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Invasive Group A Strep Infections Rising Among Children

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Well, it’s official. The U.S. has a GAS issue, where GAS stands for Group A Streptococcus or Group A Strep. The Centers for Disease Control and Prevention (CDC) has confirmed that there has indeed been a rise in the number invasive group A streptococcal (iGAS) infections among children. Now, you may have already heard about possible increases in such infections in different states. For example, on December 15, the Colorado Department of Public Health and Environment reported on 11 cases since November 1, 2022, in the Denver metropolitan area with two deaths among these cases. But “possible” ain’t the same as a “hey, let’s alert everyone about this” situation, which is what the CDC did in issuing a Health Alert Network (HAN) Health Advisory on December 22.

So, add this rise in such bacterial infections to the rises in respiratory virus infections such as Covid-19, the flu, and respiratory syncytial virus (RSV) infections that the U.S. has been facing, and the Winter of 2022-2023 has become quite a cough, cough affair. iGAS infections are caused by not surprisingly Group A Streptococcus bacteria. It’s actually quite common to have GAS—GAS bacterial infections, that is. Group A strep can cause a variety of common skin and soft tissue infections. And most likely you’ve heard of strep throat, which is a pharyngitis or inflammation of the throat caused by GAS bacteria. This typically isn’t a deep throat problem because a course of oral antibiotics can usually clear the infection when taking in a timely manner.

iGAS infections are a different story. Although they usually are much rarer, much bigger problems can arise when the bacteria gets more invasive. In this case, invasive doesn’t mean that the bacteria asks you a bunch of very personal questions such as how many partners have you had and why do you have handcuffs in the closet. Rather, it means that the bacteria gets deeper inside your body causing bad things such as sepsis, streptococcal toxic shock syndrome, and necrotizing fasciitis. All of these things can be quite life threatening.

Sepsis is when the infection spreads to your bloodstream and prompts a rather extreme reaction from your immune system and body. It can result in change in your mental status, severe drops in your blood pressure, very rapid breathing, and eventually organ failure. Having sepsis is not a positive thing. When sepsis proceeds to septic shock, mortality can jump to around 40%.

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Toxic shock syndrome may sound like the name of a punk rock band but is when toxins secreted by bacteria lead to a variety of systemic problems in your body. This can include fever, lethargy, confusion, rash, skin peeling, drops in blood pressure, and damage to different organs. Clearly anything with the words “toxic” and “shock” are not good things, unless you are saying something like “I’m shocked that you are not as toxic as I had thought.”

Necrotizing fasciitis is a severe form of skin and soft tissue infection. If your date calls you necrotizing, then that doesn’t bode well for a second date. Necrotizing means causing necrosis, which is the death of living tissue. Therefore, necrotizing fasciitis is when pieces of your skin and underlying tissue begin to die and potentially slough off your body. That clearly is not a positive thing either.

Yep, all of these possibilities ain’t good. Therefore, when you or your child has a GAS infection, you certainly should stay vigilant about any signs that things are getting more invasive. Stay aware of any indication that the bacteria is spreading beyond the throat or the initial portion of the skin affected. Contact your doctor if the antibiotics do not seem to be improving symptoms within two to three days.

Vigilance does not mean panic, though. It also doesn’t mean flapping your arms above you and yelling, “It’s just like the Covid-19 pandemic! It’s just like the Covid-19 pandemic!” It isn’t. Before you drop everything and start hoarding toilet paper again, keep in mind that the CDC did indicate that the overall number of these more severe invasive cases among children has “remained relatively low.” Therefore, if you or your child has a GAS infection, chances are it won’t progress to iGAS as long as you get proper treatment in a timely manner. Nevertheless, any rise in such severe, albeit very rare, illnesses does deserve monitoring from the CDC, other public health authorities, health care systems, and health care professionals. Hence the CDC alert.

