It is thought that a & # 39; more toxic & # 39; strain of Strep A has been behind the increase in scarlet fever since 2014. Scarlet fever causes a significant red rash. Starting at the neck, forearm and groin, it spreads over the body, resulting in small lumps that feel like sandpaper (stock)

An aggressive strain of Strep A is assumed behind an & # 39; unprecedented & # 39; increase of scarlet fever since 2014, research suggests.


Scientists from Imperial College London analyzed the bacterial strains that circulated in England and Wales between 2014 and 2016.

They identified strains of the insect Streptococcus pyogenes producing up to nine times more of the & # 39; scarlet fever & # 39 ;.

It is thought that these have caused cases of scarlet fever to rise to more than 15,000 in England in 2014 – the highest level since the 1960s.

The figures have continued to rise since then, with more than 17,000 cases in 2015 and more than 19,000 in 2016, statistics show.

It is thought that a & # 39; more toxic & # 39; strain of Strep A has been behind the increase in scarlet fever since 2014. Scarlet fever causes a significant red rash. Starting at the neck, forearm and groin, it spreads over the body, resulting in small lumps that feel like sandpaper (stock)

It is thought that a & # 39; more toxic & # 39; strain of Strep A has been behind the increase in scarlet fever since 2014. Scarlet fever causes a significant red rash. Starting at the neck, forearm and groin, it spreads over the body, resulting in small lumps that feel like sandpaper (stock)


Although rarely severe, scarlet fever can cause complications such as pneumonia, arthritis, and heart and lung diseases.

The scientists are concerned that mutated Strep strains can also cause invasive infections, such as necrotizing fasciitis & carnivorous disease & # 39 ;.

& # 39; The new, more toxic species we have identified has become the dominant cause of more serious Strep A infections & # 39 ;, said joint lead author Dr. Elita Jauneikaite.

Strep A bacterium, such as Strep pyogenes, lives in the nose and throat. The bacterium spreads through small droplets when an infected person sneezes or coughs.

Scarlet fever is usually mild, with early symptoms such as fever, sore throat and chills.

The significant result usually appears one or two days later. Starting at the neck, armpits and groin, it eventually spreads over the body, causing small bumps that feel like sandpaper.

Roodvonk usually affects children, with outbreaks occurring frequently at schools, daycare centers and daycare centers.


Antibiotics can help speed up a patient's recovery, relieve symptoms, prevent the spread of bacteria and prevent serious complications.

In the journal The Lancet Infectious Diseases, the scientists wrote that scarlet fever and other Strep A infections increased in 2016 compared to the previous five years.

To understand why, they looked at Strep bacteria that circulated in England and Wales in recent years.

After identifying Strep pyogenes, they found that the strains emm3 and emm4 were responsible for the initial increase of scarlet fever in London in 2014.

During the British spring of 2015 and 2015, EMM1 strains became the leading cause of throat infection.


In the spring of 2014, only five percent (five out of 96) of the bacteria collected from Step patients in north-west London were emm1, which rose to 19 percent the following year (28 out of 147).

In 2016, emm1 was behind 33 percent (47 out of 144) samples.

Outside London, 42 percent (267 out of 637) of strains gathered in England and Wales in the spring of 2016 were emm1, a 31 percent increase (183 out of 587) in the same period the year before.

To further investigate emm1, the scientists determined the genes of all 135 samples collected in north-west London between 2009 and 2016.

They also looked at the DNA of all 552 samples collected in England and Wales during the seasonal peaks from 2013 to 2016. Strep A usually peaks between March and May.


The team assessed the amount of toxins that the emm1 strains produced.

Most of those circulating between 2015 and 2016 were a & # 39; separate, separate emm1 clone & # 39 ;, called M1UK.

M1UK had 27 mutations and was associated with increased production of the toxin streptococcal pyrogenic exotoxin A (SpeA).

SpeA causes scarlet fever and can also contribute to throat infection and some invasive infections, the scientists warn.

An analysis confirmed that M1UK produces nine times more toxins than other emm1 strains with 190 nanograms per milliliter (ng / ml) compared to 21 ng / ml.


M1UK was already in England in 2010.

