Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SATURDAY, January 28, 1995 TAG: 9501300023
SECTION: VIRGINIA PAGE: A-1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY STAFF WRITER
DATELINE: LENGTH: Long
On Dec. 11, a couple in their 80s arrived at Augusta Medical Center in Fishersville suffering from Group A streptococcus bacterial infections.
The woman died shortly after. She had been sick before the strep invaded her body, health workers say, and was especially susceptible to an ugly version of the bacteria best known as the culprit in everyday strep throat.
Within 24 hours, the husband also was dead. It is believed that the bacteria invaded his body while he cared for his wife.
It wasn't so unusual for two elderly, ill people to die of Group A strep, said Dr. Donald Fowler, medical director at the center.
But it didn't stop there. Close behind the husband and wife came a third patient, a man suffering from cancer who now had a Strep A infection.
Again, because the victim had been debilitated by disease before the strep invasion, the severe reaction didn't seem all that extraordinary.
When still another person severely ill with a Strep A infection arrived at the hospital, however, Fowler notified the state Health Department.
In 30 years of medical practice, Fowler had seen only two other severe strep A cases: one more than 20 years ago when he was a Navy doctor practicing in Philadelphia, the other in the 20 years he has been in the Shenandoah Valley.
Unbeknown to Fowler, health workers at Rockingham Memorial Hospital in Harrisonburg were having a similar experience.
A 47-year-old man from Lost City, W.Va., came to the Rockingham emergency room on Dec. 9 with a strep infection. He died.
A second Strep A patient was hospitalized at Rockingham near the end of December. After a period at home, that patient is back for further treatment.
As of Friday, one more case had been found, a Rockbridge County resident. That person is recovering.
This latest case brought to nine the total of identified severe strep A cases. Five victims died. All of those infected lived in a corridor from Rockingham County to Rockbridge County, except for the West Virginian who was from just across the state line.
There were two instances in which two people in the same family were infected.
Dawn Kizer, coordinator of infection control at Rockingham Memorial, suspects more Strep A cases have come and gone there.
Based on a review of case records, ``we think some cases fit this picture,'' she said.
The law doesn't require Strep A infections to be reported, and an isolated case might not be considered worth bringing to authorities' attention.
It was only because there were so many cases at the same time in a small area that the outbreak was made public, said Dr. Suzanne Jenkins, assistant state epidemiologist.
Now, the Health Department has asked hospitals and doctors to report past cases in which Strep A bacteria were found elsewhere in the body than on the skin or in patients' throats. Found in the blood or in muscle, the infection can be deadly.
Could there be more cases?
``Maybe,'' Jenkins said.
It's likely, though, that the Strep A has moved on as rapidly as it appeared; that's its nature.
The bacteria that took the life of Muppets creator Jim Henson in 1990 and last month caused the amputation of the left leg of a Canadian politician pops up quickly, then just as quickly returns to hiding.
From winter 1993 to spring 1994, 28 cases of invasive Strep A were documented in the Los Angeles area, three cases involving children with chickenpox in Maryland, and 28 cases in Britain. Eleven died in Britain.
In the same period as the Shenandoah Valley cases, a northwest Chicago woman died from Strep A, the third Illinois victim of the year. Ontario had 21 cases, including eight deaths. The Seattle, Wash., area had six cases.
There is nothing new about Strep A. In almost any classroom, half of the children will have Strep A bacteria in their throats, health workers say. It was identified in soldiers during the Civil War. In the 1920s, it killed 50,000 in China. The scarlet fever epidemics of the 1930s and 1940s were caused by invasive Strep A and included some tissue-eating strains.
Each year, there are 30 million to 50 million cases of strep in the United States, but only 10,000 to 15,000 involve the destruction of exterior tissue and the body's systems.
Chances of becoming infected with the bad strain of strep are far less than being killed on Interstate 81 or shot in some inner cities, Jenkins of the Health Department says.
But medical investigators became more concerned about Strep A in the mid-1980s when it began acting more viciously, creating a toxic-shock-like syndrome usually caused by staphylococcus bacteria.
To get a closer look at what was going on with Strep A, the national Centers for Disease Control and Prevention in Atlanta asked health departments in several states to provide information about and cultures from invasive Strep A cases.
The reporting was voluntary - states control which diseases are reported - and the results incomplete, but findings did not indicate an increase in cases, according to Dr. Stephen Ostroff, associate director for epidemiological science in the National Center for Infectious Diseases at the CDC.
What the results did show, Ostroff said, was that a slightly greater percentage of the cases were the tissue-eating type that prompted British tabloid headlines like ``I Watched Killer Bug Eat My Body.''
The information collected by the CDC in Atlanta wasn't sufficient, however, to help the disease experts make any predictions about what might happen in the United States after the problem hit Britain last spring, Ostroff said.
He expects to get better data from the Emerging Infections Programs being established in four states. Centers in Oregon, California, Connecticut and Minnesota hope to accumulate information that will make it possible to warn doctors when a disease is about to strike.
Meanwhile, investigators with the CDC are helping Virginia Health Department workers build files on the Shenandoah Valley cases.
Investigators are knocking on doors of homes asking permission to take cultures from the residents' throats and then asking them questions about their habits.
In addition to interviews with families of those infected, two nearby households and two distant households of each of the nine cases will be visited.
Chances of finding a link among nine cases from a population of 225,000 are very slim, epidemiologist Jenkins said.
Most of the infected people ``got infected by people who carried the bacteria but didn't get sick from it,'' she said.
The best protections against invasive Strep A, experts say, are the common-sense rules: Keep wounds clean, cook foods completely, wash your hands regularly and seek treatment when you get sick.
by CNB