Invasive Group A strep cases rising, but the reason is a medical mystery

It's been just over a year since a common type of bacteria that lives all around us usually harmlessly changed CariKirkness's life forever.

"My body was aching. I had a sore throat, headache, fever," the Winnipeg mother of two, now 29, remembers.

Kirknessthought she had the flu and went to a walk-in clinic. Withoutapparent serious symptoms, she was sent home to rest.

Buta bump on her arm was forming, and "it was just getting worse within the hour."

She went to herlocal hospital, where emergency department staff realized they were dealing with necrotizing fasciitis more commonlyknown as flesh-eating disease caused by invasive Group A streptococcus bacteria.

Kirkness was rushed to Winnipeg Health Sciences Centre, where surgeons gave her a terrifying prognosis. In ordertosave her from the life-threatening infection, they would have to amputate her arm.

Cari Kirkness lost an arm and both legs to invasive Group A strep

7 years ago

Duration 0:37

She knew surgeons would have to remove her arm after becoming infected with flesh-eating disease caused by invasive Group A strep. She didn't know she would end up losing both legs, too.

But while Kirknesswas still unconscious after her arm was removed, the infection continued to ravageher body. Doctors told her parents, Tom and Loretta Kirkness, thattheonly hope of saving their daughter was to amputate both her legs.

They did, and for 12 excruciating days, Cari'sparents, sister, and two sons prayed she would pull through as she lay unconscious in her hospital bed. When she finally woke up on Feb. 20, 2017, her parents rushed to her side ecstatic that Cariwas alive, but forced to break the devastating news that her legs were gone.

"It was a shock," CariKirknessremembers. "But when my mom had told me that it was to save my life, that's when I was OK with it."

"She was telling me that God had saved my arm because I can hold my babies. I could hug them."

Kirknesslives with her "babies" Chaz, 12, and three-year-old Andrew and her parents in a one-level housethey bought, with the help of donations,to accommodate the wheelchair she now relies on.

To this day, Kirknessand her family have no idea how or why the infection happened. Neither do the doctors andnurses who treated her.

"[I] didn't really get a definite answer. It was just something freaky, is what I get a lot of people say[ing], like in the medical field," Loretta Kirkness said.

That's because, as several health experts acknowledged to CBCNews, strep A bacteria is still somewhat of a medical mystery.

Public concernabout strep A bacteria escalated in early March, after Markham-StouffvilleHospital, just north of Toronto, confirmed there had beenthree cases of infection in its childbirth unit in February and that a mother had died from a severe form of it.

• Days after giving birth, mom dies of strep A

Group A streptococcus is a common bacteriathat exists everywhere, including inside people's noses andmouths andonskin wounds,said Dr. Isaac Bogoch, an infectious disease specialist at University Health Network in Toronto. People often don't even know it's there.

Strep A is transmitted through direct contact with the bacteria, including coughing, sneezing or touching a wound. When strep A makes people sick,it'susually nothing more serious thanstrep throat.

But in rare cases, the bacteria becomes "invasive," entering parts of the body where it doesn'tnormally go, including the bloodstream, musclesand organs.

That causes serious infections the most severe of which are flesh-eating disease and streptococcal toxic shocksyndrome. Both can be fatal. Treatment includes antibiotics and sometimes surgical removal of infected tissue.

Number of cases doubles

Although theinvasive form of strep A is rare, the number of reported cases in Canada has been rising steadily over the last 15 years, according todata from the Public Health Agency of Canada and fromprovincial and territorial public health departments.

In 2002, there were 866 reported cases across the country. By 2017, that number more than doubled to at least 2,178 cases (thattotal does not include Alberta, New Brunswick, Nova Scotia, Nunavut, P.E.I. or Yukon, whose numbers weren'tavailable.)

More than 100 people died of an invasive Group A strep infection in Canada in 2017, according to information provided by provincial and territorial public health agencies to CBCNews.

Public health experts, including the Public Health Agency of Canada,say they don't know why the numbers are rising and that they continueto investigate. They also don't know exactly what makes common strep A bacteria turn into a destructive invader of the body.

