What is the link between COVID and the advance of the bacteria that causes pharyngitis and scarlet fever?

The bacterium Streptococcus pyogenes, commonly known as “group A strep,” only affects humans. It can cause skin infections such as impetigo, cellulitis, and scarlet fever. Sometimes it can be deadly/ HZI / M. Rohde

The bacterium Streptococcus pyogenes, commonly known as “group A strep,” is a pathogen that only affects humans. It can cause skin infections such as impetigo, cellulitis, and scarlet fever. On some occasions, the infection can develop into a severe form and be fatal.

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Since the end of last year, there has been a reemergence of this pathogen in several countries in Europe, China, Australia, Uruguay and the United States. The COVID pandemic could be one of the factors that has facilitated the advance of the bacteria.

In Argentina, last Saturday the National Ministry of Health issued an alert because 118 confirmed cases of invasive infection by Streptococcus pyogenes were reported. That number represented an increase of 281% compared to 2019. 16 people have died.

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Although the epidemiological situation remains under surveillance, there is a suspicion that the reemergence of the bacteria is related to the impact of the coronavirus pandemic that causes the disease COVID-19.

Since the end of 2022, outbreaks of Streptococcus have been detected in Europe, North America, Asia, and South America/ NIH National Institute of Allergy and Infectious Diseases (NIAID)

“There is a hypothesis that postulates that, by having an affinity for the cells of the pharynx and tonsils, the coronavirus causes damage to local cells of the body’s defenses. This damage makes the tissues permeable and thus facilitates the access of the Pyogenes streptococcus to the blood or lymphatic circulation and allows its displacement to distant foci,” Dr. Leda Guzzi, an infectious disease doctor and member of the Argentine Society of Infectious Diseases, told Infobae.

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On 8 December 2022, the World Health Organization (WHO) reported that at least 5 Member States in the European region (France, Ireland, the Netherlands, Sweden and the United Kingdom of Great Britain and Ireland) had reported an increase in the number of cases of invasive disease by the bacteria.

Also, in some of these countries, there was an increase in deaths related to infections by the pathogen. Children under 10 years of age were the most affected age group.

A few days later, on December 19, the Pan American Health Organization (PAHO) reported cases of diseases caused by streptococcus in Uruguay. As a result of intensified surveillance, 21 cases admitted to health centers in eight departments of the country due to complications due to the invasive clinical form of the bacteria were identified. Four adults (69 to 79 years) and four immunocompetent children, 1 to 7 years of age, died.

It is suspected that the infection by the coronavirus that generated a pandemic in the world could facilitate the development of the bacterium Streptococcus pyogenes in more invasive and serious forms in the organism/File

At the time, the health agency suggested that the increase in cases may reflect an early start to the season coinciding with increased circulation of respiratory viruses and the risk of viral co-infections. Coinfections were thought to increase the risk of developing invasive group A streptococcal disease.

“Since the WHO alert last December, it was observed that some cases of people with the Streptotcoccus pyogenes bacterium had coinfection with the virus. So, from that moment on, the suspicion was generated that viruses could facilitate the advance of the bacteria”, added Dr. Guzzi.

There is a history of viruses that facilitate invasion by bacteria with other microorganisms. For example, if a person has the flu virus, the risk of invasive disease from pneumococcal bacteria may be increased. This could be occurring between the coronavirus and the strep bacteria.

The vast majority of symptoms are mild and are treated with antibiotics. “The percentage of invasiveness of Streptococcus is low. But it will be necessary to monitor if this is changing,” said the expert.

Streptococcus infection is treated with antibiotics that must be prescribed by health professionals. In Argentina there were 118 confirmed cases of invasive infection by Streptococcus pyogenes. 16 people died in 2023/File

“More research is necessary to detail how the coronavirus directly or indirectly influences the biological behavior of other pathogens, such as the greater virulence or the change in the months of circulation of viruses such as influenza, the syncytial virus that causes bronchiolitis or metapneumovirus”, commented the specialist.

There is not yet a vaccine available against the bacteria. For this reason, last March, the WHO made it explicit that Streptococcus pyogenes, together with the Shigella bacterium and the respiratory syncytial virus, were identified as important by four or more regions to invest more attention in the development of immunization.

Transmission of the Streptococcus pyogenes bacteria occurs by close contact with an infected person and can be transmitted through coughing, sneezing, or contact with a wound. The incubation period for the disease varies according to the clinical presentation, between 1 to 3 days.

When a person becomes infected, they must receive an antibiotic. Within 24 hours of taking the antibiotic, the ability of the pathogen to spread to another person is usually eliminated.

Among the most common symptoms of pharyngitis are: sore throat; fever; headaches; abdominal pain; nausea and vomiting; redness of the pharynx and tonsils (Getty Images)

Symptoms of pharyngitis caused by the bacteria are sore throat; fever; headaches; abdominal pain; nausea and vomiting; redness of the pharynx and tonsils; bad breath; enlarged nodes in the neck.

When the bacteria cause scarlet fever, the most common symptoms are a red, sore throat; fever (38.3 °C or more); red rash with sandpaper texture; deep red skin in armpit, elbow, and groin folds; whitish coating over tongue or back of throat; “raspberry” tongue; headache; nausea or vomiting; swollen glands; pains in the body

In the presence of some of these symptoms, it is important to avoid self-medication with antibiotics and make a medical consultation to have a timely diagnosis, according to the Nation’s Health portfolio.

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