CHP investigates case of Group A Streptococcal infection with necrotising fasciitis
The Centre for Health Protection (CHP) of the Department of Health today (April 29) is investigating a case of Group A Streptococcal infection with necrotising fasciitis (NF).
The case involves a 47-year-old male with underlying illnesses. He developed a fever and left thigh pain on April 11 and sought medical treatment from a private hospital on Hong Kong Island on the same day. Due to the clinical diagnosis of NF complicated by septic shock, he was transferred to Queen Mary Hospital for treatment on the following day. He underwent amputation of his left lower limb on April 13. The patient is still hospitalised and is in stable condition. His clinical specimens tested positive for Group A Streptococcus.
Preliminary epidemiological investigations revealed that the patient sustained an accidental sprain on April 6 while lifting a heavy object and subsequently developed left buttock pain as well as numbness in his left leg and foot. As such, he received acupuncture treatments on April 7, 9 and 10 from two registered Chinese medical practitioners in Sheung Wan and Causeway Bay respectively. He has no travel history and no other wound or trauma causing skin damage during the incubation period. His household contacts have remained asymptomatic so far.
DH staff visited the premises of the registered Chinese medicine practitioners where the patient received acupuncture treatments. Regarding the registered Chinese medical practitioner in Causeway Bay, the DH staff reviewed the procedures of acupuncture and infection control, and collected environmental specimens for testing. Laboratory results showed that one of the environmental specimens at the premises tested positive for Group A Streptococcus belonging to the same emm type 4 as the patient's specimens. A further genetic analysis is still in progress. Furthermore, during the investigation, the investigators suspected that the Chinese medicine practitioner had not strictly followed infection control procedures when performing acupuncture. The investigation is still in progress. The DH will consider referring the case to the Chinese Medicine Council of Hong Kong for follow-up action if there was suspected professional misconduct by the Chinese medicine practitioner.
As for the registered Chinese medicine practitioner in Sheung Wan, the DH staff have visited the premises on multiple occasions but it has not been open for business. The DH will continue to follow up on the investigation and seek to contact the registered Chinese medicine practitioner concerned in this incident.
So far, the DH has not received any reports of adverse reactions from other patients receiving acupuncture treatments from the Chinese medicine practitioners concerned. The DH will continue to investigate the incident and follow up with the other registered Chinese medicine practitioner.
Group A Streptococcal infection is caused by bacteria, namely Streptococcus pyogenes that can be found in the throat and on the skin. It can be transmitted by droplets and contact. The bacteria can cause mild diseases, including pharyngitis, impetigo and scarlet fever, to invasive Group A Streptococcal (iGAS) disease such as NF and streptococcal toxic shock syndrome. Anyone can get iGAS disease, but the elderly and young children, persons with chronic illnesses (e.g. diabetes) or immunocompromised persons may be at a higher risk. People with breaks in the skin or with recent viral infections (e.g. chickenpox, influenza) are also at a higher risk of developing iGAS disease. On the other hand, Group A Streptococcal infection can be effectively treated with antibiotics, and prompt treatment helps alleviate symptoms faster and prevent complications. Members of the public are reminded to maintain good personal and environmental hygiene and to practise good wound care in order to reduce their chance of becoming infected. Among others, members of the public are strongly advised to practise hand hygiene frequently, avoid sharing personal items and put on a surgical mask if going to crowded places.
In addition, NF (commonly known as "flesh-eating infection") can be caused by different types of bacteria, and Group A Streptococcus is considered the most common cause of NF. The bacteria that cause NF most commonly enter the body through a wound in the skin, such as a cut, scrape, burn, insect bite, or puncture/surgical wound. The skin of the patient may be warm with a reddish swelling that spreads rapidly, and there may be ulcers, blisters or black spots. The patient may experience intense and severe pain, and may also have fever, chills, fatigue, diarrhoea, vomiting, or pus from the infected area. NF can progress rapidly, and may result in complications and death. Patients require hospitalisation, and some even require intensive care. Prompt treatment with appropriate antibiotics is necessary to kill the bacteria. In order to stop the infection from spreading, surgery, e.g. removal of the dead tissues or amputation of the limb, may be required.
To prevent infections causing NF, members of the public should maintain good personal hygiene and practise good wound care, and wear protective gloves when handling raw shellfish or other seafood.
• Perform hand hygiene frequently. Wash hands with liquid soap and water, and rub for at least 20 seconds; then rinse with water and dry with a disposable paper towel or hand dryer. If hand washing facilities are not available, or when hands are not visibly soiled, they may be cleaned with 70 to 80 per cent alcohol-based handrub;
• Clean wounds immediately and cover properly with waterproof adhesive dressings until healed;
• Treat wounds immediately even for minor or non-infected wounds;
• Perform hand hygiene before and after touching wounds;
• Avoid going to swimming pools, other water facilities or natural bodies of water, e.g. rivers, lakes and oceans if you have an open wound; and
• Consult a doctor promptly if symptoms of infection develop, such as increasing redness, swelling and pain on the skin.
