it has seen more than 60 patients with invasive strep A in October and November — a fourfold increase from the same period the previous year. James Versalovic, pathologist-in-chief for the medical center, said many of the affected children had current or recent viral infections. But, he said, it is still too early to rule out other factors that may be contributing to the seriousness of their illnesses.

“It could be we have altered patterns of immunity due to the pandemic that may have increased our vulnerability. But it could also be … different variants” of strep, he said. “It could be a combination of factors. No one knows.”

Unlike SARS-CoV-2, strep A is something humans have battled for centuries.

It has variously been described, incorrectly, throughout history as being associated with phenomena such as comets and eclipses, or the introduction of nonliving matter into humans. It wasn’t until 1874 that Austrian surgeon Theodor Billroth described an organism he saw under a microscope that appeared to be grouped in chains of four or more that would later be classified as bacteria. Bacteria can live in or out of a patient’s body, unlike viruses, which are a collection of molecules that can only replicate in a host. Both are transmitted in similar ways — through air, water, food and living things.

Several million people in the United States are infected each year with strep A, and in our modern world, with its ample supply of antibiotics, it is mostly a nuisance. It usually translates into a sore throat, and maybe a missed day of school or work during the 24 hours it takes to stop being contagious after taking antibiotics such as penicillin and amoxicillin.

Strep A: What you need to know about the usually mild infection

“The good news is that we know how to treat it and how to test for it,” said Kristin Moffitt, an infectious-disease expert at Boston Children’s Hospital who studies bacterial infections. “Normally it’s not a source of serious concern that I would be hyper-anxious about.”

But in a small number of cases, strep A can turn dangerous when it invades parts of the body where bacteria don’t normally exist. When it goes into such areas, including the blood, cerebrospinal fluid, bone marrow and organs such as the brain and heart, it can spread quickly and kill.

The first reports of unusual activity as a result of invasive strep A, mostly involving children 5 and under, came from the Netherlands between March and July. It was not only the number of cases and their severity, doctors…