By 2016, the clone represented 84 percent of all emm1 samples analyzed in England and Wales.


According to certain scientists of ancient diseases, the Greek founder of Western medicine Hippocrates may have described scarlet fever symptoms as early as the 4th century BCE.

It was first officially identified in 1953 when the Italian physician Giovanni Ingrassia started the & # 39; rossalia & # 39; called.

The name scarlet fever was introduced by the British physician Thomas Sydenham in 1676.

Scarlet fever was currently considered a mild disease due to its rarity, especially when compared to pests.

Yet the industrial revolution of around 1820 in Western Europe and the US caused a population growth that led to overcrowded cities and poor hygiene.

Such circumstances caused scarlet fever to thrive, with fatalities in the UK from two percent of cases in the late 18th century to 15 percent in 1834.

Dirty living conditions caused the disease to occur in bicycle epidemics that had no influence on the countryside.

During the 1850s, Charles Darwin lost two children to the disease, which is also believed to have lost sight and hearing to the American author Helen Keller.


At the end of the 19th century, an urge for public health and urban cleanliness would have led to the emergence of scarlet fever.

Nonetheless, with a steadily rising number since 2013, experts fear poor nutrition and a fall in living standards may encourage the resurgence of this disease from the Victoria era.

In a second part of the experiment, the scientists compared M1UK with 2,800 emm1 genomes from all over the world. They found strains in Denmark and the US had M1UK-like mutations.

It is unclear whether M1UK could flourish in other countries, with climate and infection management affecting how bacteria develop.

Strep pyogenes that expressed the scarlet fever SPE A appeared again around the world in the 1980s.


This caused sepsis, severe soft tissue invasion and toxic-shock-like syndrome, according to a 1992 article in The Lancet.

As a result, M1UK should be followed globally, the researchers emphasize.

Main author Dr. Nicola Lynskey added: & # 39; Given that this species apparently has an improved ability to cause all types of Strep A infection, it is important to monitor the bacteria both here and worldwide. & # 39;

However, the M1UK team stress does not seem to have occurred outside the UK.

& # 39; The individual bacterial clone that we have discovered to date appears to be largely restricted to the UK, & # 39; said senior author professor Shiranee Sriskandan.


& # 39; But the fact that we have identified two examples elsewhere suggests that the potential can be spread internationally and may already be present in other countries.

& # 39; However, it is also possible that the origin will not last long.

& # 39; Some lines appeared in the past and then quickly disappeared. Only further research into recent species will provide more insight. & # 39;

Professor Mark Walker of the University of Queensland wrote in a linked comment: & # 39; The continuing increase in reports of scarlet fever and invasive diseases in the UK is an example of the essential need to install global surveillance.

& # 39; We believe the report sends out an important warning to the global community of public health – recently emerging scarlet tensions have a greater invasive potential that can have a major impact on the future global health burden. & # 39;

Professor Jimmy Whitworth, of the London School of Hygiene and Tropical Medicine, added: & # 39; This important study gives us a plausible indication of the worrying recent increase of scarlet fever in children in England.

& # 39; The researchers have discovered that a new virulent strain of streptococcal bacteria has emerged, producing nine times the amount of toxin found in other strains.

& # 39; The researchers are right to call for more surveillance to confirm these findings, as these streptococcal infections are highly susceptible to antibiotics, unlike most other types of sore throat in children. & # 39;

Professor Whitworth added the existing methods for diagnosing Strep A infections to help GPs identify patients more quickly.

What is scarlet fever and what symptoms should you look for?

Scarlet fever is a bacterial disease that primarily affects children. It causes a striking pink-red rash.

The disease is caused by Streptococcus pyogenes bacteria, which are located on the skin and in the throat.

The first symptoms of scarlet fever are sore throat and fever that may be accompanied by headache, nausea and vomiting.

Between 12 and 48 hours thereafter, a characteristic fine, sandy rash develops, often appearing first on the chest or stomach.

Other symptoms include a white coating on the tongue, which peels off a few days later and leaves the tongue red and swollen (this is known as strawberry tongue).

Cases are more common in children, although adults of all ages can also develop scarlet fever.

People who think they or their child may have scarlet fever should consult their doctor.

Source: NHS Choices

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