Rare that strep causes septic shock; Ask the Doctors

Dear Doctor: It was really scary to read about the man who lost parts of his hands and feet after a bout of strep throat. What's going on? I get strep fairly often; am I at risk too?

Dear Reader: Considering that strep throat is a common infection that typically results in a sore throat, the news reports you're referring to were indeed alarming. We suspect you have quite a few fellow strep sufferers also wondering whether that next episode will turn out to be deadly.

Let's start with reassuring news. For a strep infection to move beyond the throat and tonsils and wreak the kind of havoc we heard about in that case is extremely rare. That's why stories like those get such prominent play in the news. To put things into perspective, just 3.5 of every 100,000 cases of strep will go on to cause severe complications, according to the Centers for Disease Control and Prevention.

Strep throat occurs when the throat or tonsils (or both) become infected with group A Streptococcus bacteria, often referred to simply as "group A strep." It's a lot more common in children, but as you know from experience, adults do get it as well. The bacterium, which is highly contagious, spreads through contact with the spray of tiny droplets from an infected person's sneeze or cough, or with the skin rash that can sometimes appear. Transfer those droplets to your own nose, mouth or eyes, and you're at risk of becoming infected.

Symptoms often begin with a painful sore throat, which develops quite rapidly. A case of strep throat often includes fever, headache, swollen lymph nodes and distinctive white spots that appear on the roof of the mouth, tonsils, and soft and hard palate. You can have many of these symptoms but not have strep. You can also be exposed to strep and not become visibly ill. And while certain symptoms can suggest a strep diagnosis, a throat swab is the only way to definitively diagnose the infection.

In the case you mentioned, a 44-year-old man whose son had recently recovered from strep throat became ill with flulike symptoms. He tested negative for strep. He soon developed severe abdominal pain, which was accompanied by visible swelling. This led to exploratory surgery, which revealed a large quantity of infected pus within his abdomen. Typically, this is due to a puncture in an organ such as the colon, but none was found. It wasn't until a red rash appeared on the man's chest that his baffled medical team realized the patient had developed a strep infection in his abdomen.

Unfortunately, the infection had a head start and caused the man to go into septic shock. This inflammatory response to infection causes a life-threatening drop in blood pressure that can lead to organ failure, respiratory failure and stroke. The medical team was able to control his infection, although the treatment caused tissue death, which required partial amputation of his feet and fingers.

It's a difficult story with a challenging outcome, which is why we're going to repeat ourselves -- this type of complication from a strep infection is exceedingly rare.

Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.

Credit: Dr. Eve Glazier; Dr. Elizabeth Ko