It’s not completely surprising that iGAS infections among children have been on the rise. Over the years prior to the Covid-19 pandemic, cases of GAS infections in the U.S. have tended to follow a seasonal pattern, rising during the Winter months, peaking in December through April, and subsiding during the late Spring and Summer. Over the past two Winters, GAS infections have actually been lower than normal, probably due to people taking Covid-19 precautions. Such precautions could have directly prevented the transmission of GAS, which occurs via direct contact, respiratory droplets, or contaminated objects and is typically highest among school-aged children from five to 15 years of age.

Additionally, such precautions could have indirectly decreased GAS infection by decreasing the activity of viruses such as influenza. In the past, iGAS infections have tended to go up when flu activity has been high. An influenza infection can make you more prone to get bacteria infections because your immune system is busy fighting the virus.

So what do you do to prevent a GAS infection, which could potentially progress to iGAS? Here are several things:

  • Wash your hands frequently and thoroughly. If you already haven’t figured out that good hand hygiene is important after the past three years, then please don’t touch anyone else’s food ever.
  • Regularly clean and disinfect high-touch surfaces. Similarly, this is a practice that you should have down pat by now.
  • Get up-to-date on all recommended vaccinations. This includes getting the influenza, varicella (chickenpox), and Covid-19 vaccines. Having the flu or chicken pox can increase you risk for an iGAS infection.
  • Keep your wounds clean and properly covered. You probably won’t run into too many people who’ll tell you that open and dirty wounds are sexy. Plus, wounds and other things that cause cracks and openings in your skin can essentially create a revolving door for bacteria.
  • Don’t come into close contact with someone who has GAS, meaning a GAS infection. This can be easy to remember if you just keep repeating, “Stay away from anyone with any kind of gas.”
  • Maintain Covid-19 precautions. Again, it’s probably no coincidence that iGAS infections dropped the past two Winters when many more folks were wearing face masks while in public indoors and practicing more social distancing.

Most of the recently reported iGAS cases have been in kids ranging in age from 10 months to 6 years. But remember the Group A Streptococcus bacteria, like most such pathogens, doesn’t discriminate by age. The bacteria won’t say, “You’re too old for me,” and avoid infecting you if you are beyond a certain age range. In fact, those over 65 years of age are at greater risk for an iGAS. Those who live long-term care facilities, have chronic medical conditions such as diabetes, heart disease, lung disease, kidney disease, or cancer, inject drugs, or are experiencing homelessness are at higher risk as well.

Again, this new CDC warning doesn’t mean that you should panic. It’s not the same as the Covid-19 pandemic. Just try to maintain the aforementioned precautions. And if you or your child does get a GAS infection, get the proper antibiotic treatment as soon as you can. Meanwhile, be on the lookout for any signs that the GAS infection may be getting worse and becoming invasive. After all, you don’t want to add “i” to the GAS problem that you are having.

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Deadly fungal infections a concern in patients post-COVID-19, flu | CTV News – CTV News Calgary

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While fungi are not about to start turning the human race into zombies, like in the HBO blockbuster series The Last of Us, the World Health Organization (WHO) says invasive fungal infections are an increasing threat to human health.

Aspergillosis is one fungal infection common in our environment but, in some circumstances, it can turn deadly. In an average day, most of us will inhale hundreds to thousands of Aspergillus spores with no adverse effects, but for people with weakened immune systems it can cause deadly infections. That includes people undergoing cancer treatments, or bone marrow transplants, but it is now recognized that some viral infections, like influenza (flu) and SARS-CoV-2 (COVID-19) increase the risk of deadly fungal infection even in otherwise healthy people.

“When these kinds of things happen in the ICU, it can be devastating because even advanced medicines still can’t treat these infections,” said Dr. Bryan Yipp, an intensive care physician and researcher at the University of Calgary.

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“Once many of these infections really get ingrained and take over, clearing them with medications alone, antifungal or anti microbials, can be very difficult.”

Dr.Yipp began studying Aspergillus — a type of fungus that is a common mould — and its connection to viral infections in 2019, following three deaths in intensive care units of patients initially admitted for influenza, but who subsequently died of the fungal infection.