"This is an area of active study in the research community," a spokesperson for Health Canada told CBCNews in an email.

That research is producing some theories, Bogochsaid.

"Probably, some of it is related to the bacteria itself," he said. "There can be many strains of the bacteria and some strains might be more invasive than others."

The other part of the equation that requires more understanding, Bogochsaid, is why some people are hit with an invasive infection, while others who might have been exposed to the same strep A bacteria aren't.

"Some people might have subtle deficits to their immune system, or major deficits to their immune system, that might make them more predisposed to having an invasive infection," he said.

"So basicallyit's a dance between the bacteria itself and the person that the bacteria is on that might make someone more susceptible to having an invasive infection."

But as a physicianwho seesthe devastatingeffects of invasive Group A strep infectionslike flesh-eating disease,the lack of concrete answers makes for "very challenging conversations" with patients and their families.

"It is quite sad because sometimes we don't have obvious arrows pointing into a direction as to how this person acquired the infection," Bogoch said.

But other times, those arrows point to risk factors that experts do know about. As with many communicable diseases, the most vulnerable people in society tend to be particularly susceptible to invasive strep A infections.

Those risk factors include homelessness whether living on the street or living in crowded shelters. Another risk factor is injection drug use.

The city of London, Ont., which struggles with both risk factors, has been battling an invasive Group A strep outbreak for two years.

• What you need to know about the outbreak in London, Ont.

Half of the more than 130 people infected in the city of 400,000 aren't properly housed, are battling drug addiction, or both, according to the Middlesex-LondonHealth Unit.

One of them is a woman who has been chronically homeless for months, sometimes sleeping in the streets and sometimes couch surfing. She suffers from addiction and uses injection drugs. CBCNews has agreed to protect her identity because of the stigma she faces.

Last spring, she had a bruise on her shin that turned into a blister, but didn't think anything of it until she became ill while with friends and they called an ambulance.

She remembers waking up in the hospital and staff tellingher they were prepping her for surgery.

"I said, 'For surgery for what?' And they said I have a flesh-eating bacteria on my leg," she said.

Her surgeonsremoved a large chunk of flesh from her foot and shin. It took weeks before she could walk.

'It looks like a shark bit me'

"It looks like a shark bit me, bit half my foot off, leg off," she told CBCNews.

Unlike many people who are homeless, she was able to get housing after being discharged from hospital and has been able to keep her wound clean and bandaged, as well as complete her antibiotic treatment.

That's due largely to Dr. Andrea Sereda, who works with vulnerable women through the London InterCommunityHealth Centre.

Seredasaid between the unhygienic living conditions caused by a lack of stable housing and her injection drug use, her patientwas at high risk of invasive strep A infection, even through minor scrapes, bumps or wounds.

"Her infection was caught in time. She received great hospital care ... she was able to get housing at the right time," Seredasaid. "All of those things meant that she's been able to recover. But each step along the way, things could have fallen apart.

"She could have lost her leg."

For vulnerable patients with known risk factors, invasive Group A strep can be largely prevented by providing appropriate housing, effectiveaddiction treatment, and safe consumption sites for injection drug use, Sereda said.

But for many other Canadianswithout any apparent risk factors, like CariKirkness, the devastating infection comes, seemingly, out of nowhere.

"Sometimes we don't have a risk factor that we can identify. So what we continue to do is, with each and every case,try to understand a little bit more about them, a little bit more about how that could add to our overall understanding in the broader population," said Dr. Liane Macdonald, a physician with Public Health Ontario.

"I think we're still trying to understand this increase that we've been seeing."

How to protect yourself

Although health experts are still trying to determine why the strep A bacteria turns invasive and why infections are on the rise, they emphasize these cases are still rare. They also recommend you:

• Wash your hands frequently.
• See a health care provider immediately if you have a throat infection that doesn't go away.
• Seek immediate medical attention If you have a cut and your skin turns red or is hotor painful.
• Ensure any drug paraphernalia you use, including needles, is safe and clean.