New Straits Times

Tuesday, 28/06/2011

Scarlet fever bugs antibiotic resistant

HONG KONG: Ultramodern Hong Kong is tussling with a centuries-old bug long forgetten in many developed countries an outbreak of drug-resistant scarlet fever that has killed the first children there in a decade. And with it is the rise of a mutated strain that appears to be more contagious.

The number of cases has spiked this year to more than 500, with health officials issuing warning in this city jammed with 7 million people and hypersensitive to any type of disease aoutbreak. Experts warn the main strain of the bacterial infection is likely transmitted easier. It is 60 per cent resistant level of 10 to 30 per cent previiously.

The illness leaves children with a fever, sore throat, bright red tongue and sandpapery rash. Penicillin still cures it, but doctors worry options will be limited if the germ eventually outsmarts that antibiotic before a vaccine is developed.

“That’s the cause of lots of nightmares,” said Dr Edward Kaplan. He heads a World Health Organisation research centre at the University of Minnesota that focuses on the strep germ, which causes scarlet fever.

The widespread availability of penicillin and the development of other new antibiotics in the 20th century virtually wiped out diseases that were once major killers in developed countries, such as tuberculosis. But the overuse and misuse of drugs patients not finishing a full prescription or taking antibiotics for a virus when they are only effective against bacteria have allowed old bugs to fight back and eventually overpower antibiotics.

Penicillin, once useful to treat a number of ailments from gonorrhea to pneumonia, has lost much of its potency due to resistance that has built over decades. Some say it’s a miracle it still works for the streptococci group that causes an array of diseases from strep throat to toxic shock syndrome and flesh eating disease.

“That’s the one thing that we’re both a bit fearful of and also, in one respect, really surprised that the bug hasn’t developed penicillin resistance yet,” said Mark Walker, a microbiologist and strep expert who heads the Australian Infectious Disease Research Center.

But even penicillin has its problems because many people are allergic to it. That means trying older antibiotics or newer drugs of last resort, which doctors typically try to avoid for fear of rendering those drugs useless, too. A vaccine againt the germ that causes scarlet fever is likely years away.

Pockets of drug-resistant scarlet fever, which typically sppreads through coughing and sneezing and is most common in children under 10, have sprung up over the past few decades in various parts of the world.

And while the Hong Kong deaths and rise in cases were disturbing, the resistance seen in the standard drugs used in treatments, eryhromycin and clindamycin, were not new, Dr Kaplan said.

A 7-year-old girl who died in May became the first recorded scarlet fever death in Hong Kong in at least 10 years, while a 5-year-old boy also died last Tuesday. Both deteriorated quickly in the hospital and were killed by toxic shock syndrome resulting from the infection.

The children were infected with two different strains of scarlet fever that are circulating simultaneously, both antibiotic resistant.

– AP