Scarlet fever bugs linked to fatalities

Press, 21 August 1989, Page 10

Scarlet fever bugs linked to fatalities

NZPA-AP Boston Scarlet fever bacteria, which have largely disappeared since the 19405, may be returning to cause a disease that can progress from a minor skin infection to death in a single day, doctors report. In the most recent issue of the “New England Journal of Medicine,” doctors describe 20 cases of severe illness, including six deaths, that were seen from 1986 to 1988 in four western American states. They blamed the outbreak on microbes known as group A streptococcal bacteria that make a toxin that causes scarlet fever. Other group A strep bacteria that do not make this poison cause sore throats as well as rheumatic fever and other illnesses. . The scope of .the newly identified outbreak is un- z clear. But doctors said it could be part of the apparent reappearance of especially potent strains of streptococcal bacteria. Strep bacteria were once a big cause of lifethreatening diseases, mainly scarlet fever and rheumatic fever, but these

illnesses largely disappeared around 1940/ No one knows precisely why, since this was before the development of antibiotics. About two years ago, other doctors began reporting an increase in the number of cases of rheumatic fever. In addition, outbreaks of severe strep disease have recently been reported in England and Scandinavia. “It’s a bigger problem than 20 patients, believe me,” said Dr Dennis Stevens, chief author of the study. “This is just being recognised. After this article is published, I suspect I will get a lot of calls and find out about a lot of cases.” Dr Robert Breiman of the United States Centre for Disease Control, in Atlanta, cautioned that occasional severe strep attacks may have escaped doctors’ attention in the past. “Whether these 20 cases .are a major change from the past it’s hard to know,” Breiman said. Stevens saw his first case in 1984 at the Veterans Administration Medical Centre in Boise,

Idaho. The victim had gone to the hospital with a mild fever. After 10 hours he went into shock and died eight hours later. “I was amazed at the rapidity with which this occurred,” he said. “I saw another case a year later. I started talking to colleagues. They told me of similar cases.” His colleagues, a group of infectious disease specialists who meet once a year, assembled the 20 cases from Montana, Idaho, Utah and Nevada. He has since seen more, including some in California and Washington state. Stevens believes the disease is caused by streptococcal bacteria that make scarlatina toxin, the poison responsible for scarlet fever. He prefers' to call the newly recognised disease streptococcal toxic shock syndrome, since it can kill without causing the classic rash of scarlet fever. Dr Edward Kaplan of the University of .Minnesota, a co-author of the latest study, said he believed there might be some connection between the emergence of these dangerous strep illnesses, perhaps a genetic change -in the strep bacteria. '