When Strep Becomes Sepsis: It 'Decimated My Whole System'

Invasive group A strep infections are on the rise in the United States and Canada, yet many remain unaware of its potential to cause sepsis — a life-threatening medical emergency.

In March of 2012, Fiona Bramble developed a sudden feeling of extreme unwellness. Within minutes of the onset of her symptoms, she found herself shivering violently — something she had never experienced before.

Unaware of what was happening to her body, Bramble went to the hospital only to be told she likely had a urinary tract infection or a norovirus. She returned home for nine days and became increasingly ill, suffering from severe abdominal pain, vomiting, diarrhea, extreme weakness, and terrible pain all over her body. It was the intolerable pain, ultimately, that led her back to the hospital, only to discover that she was near death.

“I had a lot of classic sepsis symptoms that I would now know what to look for, but I did not know at the time,” Bramble tells Healthnews.

Upon her return to the hospital, Bramble was told she had an infection without further detail before undergoing a host of medical procedures. Only years later, after requesting her own medical records, did she find out that she had group A streptococcus, or a streptococcal (strep) infection, in her bloodstream, which triggered sepsis.

Surge in invasive group A strep (iGAS) infections

Rising iGAS cases have been observed in a number of countries recently, including the U.S., Canada, the United Kingdom, and Japan. According to the Centers for Disease Control and Prevention, preliminary data indicate the number of severe infections caused by group A strep reached a 20-year high in 2023.

Alison Fox-Robichaud, M.D., a professor of medicine at McMaster University and the scientific director of Sepsis Canada, tells Healthnews that she recently had four people in the ICU with invasive group A strep. “I don't think in my entire 20-plus year career have I ever had four patients with group A strep in the ICU at the same time, so it's significant,” she says

Group A strep is a family of bacteria that harmlessly live on the skin of many people, though they can cause a number of infections, including strep throat in adults and scarlet fever in children. Symptoms of streptococcal infections include a sore throat as well as ear infections and redness of the skin in children. The bacteria spread through respiratory droplets or on surfaces, especially in communal living settings.

For some individuals, however, a strep A infection can become severe, which is when it turns to iGAS, according to Fox-Robicheau. This occurs when the bacteria invade the soft tissues of the skin, the muscles, or the bloodstream. This more invasive variety can cause extremely painful, red, swollen limbs, potentially on an entire side of a person’s body. Or, like in Bramble’s case and perhaps most dangerously, it can cause no symptoms at all.

While those with strep throat or other mild strep A infections can be treated with antibiotics, Fox-Robichaud says the invasive variety often requires critical care management. This is because it can develop into more serious, potentially fatal conditions — like sepsis.

What is sepsis?

Sepsis, by definition, is organ dysfunction caused by an overreaction to an infection in which toxins are released into the bloodstream and inflammation is triggered, leading to organ shutdown. It’s life-threatening and fast-acting, meaning it can quickly result in death if not treated promptly. Any infection at all can potentially lead to sepsis, according to Fox-Robichaud, including viral, bacterial, and fungal infections.

Its impact is wildly underestimated and misunderstood.

Sepsis is listed as only the 12th leading cause of death in Canada, for example, but Fox-Robichaud says this doesn’t take into account that essentially all deaths from infections are the result of sepsis — including every single individual who’s died from COVID.

“When you add up the data, it ends up that sepsis is probably the third leading cause of death in Canada,” she says.

In the U.S., sepsis is the third most common cause of death in hospitals, affecting 1.7 million people across the country each year. At least 350,000 adults who develop sepsis either die during their hospitalization or are discharged to hospice.

And it’s actually the deadliest health condition in the world, killing more people globally than cancer. The World Health Organization (WHO) identified sepsis as a "global health priority" in 2017, urging countries to take steps to increase awareness and improve diagnosis and treatment options for the deadly condition.

But a recent Canadian study conducted by Fox-Robicheau and other researchers, indicates that only 61% of Canadians are even aware of the existence of sepsis, and less than a quarter are able to accurately identify its symptoms. Less than 50% recognize the necessary strategies to prevent sepsis, which include vaccinations, hand hygiene, good nutrition, and treating chronic diseases appropriately.

