Arizona Indians have higher rate of invasive strep infections Story-Date: 11:46 a.m. PST Friday , March 27, 1998 ------------------------------------------------------------ Arizona Indians have higher rate of invasive strep infections By Arthur H. Rotstein Associated Press Writer TUCSON, Ariz. (AP) -- Health officials don't know why but have found that American Indians in Arizona are infected by potentially flesh-eating and deadly strep bacteria at rates twice to three times the general population. The invasive group A streptococcal disease can kill if left unchecked. It has claimed two Arizona victims this year, neither of them Indians. In 1997, the Arizona Department of Health Services recorded 182 cases of invasive strep -- most of which did not involve flesh-eating infections. The total was the highest number since it became a reportable disease in 1993. Figures compiled from 1994 through 1996 showed overall rates of 3.3, 3.4 and 2.9 per 100,000 population, respectively. But for Indians, the rates were 11.3, 8.9 and 9.4 per 100,000 population. "We'd like to know why, but we don't," says epidemiologist Clare Kioski. "The data does suggest they are at higher risk," Ken Komatsu, another epidemiologist with the department, said Thursday. "We thought maybe it was due to higher incidence of diabetes" among Indians than the general population, but that has not been borne out in cases analyzed, he added, though tribal information has not been analyzed in detail. There were 131 cases of invasive strep reported in Arizona in 1994, 142 in 1995 and 119 in 1996, but the department has no accurate total on the number of resultant deaths because "we don't know the outcome of many of these cases," Komatsu said. Since November, Texas has reported 31 deaths stemming from 144 cases of invasive group A strep infections. Two of the most severe forms of the invasive strep are necrotizing fasciitis, sometimes referred to as the "flesh-eating bacteria," and streptococcal toxic shock syndrome, an infection that progresses quickly, attacking vital organs such as the liver, lungs and kidneys. Dr. Ronald Spark, a pathologist at Tucson Medical Center, said the bacteria can release tissue-destroying enzymes and toxins. Strep infections commonly are treated with penicillin. Doctors may resort to surgery in situations where the more serious infections have damaged tissue. The Centers for Disease Control in Atlanta estimates more than 2,000 deaths annually throughout the nation from 10,000 to 15,000 cases of invasive group A strep. Of the total cases, CDC estimates that one-fifth of 500 to 1,500 people who contract necrotizing fasciitis and 60 percent of an estimated 2,000 to 3,000 others stricken with streptococcal toxic shock syndrome die annually. What appears to be an increase in the number of cases may be more a matter of more comprehensive reporting. Kioski said that in 1997, Arizona changed its reporting procedures to include cases from medical laboratories as well as from hospitals and doctors. The strep organism commonly causes sore throats, but most such infections do not reach levels of severity that can be life-threatening. Doctors are trying to keep the public informed but don't want to cause panic, health officials in Arizona and Texas say. "This thing has a faster development, and the public should have an awareness," Spark said. "A lot of these cases have been in a matter of a day, day and a half or two days. Most of us, when we have an infected cut, we have more time than that." Flesh-eating infections usually occur from wounds on the arms, hands or legs, with symptoms including pain, redness, warmth and swelling. Komatsu said cases of invasive group A streptococcal disease have ranged from Scottsdale to South Phoenix, "so it doesn't seem to follow any socioeconomic pattern." "Tucson seems to have a higher rate than Phoenix," he added. ------------------------------------------------------------