On 26 February 2019, an Idaho couple shared a cautionary tale on Facebook that had garnered over one million shares by the time of this reporting. The post detailed a strange mark on their son’s face and the ultimate diagnosis of a form of strep throat that infects the sinuses:
It is true that a form of strep throat is capable of infecting the nasal passage, sinuses, face, and even other organs. Clinically known as invasive Group A Streptococcal Disease, or iGAS, it occurs when the bacteria responsible for common strep throat infect other organ systems or the bloodstream, as described by the Middlesex-London Health Unit of London, Ontario, which experienced an outbreak of iGAS cases in 2017:
Group A streptococcus (GAS) are common bacteria which can cause skin and throat infections, including strep throat and cellulitis ... While the majority of GAS infections cause relatively mild illnesses like strep throat and impetigo, sometimes the bacteria can become invasive and can cause more serious and potentially life-threatening infections when they get into muscles, blood and other organs. Symptoms of an iGAS infection depend on the site of the infection and may include fever, chills, sore throat, dizziness, confusion, severe pain, redness or swelling around a wound or injured area.
In its most severe form iGAS can result in life-threatening conditions, including necrotizing fasciitis (commonly known as a “flesh-eating disease”), myositis and myonecrosis (muscle inflammation and a “muscle eating” disease, respectively) and Streptococcal Toxic Shock Syndrome (StrepTSS), which can lead to total organ failure. Though it is extremely rare, when the latter occurs a person is at extreme risk and requires medical treatment immediately, as described by Canada’s Globe and Mail in response to the 2017 outbreak: "When strep A gets into tissue or bone — usually because a person has an open wound — it can turn deadly, and quickly. In a matter of hours, an infected person can go from having a mild fever to having flesh-eating bacteria spreading so relentlessly that the only way to stop the infection is by amputating limbs."
iGAS infections often occur in clusters and affect groups more likely to be immunocompromised, but more recent research suggests that adults and children of any age and in any medical condition can contract the disease. Nevertheless, severe iGAS infections remain quite rare, as described in the 2016 book Streptococcus Pyogenes: Basic Biology to Clinical Manifestations:
[iGAS outbreaks] were first described in the United States and Europe during the mid- to late 1980s. Since then, reports of StrepTSS in adults and children have emerged worldwide. Most cases have occurred sporadically, though some clusters have been reported. The highest incidence of invasive streptococcal disease occurred in a small Minnesota community, where 26 cases/100,000 population were recorded.
In addition, outbreaks have occurred in closed environments, such as nursing homes and hospitals. ... Although many of the initial reports described StrepTSS in adults, children are also affected. In 2010, the incidence of invasive infection in children in Utah reached 14 cases/100,000 population. Thus, persons of all ages can be afflicted and, although some have underlying medical conditions such as diabetes and alcoholism many have no predisposing medical condition and are not immunocompromised.
In the case of the Idaho family, iGAS was diagnosed in time, and the pictured boy was reportedly recovering well.