A SPECIALIST TALKS ABOUT THE BAFFLING INFECTION THAT FELLED HENSON

How can a healthy man in his 50s succumb so abruptly to a garden-variety illness like pneumonia? To Dr. Edward Kaplan, an authority on streptococcal infections, Jim Henson's death was tragic but not unfamiliar. The organism that killed Henson, Group A streptococcus bacteria, is not rare, but it can occasionally cause an overwhelming infection that is unusually virulent. Studies suggest a recent unexpected increase in serious infections caused by the bacteria, which is highly deceptive: Early on, Group A strep can be mistaken for mere flu, but before a victim has even sought treatment, it may overwhelm the body with pneumonia, kidney failure or liver failure, A professor of pediatrics at the University of Minnesota and director there of the World Health Organization Collaborating Center for Reference and Research on Streptococci, Kaplan, 54 (below), spoke about Group A infections with correspondent Margaret Nelson.

Just what is Group A streptococcus?

It is one of an enormous variety of streptococcal bacteria. Group A streptococci cause a number of diseases, from mild ones like impetigo to serious illnesses like scarlet fever. It is almost always associated with strep throat, and it is the only kind of streptococcus that causes rheumatic fever.

How is the Group A bacteria contracted?

It is usually inhaled, but it can get into the body through a cut or abrasion. Once there, it likes to live in the respiratory tract, especially in the throat.

How often is it deadly?

We don't know. We don't have exact figures because doctors are not required to report strep diseases. We know only that Group A strep is a very rare cause of pneumonia. Lately, however, there has been evidence of a more virulent type, a meaner bacteria. One of the first reports appeared in the New England Journal of Medicine last July. Of the 20 cases discussed, there was a 30 percent mortality rate, which is very high compared to most common forms of pneumonia. But I don't want to be an alarmist. This is a very rare disease.

What are the common symptoms?

They may be flu-like or they may begin like a typical strep throat, with quick onset of fever, sore throat, perhaps nausea and vomiting. In those rare instances when the infection becomes more serious, it may involve other parts of the body within a day or so. Patients may go into shock and develop problems with the lungs, kidneys and liver and infections of the muscles. Once the bacteria gets a toehold, therapy may become more difficult even with large doses of antibiotics.

This bacteria seems a more virulent one," says Kaplan, in his Minnesota lab.

Since the first symptoms may be relatively mild, when should one seek medical care? It's true, at first there may not be much that distinguishes a Group A infection from a bad case of the flu. But people should use common sense. If you suddenly become very ill—high fever, sore throat—seek medical care.

What is the treatment?

First, to identify the infectious agent, usually through a throat culture. If it is Group A, an antibiotic, probably penicillin, is prescribed. A patient who is only mildly ill can expect to feel better in a few days. The penicillin also reduces the risk of rheumatic fever or other complications. With the more serious Group A infection, antibiotics are also used, often intravenously, but other medical and surgical therapies may be required.

Are children especially vulnerable to strep?

Strep throat has been called an occupational disease of schoolchildren. If you went into any schoolroom in the winter and did throat cultures, 5 percent to 20 percent of the children would have it, with or without any symptoms. In the past few decades parents may have become a little complacent about strep throat because there have been so few complications. But these things tend to go in cycles, and they're beginning to increase again despite antibiotics. We don't know all the reasons why.