Is flesh-eating’ strep moving from A to B?
Three documented cases of necrotizing fasciitis caused by Group B streptococcus infections in less than a year have Canadian researchers wondering if they have uncovered an emerging syndrome. "We found three cases over a period of 10 months when there had previously been only four cases described [in the medical literature] over 40 years," says Michael Gardam, MD, chief resident in infectious diseases and medical microbiology at McGill University in Montreal. Almost all previous reports of the "flesh eating bacteria" have been caused by Group A streptococcus, which has caused both community and nosocomial outbreaks.
All three patients presented with severe pain and rapidly progressive infections requiring emergency surgery. Two suffered from long-standing diabetes, while one had a history of leukemia. One died. All cases were in the community, but there has been at least one prior case of a probable hospital-acquired group B necrotizing fasciitis in the United States, he says. The infections are thought to have arisen after prolonged colonization rather than transmission occurring in the community. "You get the sense that invasive streptococcal disease is on the increase; we just don’t have enough data to say for sure yet."
Group B streptococcus is seen in vaginal secretions in 10% to 30% of women and is the most common cause of serious infectious disease in newborns. It has been known to cause a variety of infections in adults with diabetes, cancer, and other serious diseases. The ability of group B streptococci to cause necrotizing fasciitis with such frequency would represent a new emerging clinical syndrome, Gardam says. "Group B in and of itself is not something from a infection control standpoint that we usually worry about. But we know now that if you are in close contact with someone with a Group A necrotizing fasciitis strain, it can be spread."
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