FRANCAIS

April 28, 2005

Manitoba Health has identified a total of four reported cases of invasive group A streptococcal disease in Manitoba in 2005.

Three cases of invasive group A streptococcal disease have been previously announced including two cases of necrotizing fasciitis (“flesh-eating disease”) from Sioux Valley and a case of streptococcal toxic shock syndrome identified on April 26 in a Winnipeg woman who is currently hospitalized.

After reviewing cases previously reported in 2005, the chief medial officer of health is including in this update a case of a woman in her 60s from Fisher River with streptococcal toxic shock syndrome and necrotizing myositis (who became ill in March and died in April).

There has been no established direct contact between any of these cases. The situation in Sioux Valley is unusual in that two cases of this disease occurred in a small community within the same month.

To enhance surveillance and to help physicians respond to the concerns of patients and manage potential cases or contacts, Manitoba Health has distributed a letter to health-care providers today.

Manitobans should be reassured that although the presence of group A Streptococcus bacteria is common, the occurrence of severe disease is rare. Severe, invasive disease is more common in people with weakened immune systems or other medical conditions. The risk for Manitobans is considered very low.

Group A streptococcus bacteria is often carried in the throats or on the skin of many individuals who are not ill. It can be spread by direct physical contact, not just by being in the same room or having a casual conversation. This is the same bacteria that can cause strep throat, impetigo, milder skin infections and scarlet fever. In rare situations and for reasons not yet entirely understood, some people get a more severe disease, known as invasive group A streptococcal disease.

Three types of this disease are reportable in Manitoba: necrotizing fasciitis, necrotizing myositis and toxic shock syndrome. Usually, less than ten cases are reported per year in Manitoba (less than one per 100,000 people).

Necrotizing fasciitis or necrotizing myositis are the severe forms of an infection of the tissues deep in the skin. When it spreads along the deep fibrous lining tissue of the muscles it is called necrotizing fasciitis. When it affects the underlying muscle tissue it is called necrotizing myositis. Both conditions are known as “flesh-eating disease” and are usually treated by antibiotics and the surgical removal of tissue or amputation. Group A streptococcus is one of several bacterial causes of these conditions.

Toxic shock syndrome is another severe illness which can be caused by group A streptococcus. Streptococcal toxic shock syndrome is diagnosed when symptoms of shock and multiple organ failure occur and there is laboratory confirmation of group A streptococcus infection. It may occur in association with infections of the fascia or muscle, so it is possible to have a diagnosis of toxic shock syndrome and necrotizing fasciitis or myositis.

Manitoba Health requires reports from physicians and labs on all cases of invasive group A streptococcal disease. In the past ten years, two-thirds of cases reported have been necrotizing fasciitis or myositis; one-third have been toxic shock syndrome.

The spread of group A streptococcus can be reduced by good personal hygiene including handwashing. Minor cuts should be washed with soap and running water, kept clean and watched for signs that may suggest infection. Most cuts or scrapes will have some redness around them. However, if this redness spreads or if pain is present, it is recommended that a nurse or doctor be seen promptly for early treatment.

Information about invasive group A streptococcal diseases is available on the Manitoba Health website at http://www.gov.mb.ca/health/publichealth/cdc/fs/necro_fasciitis.pdf.

Public inquiries can be directed to Health Links/Info Santé at 788-8200 or toll free at 1‑888‑315‑9257.

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