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What is Streptococcus Pyogenes, the bacterium spreading in the country?

The bacteria have been detected in pediatric patients, causing severe cases requiring ICU care. The Regional Health Secretary has called for prevention measures, including vaccination against Influenza A to avoid superinfection.

Publicada: Thursday 13 de June del 2024
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The latest report from the Ministry of Health, delivered this week by the national head, Ximena Aguilera, highlighted a strong presence of the Streptococcus Pyogenes bacteria in the country, with 191 cases recorded in the first five months of the year, a 189% increase compared to the same period in 2023. While the bacteria have been present in the body and monitored for over 10 years, it is now undergoing a mutation that makes it more aggressive if a respiratory illness like Influenza A, the leading circulating virus, is contracted. Indeed, the minister confirmed that the six cases of Influenza A that resulted in the deaths of five people in Chillán and one in La Florida were aggravated by the presence of Streptococcus Pyogenes.

Given the situation in the country, Regional Health Secretary Eduardo Barra urged the public to prevent the infection that primarily affects children aged 4 to 10 but can also affect adults. Preventive measures include frequent hand washing with soap and water, cleaning and ventilating spaces, and vaccination against Influenza A to prevent other illnesses that could facilitate bacterial invasion. He explained that although it is a rare disease, it can cause severe infections like pneumonia, meningitis, ear infections (mastoiditis), and throat abscesses (peritonsillar abscesses), among others, which can be treated with antibiotics.

Barra warned that the symptoms of the bacteria include fever, sore throat or pain when swallowing, and swollen neck lymph nodes. Additionally, there may be signs of superficial skin infections, fever, localized pain, small blisters, and crusts. He stressed that the community should consult a specialist if a fever above 37.8 degrees Celsius appears, accompanied by signs like a sore throat and skin redness with small blisters.

Pediatric Detection

Luis Gatica, a pediatrician and pediatric infectious disease specialist at the Regional Hospital, confirmed that the health center has already recorded some cases of bacterial infection. “We had noticed a slight increase in severe invasive infections by Streptococcus Pyogenes in hospitalized children, which has undoubtedly intensified in the last four months.

We have had severe cases hospitalized in the ICU and some secondary cases of Streptococcus infection, which, although not directly affecting, have caused kidney problems due to an immunological situation.” He confirmed that all the cases received at the hospital originated from the community, not from intrahospital contagion, and were secondary to a viral condition or skin infections.

“Streptococcus, in general, can be present in the upper respiratory tract and on the skin, so a chickenpox or a wound can become superinfected by this Streptococcus, which can lead to a more severe infection circulating in the blood or forming abscesses. These are the types of clinical cases we have seen here in the Pediatric ICU.” When the presence of the bacteria is detected, the established protocol includes isolation for 24 to 48 hours, as Streptococcus Pyogenes is sensitive to antibiotic treatment. “However, the effect of its toxins can increase the severity of the condition.”

The specialist did not provide the number of patients treated for the bacteria, stating that they are currently conducting a census of the affected children.

Epidemiological Surveillance

Fernando Rojas, interim representative of the Winter Campaign of the Talcahuano Health Service, confirmed that the network was alerted to the presence of Streptococcus Pyogenes, which has been monitored through epidemiological surveillance by network hospitals for over 10 years. The hospitals are currently strengthened to detect it and report it to the Institute of Public Health if necessary. He explained that the hospitals in the network have contingency plans and are equipped to act in case of suspected bacterial presence.

“There is an updated regulation from the Ministry of Health distributed throughout the network to reinforce the response to suspected cases, and the teams will conduct appropriate surveillance based on the patient’s clinical condition.”

Risk Factors

Carolina Mardones, an infectious disease specialist at the Dr. Víctor Ríos Ruiz Complex in Los Ángeles, stated that although Streptococcus Pyogenes is present in 20% of humans, colonizing the pharynx, vagina, and rectum, it does not cause illness. However, since 2022, the WHO has reported that the bacteria have started causing deaths worldwide, first in Great Britain, then in European countries, reaching Uruguay and Argentina in 2023, and now becoming a more severe strain. She emphasized the importance of vaccinating against Influenza A because people can contract viral diseases and then become superinfected with the bacteria, potentially leading to severe illness. She highlighted risk factors such as chickenpox, for which Chile has had a vaccine since 2020, but there is a gap of unvaccinated children.

“The idea is to get vaccinated. We have seen that we are in an Influenza outbreak (…) We are currently on the decline, but it is still circulating, and the vaccine takes 14 days to develop antibodies, so the call is to get vaccinated early.” Other risk factors include skin traumas like burns and surgeries that facilitate Streptococcus Pyogenes penetration, causing severe behavior. Immunodeficiency, congenital or acquired, high-dose corticosteroid use, vertical mother-to-child transmission, nosocomial infection, and intravenous drug use are also risk factors for bacterial entry into the body.

Why the Infection Worsens

Leonila Ferreira, head of UPC at Clínica Biobío, explained that Influenza A is a viral infection that, in some cases, can lead to pneumonia, lung involvement, respiratory failure, and advanced ventilation requirements.

“The main cause of severity is bacterial superinfection. While pneumococci and staphylococci most commonly cause these infections, Streptococcus Pyogenes can sometimes be the culprit. We have observed an increase in pneumonia secondary to Influenza caused by Streptococcus Pyogenes.” She added that the bacteria can produce toxins, leading to a severe shock (streptococcal toxic shock syndrome), a condition that develops rapidly with pressure involvement, respiratory function, and rapid patient deterioration.

“This is what we have seen in the affected cases, especially in those where the presence of the bacteria was demonstrated in the Chillán cases.” She noted that the frequency of Streptococcus Pyogenes presenting in severe forms related to Influenza is rare. “What is striking is the extremely high mortality rate when this bacteria is present, which can lead to multifocal pneumonia, necrotizing pneumonia causing respiratory failure, and toxic shock, the most dramatic form of presentation.”

Source: Diario Concepción

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