“It was very much a surprise when people first started identifying the fungus in the lung.  There was a lot of discussion around the table of ICU doctors, infectious disease doctors, asking ‘Was Aspergillosis really the cause of death, or was this just a secondary finding?'” said Yipp. “The pathologists who looked at the samples and the autopsies, were convinced that it was Aspergillosis that was the main problem.”

UCalgary researchers have determined exposure to Aspergillus, a common fungal mould, can lead to a potentially dangerous Aspergillosis infection in people with weakened immune systems.

Working in Yipp’s lab, lead researcher Nicole Sarden, a PhD candidate, isolated the mechanism by which the immune system starts failing to prevent fungal infections.

“In healthy humans. specific immune cells, called B cells, produce molecules (antibodies) that basically tag invaders so that other cells in the immune system, called neutrophils, can recognize them, eat them, and clear the infection,” said Sarden

“But when you have infections with viruses, such as influenza, or if you get COVID, these molecules are no longer present, which means that the immune systems that are trying to eat, and clear the fungi cannot do it because they cannot see it.”

Working with both mice and human blood and tissue samples, the researchers discovered that following a viral infection, neutrophils could identify a fungal infection and surround it but did nothing to destroy it.  

“The virus kills the B cells, no messenger molecules exist, so the neutrophils that would normally attack, the fungus, are blinded. They sit there and don’t know what to do,” said Sarden.

The research team also discovered that reintroducing Aspergillosis reactive antibodies can protect infected mice, leading to hopes a similar treatment will be available in the near future for humans with Aspergillosis infections.

While Yipp and Sarden focused on Aspergillus, it is not the only fungus that can cause serious, or fatal infections. It is estimated fungal infections kill an estimated 1.5 million people worldwide every year. Most of those are due to four different fungi; Cryptococcus, Candida, Aspergillus, and Pneumocystis.  Since the advent of COVID, a previously rare infection of the fungus Mucormycosis has been increasing rapidly in India. It affects the sinuses, brains and lungs of its victims. The rise in Mucormycosis has also been seen in patients who are recovering or have recently recovered from COVID.

Yipp is hopeful the research being conducted at Calgary’s Cumming School of Medicine could lead to treatments for these infections as well.

“We have some hunches that that could be a similar mechanism to what we see here with what we have found.” said Yipp. “So we think that this could be applied to multiple different types of fungi around the world.”

The research team, led by Sarden, published their findings in the journal Science Translational Medicine.

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Barrie hospital declares COVID outbreak in transitional care unit – BarrieToday

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Royal Victoria Regional Health Centre (RVH), in collaboration with the Simcoe Muskoka District Health Unit, declared a COVID-19 outbreak in the Barrie hospital’s transitional care unit on Friday, Jan. 27.

According to RVH, eight patients have tested positive for COVID-19 and have been isolated.

“Enhanced cleaning measures are underway, as well as swabbing of patients and staff,” RVH said in a news release Monday afternoon. 

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Admissions to the unit are on hold at this time, and visitors are not permitted. However, RVH says some exceptions may apply.

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Guidance for diagnosing and managing migraine – News-Medical.Net

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Migraine is a major cause of disability, affecting about 12% of people. A 2-part series published in CMAJ (Canadian Medical Association Journal) on diagnosing and managing the condition with both acute and preventive therapy provides guidance for clinicians. https://www.cmaj.ca/lookup/doi/10.1503/cmaj.211969.

“The goal of treatment of migraine attacks is to provide rapid relief from pain and other migraine-related symptoms, to restore patient function and to prevent recurrence,” writes Dr. Tommy Chan, Department of Clinical Neurological Sciences, Western University, London, Ontario, with coauthors.

“A stratified approach to treatment that empowers patients to choose from different options, depending on attack symptoms and severity, and encourages them to combine medications from different classes (e.g., nonsteroidal anti-inflammatory drugs and triptans) for severe or prolonged attacks, is preferred.”

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Part 2 of the review, which will be published February 6, focuses on preventive treatment to reduce the frequency and severity of migraine attacks.

Journal reference:

Tzankova, V., et al. (2023) Diagnosis and acute management of migraine. Canadian Medical Association Journal. doi.org/10.1503/cmaj.211969.

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