During the previous century, there was a marked decrease in the incidence of severe infections due to group A Streptococcus. Declines were observed in the number of reports of scarlet fever, septicemia (blood poisoning), and puerperal sepsis (childbed fever), and in the number of cases of rheumatic fever. Explanations for these declines include therapy with antibiotics, improved living conditions, and decreased virulence of the organism.
In the 1980s, however, group A streptococcal infections reemerged as a public health problem. In 1985 and 1986, for example, several clusters of patients with rheumatic fever were reported in Rocky Mountain states, especially in and around Salt Lake City. Over an 18-month period, 74 cases were reported, eight times the previous rate. And in Pittsburgh and Columbus, Ohio, smaller outbreaks of rheumatic fever were experienced.
In 1987, physicians first recognized a severe syndrome associated with group A streptococcal infection. The illness affected 20 individuals in the Rocky Mountain area and was accompanied by kidney failure, a precipitous drop in blood pressure, and other symptoms typical of toxic shock syndrome. Six of the individuals died within 36 hours of reaching the hospital. The illness came to be called streptococcal toxic-shock-like syndrome.
In 1990, the CDC reported isolation of a group A beta-hemolytic Streptococcus from blood cultures from 19 patients suffering blood disease in a Denver hospital. Nine of the patients had died by the time of the report. In its editorial, the CDC epidemiologists explained that factors contributing to the increase of incidence were unclear. For instance, no single serotype could be located to suggest a single source. Physicians were called on to increase their vigilance to diagnose and treat mild streptoccoccal infections (such as strep throat) to prevent their progression to severe invasive disease.
