It's a scenario straight out of a horror movie. You start with a normal bout of strep throat and figure you're going to have to deal with that week-long stretch of pain and difficulty swallowing. But after a few days, things get much worse.
Your hand, or leg, or scalp begins to feel sensitive to the touch. A rash develops. The area begins to blister and you need medical attention. You see the doctor hoping a solution can be found quickly. But sadly, there is no good news. You are diagnosed with necrotizing fasciitis, better known as flesh-eating disease. At best, you will be scarred for life. But you may need to face an amputation or worse, a 20 per cent chance of dying.
Thankfully, only a few dozen Canadians face this plight each year. But the numbers are growing. Unfortunately public health officials are having a difficult time tracking this potential killer. Usually, they only get a grasp of the problem after a case has been identified. Even then, the only advice they can give to the public is to be aware of strep throat and to ensure they are under the supervision of a health professional.
Microbiologically speaking, there are many bacterial species capable of causing flesh-eating disease. However, one specific strain is known to come from strep throat. It's called Streptococcus pyogenes M1T1. It has the unique capability of entering the bloodstream and spreading to several areas of the body. Once there, the invasion can proceed quickly. If treatment isn't sought within a few days, the outcome is dire at best.
We may have a path to a vaccine thanks to a group of Taiwanese researchers.
Researchers have known about M1T1 for decades, however they have struggled to find a way to stop its global spread. It's because this strain is only one of over 100 different types of this particular species. Accurate diagnosis requires advanced analysis of the bacterial genetic material, which is expensive and not available everywhere. Not to mention, to find one case, over a quarter-million strep throat tests would have to be performed. Quite simply, this is not a realistic option.
When faced with this type of challenge, public health officials have only a few options. One is to prepare the public for this particular disease. However, considering the rarity of this illness, such discussions may raise panic for no good reason. Another is to develop a rapid and inexpensive test, which is ongoing. A third strategy is to train health professionals to be on the lookout for the illness. That too is not easy in light of the workload on health-care workers. Finally, there is the vaccine route, which to date has not been effective.
While the other three continue to be explored, we may have a path to a vaccine thanks to a group of Taiwanese researchers. They have developed an intriguing candidate with the power to protect mice against this particular bacterium. Based on the results, the approach may help to reduce or even eliminate the risk for flesh-eating disease.
The approach was somewhat different than normal vaccination routes. Instead of focusing on using the entire bacterium, the team wanted to focus on proteins. More specifically, they wanted to target four different molecules known to be critical to invasion. But rather than try to group the proteins together, they decided to engineer a protein containing pieces of each. When they were finished, they had a protein they believed could work.
The first step was to determine whether this mash-up of strep proteins would lead to any kind of immune response. They injected the protein into mice and observed the reaction over time. As they hoped, the classic signs of vaccination were seen. Antibodies were formed and immune cells were trained. This was a good sign although realistically speaking, the easy part of the study. The hard part came next.
Should all go well, we may finally be able to close the book on this horror story.
After vaccination, the mice were infected with strep. If the team was right about their choice, the immune system would prevent the infection from progressing and spreading. They were. In comparison to the controls, in which sixty to eighty percent died, all the vaccinated mice lived.
But the best was yet to come. In addition to survival, none of the vaccinated mice suffered major signs of invasive disease, including fasciitis. They showed evidence of an infection but it was mild. The life-or-death situation had been avoided.
Despite the good news, this study is purely preliminary. It will be years, if not a decade before we even hear about a human version of the vaccine. But the results offer for the first time some hope in controlling the M1T1 strain and by extension this form of flesh-eating disease. Should all go well, we may finally be able to close the book on this horror story and perhaps keep throats everywhere healthy and safe from strep.
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