I don't know if this has been mentioned yet, but this is not a new type of Strep, as mentioned in the Community Happenings thread. It's called alpha-hemolytic Strep. It's an unusual type of Strep, but not that uncommon. What separates it from usual strep is that it has a couple extra features. 1) It has the ability to break down blood cells (which is the "alpha-hemolytic" part of its name) 2) It typically has at least one additional element that makes it more toxic than typical strep known as a virulence factor. The virulence factor is one of the major factors that makes this type of strep unusually dangerous.
This type of strep has 3 stages and can become deadly from stage 2 onward. The first is a typical sore throat. It looks absolutely nothing different than an infection from typical strep, but it's not. The test to determine this type of strep takes time since it has to be cultured on a special blood based culture dish medium. If its typical strep, it won't do anything special. If it's the alpha-hemolytic type, it will produce clear spots on the dish, showing that it broke down the blood. Unfortunately it takes time to grow the bacteria on the dish, so there is typically a delay until this can be determined. This is another reason it is unusually dangerous, if the doctor doesn't have a high degree of suspicion and prescribed antibiotics while waiting for the culture results, it can result in a delay of antibiotic treatment, which is the last thing one needs when dealing with this kind of infection. The second stage is scarlet fever. This is when the strep has left the local area and is now in the blood stream. The bright, red "rash", which gives this stage its name, occurs because the rash isn't a true rash, its actually damaged remnants of blood cells that were "eaten" by the strep accumulating near the skins surface. The second and third stages are when it is most likely to kill due to the high fever which can progress to septicemia (sepsis) which overwhelms the body and leads to multisystem organ failure. The third stage is when it progresses from scarlet fever into Rheumatic Fever. When this happens the presence of the virulence factor from the strep essentially causes the immune system to malfunction and as a result the immune system starts attacking the person, damaging tissues such as the heart and joints. This dramatically raises the risk for progression to multisystem organ failure. Even if one starts antibiotics, but it is late in the infectious process, unless one has intensive support such as in an ICU, the body can be overwhelmed, especially if one has other medical issues.
I personally had Scarlet Fever a number of years ago after one of those shitty "Rapid Strep" tests failed to detect the alpha-hemolytic Strep I had, as such the doctor said "It's viral" and didn't give me any antibiotics. It honestly felt like a very typical sore throat, but I consistently had a very high fever after another 48 hours (which was not my bodies doing, it is caused by a specific factor in alpha-hemolytic Strep that put the fever part of the infection response system into overdrive through a toxic mechanism) which ranged from 104 to 106, and even briefly spiked to 107. Normally this would be considered a medical emergency, but my doctor was still telling me to take tylenol, since the fever was responding to it, and I should get better. Not too long after the very high fever I broke out in a rash on my chest. At that point I was just a pre-med undergrad, but this distinctly rang a bell in my head as something concerning. I looked it up and was absolutely certain it was scarlet fever. Given that, I had a friend drag my 1/2 dead self back to the doctor and said "It's scarlet fever! I desperately need antibiotics!!" His response was "The rapid strep test said it isn't strep, and the culture isn't back yet. But, if you want (apparently to "humor me") we'll run another rapid strep test." The doctor has the nurse runs the test, he goes to fuck around, and comes back with a smug look on his face saying "without strep, it can't be scarlet fever" when the nurse pops her head in and says "Yep, it's strep, a fast, strong positive". The doctor looks dumb struck that not only was he wrong, but that I got the diagnosis correct. He cleared his throat and just said "I guess it is scarlet fever..." and wrote me strong, high dose antibiotics. I started taking them right away, and fortunately they worked. I never progressed to rheumatic fever and I didn't suffer any long term damage (although I lost a huge amount of weight and muscle mass which was used to fuel my fever since I didn't feel like eating. Only time in my life I could be classified as "underweight"). It took me a full two weeks start to finish before I could get back to campus. Needless to say, I never went to that doctor again since without my diagnosis, I would be dead. It was my first successful diagnosis and solidified my desire to practice human medicine (when I entered university my intent was to be a veterinarian).
Interestingly, years later, I got a comprehensive throat culture because I had the worst sore throat I've ever had. It detected that I was now colonized by alpha-hemolytic strep (so called "carrier" status) which meant I was a potential risk to patients and even just typical people I knew that might be immunocompromised or old. They tested it to find out what it was sensitive to, and gave me a high dose of antibiotics to kill it off once and for all. A follow-up culture showed it had been eradicated. Fortunately, to the best of my knowledge I never transmitted it to anyone. It's a good example of even if you are functionally cured of something, it can still continue on in your system and be a risk to others.
www.youtube.com
[A]
