Interview – Flesh-eating bacteria: Should we be worried about its spread in Japan?

In recent weeks, an outbreak of serious infections caused by group A streptococcus has worried Japan.

Thus, 474 cases of streptococcal toxic shock syndrome have been reported in the country between the beginning of the year and March 13.

TF1info takes stock of this often fatal pathology with Robert Sebag, an infectious disease specialist at PTA-Salpêtrière Hospital.

Should we be worried? Even if the Japanese government tries to put into perspective the recent outbreak of cases of serious infections caused by group A streptococcal (GAS) bacteria, the population is staggering. According to the National Institute of Infectious Diseases, 474 cases of streptococcal toxic shock syndrome (SCTS) were reported in the country between the beginning of the year and March 13. This accounted for more than half of all SCTS cases reported in Japan in 2023 (941). However, these bacteria are not unknown to health services, as Robert Sebag, an infectious disease specialist at PTA-Salpêtrière Hospital, explains to us.

What are these “flesh-eating” bacteria?

It is a common organism that belongs to the group of streptococci A (SGA), which we call beta hemolytics. Most infections caused by GAS are mild, such as bacterial tonsillitis, which is treated with antibiotics. It also causes scarlet fever or erysipelas, a skin infection that causes swelling of the lower limbs. But in Japan, what is worrying is that we see cases of necrotizing fasciitis at the muscular level which ‘eats away’ the tissue. This rare infection seems to cause flesh to disappear, hence the name. Without prompt intervention, this can lead to amputation of the infected limb. But its development differs from one person to another. For example, people with diabetes are more susceptible and at greater risk. Otherwise, these bacteria are best treated with antibiotics such as amoxicillin.

This is not a new disease.

Robert Sebag, an infectious disease specialist at the PT-Salpêtrière Hospital

How is it transmitted?

Streptococcus is a germ that is sometimes found on the skin, so if you have an open wound, there may be a risk of infection. It is also at the digestive level, so it can be in the stool. Transmission can also occur in the respiratory system through droplets when you sneeze or apparently if you have an infectious tonsillitis. In these cases, you should maintain a restraining gesture and wash your hands regularly.

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Should we fear him in France?

The bacteria is already present in France and a report by Public Health France noted an increase in infections last year. In fact, it is estimated that the increase is due to a decrease in the immune system associated with Covid. We were safe for a few years, as there was little human contact with the various captives (DWaves of invasive group A streptococcal infections also occurred in Europe, North America, and Australia in 2022–2023, editor’s note). But fortunately, the number of cases is rare. In my infectious disease department, I saw erysipelas, but I did not see the necrotizing forms. It’s not like monkeypox where suddenly we had hundreds of cases. Here, you need to know how to maintain the cause, it is not a new disease.