A Mean Strain Of Strep

Brad Andrews thought nothing of it when he scraped his arm playing racquetball in 1986. "There was a little blood--I just put a Band-Aid on it," says the Boise, Idaho, attorney, now 34. A few days later Andrews felt flu-ish and his arm started to swell. By the time he drove to the emergency room, his fever was high. X-rays of his elbow revealed an infection. His fever kept climbing, his blood pressure plunged and he showed signs of toxic shock syndrome. An infectious-. disease specialist isolated a bacteria known as Group A streptococcus in Andrews's bloodstream. After a week, he left the hospital on high doses of penicillin--30 pounds lighter but lucky to be alive.

Every parent knows about "strep"--the bacteria that causes sore throats, fevers and a rash called impetigo, mostly in children. But a mysteriously virulent strain of Group A strep has scientists worried. The bacteria has been linked to a return of rheumatic fever in parts of Utah, Tennessee, Pennsylvania, Ohio, Missouri and California--and to the rare form of pneumonia that killed Muppet creator Jim Henson in May. Last year a study in the New England Journal of Medicine described 20 cases of toxic-shock-like syndrome in the Rocky Mountain area, all caused by strep. Like Andrews, most of the patients were young and healthy, several had only flulike symptoms before their illness rapidly became life threatening. Six of them died--three within hours of reaching the hospital. Chief author Dr. Dennis Stevens of the Veterans Administration Medical Center in Boise says he has since received reports of severe strep infections from every state in the country; cases also have been reported in Europe. The Centers for Disease Control is working with officials in six states to track such infections.

The strep bacteria has been around for centuries and was responsible for outbreaks of scarlet fever and rheumatic fever in the days before penicillin. Since the mid-1900s those diseases have virtually disappeared. But in recent years scientists have noticed some forms of the bacteria acting strangely. A few strains seem to secrete the same toxins once seen with scarlet fever--prompting some experts to think that old forms of the bacteria have returned. Other experts suspect that today's virulent strains are new mutations. Unlike scarlet fever, the toxic-shock-like cases have not been linked to throat infections. In about half the patients, the source of infection seems to be a break in the skin.

Fortunately penicillin is still effective in combating the new strains, provided the infections are treated early. Experts also note that while the strep bacteria is very common-10 to 20 million Americans get strep throat each year--the virulent forms remain extremely rare. Even so, strep expert Dr. Gene Stollerman says that physicians should be "very alert to rheumatic fever--treat it as though it were cholera or plague. " To guard against the toxic-shock-like syndrome, Stevens recommends that anyone who gets a cut or burn should wash the wound thoroughly and keep it covered. If the site becomes extremely red or swollen, or if flu symptoms develop, patients should seek medical care promptly.

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