That’s at least partially because there are many sepsis symptoms, some of which resemble other common ailments. Symptoms include but are not limited to nausea, vomiting, confusion, difficulty breathing/shortness of breath, heart racing, low blood pressure, changes in skin, and not making enough urine. But its sudden severity sets it apart from other illnesses.

Some of our patients with sepsis will tell us, ‘I feel horrible. I feel like I'm gonna die,’ so it's pretty hard to miss, you would think. This is not a minor thing if you're experiencing it.

Fox-Robichaud

It does occasionally get missed, like in Bramble’s case — and at times with deadly consequences. Diagnosis is limited by the fact that there isn’t a specific test to identify sepsis, and in cases when sepsis is being caused by a strep A infection, strep tests can take up to 48 hours to show results.

But time is of the essence with sepsis, potentially marking the difference between life and death.

“The earlier we identify it, the earlier we treat it, the more likely it is to do better,” Fox-Robichaud says. “If you end up in an intensive care unit, about 20 to 30% will not survive their hospital stay, and sepsis itself becomes a risk factor for other problems down the road.”

A long road to recovery

It’s been 12 years since Bramble had sepsis, and it still impacts nearly every facet of her life. After receiving treatment that included multiple major surgeries and many antibiotics, she contracted C. difficile — a germ that causes diarrhea and colitis and commonly occurs following a large antibiotic load.

Then, most of her hair fell out. She spent about a year and a half sleeping for the majority of the day, and it took several months before she could even walk around the block. She lost all her muscle mass, her teeth demineralized, and she lost all the skin on her hands and feet.

“The infection just decimated my whole system,” she says. “There were big losses.”

Her recovery was slow and plagued by chronic fatigue, and she still, to this day, suffers from pain and inflammation that limit her daily activities — including her ability to sleep on a normal bed (she now sleeps on an air mattress). She says vitamins and supplements have helped her health, however, and she goes to the gym regularly to keep her joints moving.

“I've worked on some life hacks that have helped me deal with this, probably, lifetime struggle,” she says. “I've kind of made my life fit the pain and fatigue that I endure.”

And yet, she knows she’s luckier than the many who haven’t survived sepsis.

Sepsis awareness can be life-saving

As the scientific director of Sepsis Canada, Fox-Robichaud is working hard to determine the exact burden of sepsis in the country, to raise awareness about its signs and symptoms, and to ensure other healthcare workers know its true prominence and risks.

Education, she says, is key to prevention and effective intervention. But most people, healthcare workers included, are not sufficiently educated about sepsis, she says.

This lack of awareness is likely why Bramble was never even told she had sepsis during her hospitalization, nor was she followed up with after her release or told what to expect during her recovery.

I had oh so many post-sepsis syndrome issues, like PTSD and hair loss and fatigue, and I didn't know why this was happening. No one ever said ‘You had sepsis, and this is probably what's gonna happen over the next six months to a year and this is how we're gonna mitigate it.’ That never happened.

Bramble

After all she’s been through, Bramble wants people to know that any kind of infection can trigger a septic reaction in the body and that it can take hold incredibly quickly. She says she was lucky to stay alive as long as she did before accessing treatment, but many others with severe sepsis haven’t been so lucky and have lost their lives within just 12 hours. She says she can’t emphasize enough how important it is to pay attention to what's happening to your body and seek medical attention.

Bramble also wants people to stop thinking strep automatically means strep throat.

“It's not about necessarily having a sore throat — it's a bacteria that gets into your system,” she says. “It's not what you think it is and the symptoms might not be what you think they're gonna be, so if something is really unusual and you're not well, it costs nothing to ask to eliminate sepsis as a possibility and to really advocate for yourself in that way.”

Asking that question, Fox-Robichaud says, could save your life.

“If you feel unwell, you think you've got an infection, and you come to an emergency department or to your family practitioner, ask the question, ‘Could this be sepsis?’” Fox-Robichaud says. “That's enough to trigger that team to add a little bit of extra blood work or go deeper.”