Streptococcus: Fatal cases cause concern - What Greeks experts advise

Concern is growing about strep. The season when its impact is greatest comes in early spring, when immune systems are vulnerable.

Anxiety continues, especially among parents of young children, about fatal cases of streptococcus. In the first two months of 2024, two deaths have been reported, a child and an adult. Both were positive for strep.

In the second, an extremely rare strain was identified, the hearing of which added additional concern and reflection. The 28-year-old ended up on February 1 at the Papageorgiou Hospital in Thessaloniki.

"The patient was transferred on 31.01.24, at 16:20, from the 424 General Military Training Hospital, with the diagnosis of resistant heart failure on the ground, complicated endocarditis of the aortic, mitral and tricuspid valves, with a positive blood culture for Granulicatella adiacens," said the administration of the hospital in a statement.

On February 1, he underwent emergency heart surgery but unfortunately passed away the same day.

Granulicatella adiacens is a type of streptococcus. It is difficult to find in the laboratory due to the requirements for its identification.

"One has to be suspicious. It doesn't come out in the classic culture materials," notes the Associate Professor of Epidemiology of the National and Kapodistrian University of Athens (EKPA), Gikas Majorkinis.

This bacterium has been reported mainly from bloodstream infections, infective endocarditis, infections of the eye socket, nasolacrimal duct and breast implants.

As reported in foreign studies, even though it is part of the oral, gastrointestinal and genitourinary flora, G. adiacens is rarely involved in infections due to its difficult isolation and differentiation techniques compared to other types of streptococcus.

The immune vulnerable target of streptococcus

The case of the 28-year-old was special, as it can be seen from the statements of his family that he was a vulnerable person. The brother of the 28-year-old from Larissa, Apostolos Kominis, speaking to Proto Thema, said that the streptococcus was the final blow and that his brother was suffering from rheumatoid arthritis and was undergoing treatment.

"Everything happened very quickly; the blows were unanswerable for my brother, and within eight months of suffering for him, he unexpectedly passed away," he said, among other things.

The vulnerability of the human body is exactly what strep infection "prefers". As Mr. Majorkinis points out, the epidemiologically sensitive populations are young children and the elderly.

It is characteristic that the common streptococcal infection mainly affects young children up to 10 years of age and affects them at a time when the immune system is weakened by repeated winter infections and, especially, by the flu.

It is worth noting that the type of strep identified in the 28-year-old is a community bacterium, but it is not related to Invasive Group A Streptococcus (iGAS), the severe expression of the common bacterium that is responsible for the increased cases and deaths of the old continent for a year and a half.

In our country, since the beginning of 2023, 11 deaths of children with iGAS and 12 deaths of adults have been recorded. The most recent fatal incident in a child concerns a 9-year-old girl from Didymoteicho who was admitted to the city's nursing institution with a serious clinical picture and died a few hours later.

iGAS infections are not included in the mandatory disease notification system. However, Hellenic National Public Health Organisation (EODY) has recently been monitoring them due to the international increase in iGAS incidents. From the beginning of 2023 until 11/1/2024, 89 cases of iGAS were reported to EODY, 40 in adults and 49 in children, most of them under ten years of age.

The incidents included 22 deaths, 10 in children aged twelve months to eight years and 12 in adults, most of them with underlying diseases. The 9-year-old died after the above period of time and is not included in these numbers, while the 28-year-old was not reported as a case of invasive streptococcal A infection.

What parents should watch out for

Strep is usually a mild infection. An extremely small percentage may express the invasive form of the disease – which remains rare – for reasons such as immunosuppression from previous infections, stress on the body, randomness, and the fickle nature of the child's immune system.

According to pediatricians, strep "strikes" when all the winter infections, especially the flu, have weakened children's bodies. This period is usually the beginning of spring when there is an increase in streptococcal infections from time to time.

So, parents should be alert.

A very bad colour in the child (i.e. pale) combined with other signs can alert a parent that the infection may be getting more serious. The signs isolated by pediatricians are the following: Lethargy, anorexia, inability to interact normally with the environment, shortness of breath, and rashes.

These are symptoms of any other microbial infection that should guide parents seeking medical attention.

Maria Niki Georgantas is a columnist for Ygeiamou. 

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