What is STSS? Japan sees rise in cases of THIS flesh eating bacterial infection

STSS is caused by group A streptococcus bacteria and can be fatal; caused by flesh-eating bacteria

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Japan is currently experiencing a rise in cases of a rare and deadly disease caused by flesh-eating bacteria, known as streptococcal toxic shock syndrome (STSS). As of June 2, 2024, the nation has reported 977 cases, surpassing last year's total of 941. Experts are concerned that if this trend continues, Japan might see up to 2,500 STSS cases this year.

The increase in STSS cases in Japan is linked to the easing of COVID-19 restrictions. Similar patterns have been observed in several European countries, where there was a surge in invasive group A streptococcus diseases after the lifting of pandemic measures.

What is STSS?

Streptococcal Toxic Shock Syndrome (STSS) is a severe and potentially fatal condition caused by group A Streptococcus (group A strep) bacteria. This rare illness occurs when bacteria spread into deep tissues and the bloodstream, leading to systemic infection and organ failure.

Symptoms and Progression

The onset of STSS is marked by initial symptoms such as fever, chills, muscle aches, nausea, and vomiting. Within 24 to 48 hours, these early signs can escalate to more severe conditions, including:

  • Hypotension (low blood pressure)
  • Tachycardia (faster than normal heart rate)
  • Tachypnea (rapid breathing)
  • Organ failure, indicated by symptoms such as reduced urine output in kidney failure, excessive bleeding or bruising in liver failure, and jaundice (yellowing of the skin and eyes)


STSS often leads to serious complications due to rapid organ shutdown and systemic shock. In some cases, surgery is required to remove infected tissue or limbs to control the infection. Despite prompt medical treatment, STSS can be fatal, with a mortality rate of up to 30%.

Risk Factors

STSS can affect anyone, but certain factors increase the risk:

  • Age: It is most prevalent in adults aged 65 and older.
  • Infections or injuries that break the skin: Open wounds, recent surgeries, or viral infections that cause sores, such as varicella (chickenpox and shingles), elevate the risk.
  • Underlying health conditions: People with diabetes or alcohol use disorder are more susceptible to STSS.

Causes and Transmission

Group A strep bacteria are the primary cause of STSS. While the transmission of STSS itself is rare, less severe group A strep infections can progress to STSS, and these bacteria are contagious.


There is no single test to diagnose STSS. Healthcare providers rely on a combination of tests, including blood samples and organ function assessments, to identify the presence of group A strep infection, low blood pressure, and multi-organ dysfunction.

Treatment and Recovery

STSS requires immediate medical intervention in a hospital setting. Treatment typically involves:

  • Antibiotics to combat the bacterial infection
  • Intravenous fluids to manage shock
  • Supportive care for organ failure
  • Surgical removal of infected tissue in severe cases


Preventing group A strep infections is crucial in reducing the risk of STSS. Maintaining good hygiene, promptly treating open wounds, and managing chronic health conditions can help mitigate the risk.