A rare disease caused by a "flesh-eating bacteria" that can kill people within 48 hours is spreading in Japan. For the second consecutive year, Japan has reported record-high numbers of the casualties and infections caused by this bacterial illness.


The Streptococcal toxic shock syndrome (STSS) can kill a person in just 48 hours of being infected, giving the person no time to even understand what went wrong.


Although the experts are yet to figure out the reason behind the sudden surge in the STSS cases in Japan, here's all what you need to know about the deadly rare bacterial illness.


Rapid Surge In STSS Cases & Deaths In Japan


According to Japan Times, the Japan Health Ministry reported 977 cases of STSS as of June 2nd. This figure is the highest ever recorded in a single year, which has already surpassed last year’s record of 941 infection cases.


Until March, STSS has claimed the lives of seventy-seven individuals in Japan this year.


"Experts don't know how the bacteria got into the body for nearly half of people who get STSS," according to the US Centres for Disease Control and Prevention (CDC).


Japan's National Institute of Infectious Diseases (NIID) said in March: "There are still many unknown factors regarding the mechanisms behind fulminant (severe and sudden) forms of streptococcus, and we are not at the stage where we can explain them."


As per a report by Healthline, STSS has caused 77 deaths so far in Japan in 2024. In 2023, 97 mortalities due to STSS occurred — the second highest number in the past two years. This is behind the 101 deaths reported in 2019.


STSS is a condition that results in death in more than 30 percent of the cases, the report said.


Ken Kikuchi, a Professor of infectious diseases at Tokyo Women’s Medical University, said in an interview with The Japan Times that at the current rate of infections, "the number of cases in Japan could reach 2,500 this year, with a mortality rate of 30%."


What is STSS?


STSS or Streptococcal Toxic Syndrome, is a severe infection caused due to complication of Group A Streptococcus (GAS)Trusted Source, specifically the variant Streptococcus pyogenes.


Though a rare disease, STSS is typically caused by infection with the bacteria Streptococcus pyogenes.


Initially, it causes fever and throat infections, which can develop into a life-threatening emergency, organ failure and causing "toxic shock," within days of infection.


"Even with treatment, STSS can be deadly. Out of 10 people with STSS, as many as three people will die from the infection," the US Centers for Disease Control and Prevention (CDC) stated on their website.


STSS arises from infections such as strep throat (Pharyngitis), skin infections such as (cellulitis or impetigo), presence of bacteria in body (bacteremia) or invasive infections( flesh-eating disease).


How Does It Spread?


Several people already carry Streptococcus pyogenes on their skin, without ever falling sick. The situation turns serious once the bacteria gets into the bloodstream or deep tissue.


STSS is the same bacteria that causes strep throat. It is a deadly condition that has a mortality rate, exceeding 30 percent.


STSS develops when the bacteria spread into deep tissues and the bloodstream, casuing a systemic inflammatory response and toxic shock.


As the bacteria reaches the bloodstream it begins to produce exotoxins, toxic compounds that destroy cells and tissues in our bodies. This is how the term "flesh eating bacteria" has been derived. These toxins are the primary reason that trigger the inflammatory response in the body, further leading to STSS symptoms.


Once the bacterial infection spreads in the body, it can lead to organ failure, turning fatal. The infection causes life-threatening symptoms such as organ failure, low blood pressure, and loss of consciousness, healthline reported.


It is particularly deadly as the organ failure happens rapidly after the infection. Once the body gets infected, the initial symptoms like fever, aches, and nausea, only take about 24 to 48 hours to escalate into low blood pressure., which quickly turns into a much more serious situation.


As the body heads towards collapsing, the heat rate and blood pressure change, with organs like liver and kidneys beginning to fail as well.


However, GAS doesn't always result in such serious outcomes. The infection is usually spread among school-age children and can cause soreness, swelling, rash, or a strep throat. It is the Group A strep bacteria that are much more contagious and are likely to turn into STSS.


It can spread through coughing, talking, sneezing, or through direct contact with someone who is already infected.


Normally, STSS is treated in a hospital with antibiotics like ampicillin. But some strains of Streptococcus pyogenes showed antimicrobial resistance (AMR) to several antibiotic agents, HT reported.


To prevent the deadly bacteria from spreading further, the infected tissues can also be removed via surgery.


Symptoms


The initial symptoms inlcude:



  • Chills

  • Nausea and vomitting

  • Fever

  • Muscle aches


However, as the infection progresses to STSS, the symptoms can become serious. These include:



  • Absence of urine

  • Low blood pressure

  • Rapid breathing

  • Rapid heart rate (tachycardia)

  • Dificulty in thinking

  • Eyes turning yellow

  • Bruising and bleeding 


Who's At Risk?


The people who are at high risk of contracting STSS are older adults, who are aged above 65 years. Besides, people with health factors such as diabetes or alcohol are also at risk.


People with open wounds are at an increased risk of developing STSS.


Therefore, it is recommended that people who have undergone surgeries or have viral infections such as chickenpox or shingles, that cause open sores, must cover their wounds, in order to reduce the risk of being infected.


CDC also recommends that people must avoid contact with others who are already infected by the Group A strep infections. 


Treatment


An infected person is treated primarily with clindamycin, an antibiotic. However, additional care is needed to treat the shock as well.


To treat shock, doctors administer a range of treatments including, blood pressure medication, intravenous hydration, and oxygen. For organ failures, doctors also put patients on a dialysis or mechanical ventilation in case of kidney and respiratory failure, respectively.


In a few cases, the dead tissue is surgically removed from the infection.


Cases In USA


In the US, the CDC has reported 395 cases so far this year, which is almost the same number of 390 cases, reported at this time in 2023.


Although it is still unclear as to what is causing the surge of STSS cases in Japan, experts pointed out at two possible factors. One of them is an increase in several types of infection after the easing of quarantining during the pandemic, Healthline report noted.