Opinion

The seven children with badoball symptoms were rushed to Children’s Mercy Kansas City Hospital in Missouri last month. One complained of a “stuck” eye. Another had a lump behind one ear. The third had trouble swallowing, and then he started drooling.

“There was no reason to think these and four other cases in children under 10 were related,” recalls Angela Myers, director of infectious diseases. But when the lab tests came back, they all pointed to the same culprit.

It was type A of Strep, which can be fatal.

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

Streptococcus pyogenes – or group A strep, for short – typically leads to the famous strep throat with symptoms like a rash, fever or swollen tonsils. But in recent months, cases of rare invasive species of common bacteria have been popping up more frequently in the United States and Europe. Sometimes confusing symptoms, skin rash, fever, racing heart and unexplained swelling.

The first confirmed infant deaths in this country were two young children in the Denver area. It was reported last week. At least 16 children died as a result. United Kingdomseven in the Netherlands and two in France.

The rise of invasive strep A is one of the more unusual ways to bring pathogens with us — and each other — in the end of this year’s coronavirus-era social disruption and cover-up. Both World Health Organization and the US Centers for Disease Control and Prevention They said they are investigating the cases, including the possibility that a viral storm that has sickened many people is at least partly to blame.

Why ‘tripledemic’ makes some people sick for weeks or even months

Viral infections cause impairment in a person’s immune system, which makes it easier for secondary bacterial infections to develop and in some cases exacerbate the effects.

Minnesota Health officials said they saw 46 cases of epidemic strep A among all ages in November, more than double the average of 20 in previous months. Colorado It reports not only an increase in invasive strep A cases, but also an increase in other serious or invasive bacterial infections in children.

Texas Children’s Hospital said it saw more than 60 patients with invasive strep A in October and November — a fourfold increase over the same period last year. James Versalovic, chief pathologist at the medical center, said many of the affected children had current or recent viral infections. But it is still too early to rule out other factors contributing to the severity of their illness, he said.

We may have changed our immune systems because of the pandemic, which may have increased our vulnerability. But it could also be…various differences,” he said. “It could be a combination of factors. Nobody knows.”

Like SARS-CoV-2, strep A is something humans have struggled with for centuries.

Historically, it has been mistakenly associated with events such as comets and eclipses, or inanimate objects entering humans. The Austrian surgeon Theodor Billroth described the organism that was classified into four or more chains and observed under a microscope in 1998. It was in 1874. Bacteria can live in or out of the patient’s body, unlike viruses, they are a collection of molecules that can only reproduce in the host. Both are transmitted in the same way – through air, water, food and living things.

Millions of people in the United States contract strep A every year, and in our modern world, where there are many antibiotic supplies, it is often stressful. It often translates to a sore throat, and you may miss a day of school or work within 24 hours after taking antibiotics such as penicillin and amoxicillin to stop the infection.

“The good news is that we know how to treat and diagnose,” said Christine Moffitt, an infectious disease specialist at Boston Children’s Hospital who studies bacterial infections. “It’s not a source of stress that I normally worry too much about.”

But in small amounts, staph A can become dangerous when it enters parts of the body where bacteria are not present. When it enters these areas, including blood, cerebrospinal fluid, bone marrow, and organs such as the brain and heart, it can quickly spread and kill.

The first reports of unusual activity due to invasive strep A, mostly involving children aged 5 and under, came from the Netherlands between March and July. Not only the number and weight of the cases, but doctors in A Pre-publication research paper Posted on December 13th, but many patients also have co-infected viruses such as the flu or chicken pox. (Unlike in the United States, varicella vaccines, which cause measles, are not part of the childhood immunization program in the Netherlands.)

In the year In 2018 and 2019, the majority of children seen in Dutch hospitals developed invasive strep A sepsis, systemic infection or pneumonia. But this year, many have been diagnosed with necrotizing fasciitis, a flesh-eating disease involving bacteria that destroys tissue under the skin. Doctors Evelyn B. van Kempen, Patricia CJ Bruijning-Verhagen and colleagues urge the public to realize that early recognition and prompt treatment can save lives.

“Clinicians and parents should be alert and aware of unusual child presentations,” they wrote.

Serious illness in children has been reported in the United Kingdom, the Netherlands, France, Ireland and Sweden, but the pattern is not always the same. In the UK, doctors have reported an increase in scarlet fever – caused by the strep A bacteria – at the same time as cases of the epidemic. But this was not seen in the Netherlands.

Many hospitals in the United States say they are not aware of any rare cases of scarlet fever in their area.

Knowing what is going on in the United States is more difficult than in other countries, because there is no national health care system that facilitates tracking cases. CDC spokeswoman Kate Grusich said in an email that case numbers are “too soon to say whether they are returning to pre-pandemic levels or increasing more than we would normally expect.”

“CDC is closely monitoring these data, and is talking to surveillance sites and hospitals in several states to learn more about any trends,” she said.

E-mail addresses for pediatricians and infectious-disease specialists across this country began blowing up in October with a question from a doctor in the Midwest: Has anyone else seen an increase in invasive strep A?

The responses were, as expected, mixed, as such cases tend to be fractious. Boston Children’s never saw anything. But they had doctors in Kansas City, Houston and Denver.

In Texas Children’s, Versalovic said some children had low blood pressure and septic shock, some with bacterial pneumonia, and others with skin disease. Many are so sick that they need intensive care. He worries that some cases are being missed. To diagnose invasive strep A, doctors must take a sample of the patient’s blood, skin, or fluid from the lungs or other areas. But if a child needs emergency care, there may not be time to consider the cause of the illness.

Invasive strep A “doesn’t follow a simple linear progression,” he said.

Samuel Dominguez, an infectious-disease specialist at Children’s Hospital Colorado in Denver and a professor at the University of Colorado School of Medicine, said the cases he’s seen are “above the age range” in children, saying they may be more vulnerable because bacteria tend to colonize their throats and skin more strongly than adults. .

Dominguez sought to balance the reassurances with calls to watch for warning signs that this is a relatively rare infection.

Versalovich agreed. “We don’t want to raise too many alarms, but these infections can move very quickly,” he said.

Myers said all of the patients seen at Children’s Mercy in Missouri have recovered medically, but she urged parents to make sure their children’s vaccinations are up to date and avoid a viral infection that could open the door to worse bacteria. “I think there are a lot of things at play that we don’t fully understand yet,” she says.

One of the tricky things about the disease, she says, is that it looks so different in different children. The child who had trouble moving their eyeballs had an infection of the soft tissues of the eye socket; Swelling behind the ear, bone infection in that area; And the third patient, a cluster of vertebrae in the throat.

Myers urged parents to be careful.

“If a child seems sicker than they should be after a fever, it’s always a good idea to bring them to the doctor if they have trouble breathing or you notice anything else — even if they have swollen eyes,” she says.

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