One child died from strep infection in Mecklenburg County. Cases are on the rise.

One child died in Mecklenburg County and another was hospitalized after getting strep infections in May, according to North Carolina’s Department of Health and Human Services.

Both had infections from the bacteria that causes strep throat, the state said. Infections can turn invasive and deadly when bacteria — specifically group A strep (GAS) bacteria — enters the bloodstream, the agency stated.

These invasive infections also are responsible for increased adult and children hospitalizations across the county, state and nation, according to state and U.S. data.

Once infected, there’s no consistent time frame for when — or if — infections turn deadly, said Dr. Amina Ahmed, chief of pediatric infectious diseases and immunology at Levine Children’s Hospital. “Once it’s in your throat, it’s unfortunately just a matter of bad luck how it gets into your bloodstream or if it gets into your bloodstream,” Ahmed said.

The child’s death in May was the first pediatric death due to an invasive GAS infection in Mecklenburg County this year, county data provided by public information officer Suzette Nedrich showed. Neither the county nor the state would say how old the child was.

There have been a total of 33 invasive infections so far this year, including five pediatric cases. Two adults also died with infections this year in Mecklenburg, county data indicated.

Last year, there were 43 total cases in Mecklenburg County, and in 2021 there were 24.

Rising strep infections in NC and Mecklenburg County

A spike in cases typically happens from October to April every year, Ahmed said.

Before last year, there were an average of 15 invasive pediatric GAS cases during that seven-month span, according to state data from the past seven years.

But since October 2022, North Carolina has seen 62 pediatric infections, state data indicated. Mecklenburg County had the most cases, accounting for nine of the state’s infections.

Cases last peaked in Mecklenburg County in 2019, when 61 adults and children were infected, Nedrich said.

Statewide, there have been 468 invasive GAS cases to date, compared to 461 for all of last year, N.C. health records show. And there have been 47 deaths from invasive GAS cases in the first five months of this year in North Carolina. That’s more deaths than any other year in the state going back to at least 2016.

And through June 1, there have been 46 pediatric invasive GAS cases in the state, N.C. data show. That total also is higher than any other year going back to at least 2016.

Officials don’t know why cases are spiking again, Ahmed said. Some infections are preceded by chicken pox, COVID or the flu, Ahmed said, but not all are.

Experts originally thought the spike was due to decreased immunity from wearing masks throughout the pandemic and quarantine, but she said that doesn’t align with historical findings.

Some experts thought it was a more powerful strain. Sometimes it is, Ahmed said, but tests in Mecklenburg County don’t reflect the more intense type doctors found in other parts of the country.

From strep throat to an invasive infection

The uncomfortable swab at the doctor’s office doesn’t just test for strep throat. It tests for the presence of GAS bacteria, Ahmed said.

When it spreads to the blood, heart or spinal fluid, the bacteria can cause dangerous infections and diseases. These include scarlet fever, rheumatic fever, necrotizing fasciitis — a flesh-eating disease — and strep throat, according to the Centers for Disease Control and Prevention.

The reason to treat strep throat is not just to prevent invasive infections, according to Ahmed, but mainly to prevent non-infectious complications like rheumatic fever.

Amoxicillin is the preferred treatment for strep infections. But a national shortage has created another hurdle for doctors, Ahmed said. The American Academy of Pediatrics issued a list of alternative treatments while the shortage is expected to continue for several months.

Ahmed said each month she sees 10 to 15 hospitalized strep patients at Levine Children’s Hospital While some cases aren’t considered invasive infections, their severity still lands them in the hospital.

Skin and soft tissue infections make up most of those cases, she said. They occur when GAS bacteria lands on and infects skin, not just the throat or mouth.

But invasive infections become most problematic and potentially fatal when it develops into streptococcal toxic shock syndrome, Ahmed said.

For nearly half of people suffering from the toxic shock syndrome, according to the CDC, doctors do not know how the bacteria got into the body. Once in deep tissues or bloodstreams, bacteria causes low blood pressure, rapid breathing and increased heart rate, the CDC said.

How to prevent and detect strep infections

GAS bacteria typically causes mild symptoms, like strep throat, impetigo — a skin infection — or pneumonia, according to the CDC. Many people, and 10% to 15% of children, carry GAS bacteria in their throat without getting sick, Ahmed said.

Invasive infections can happen when the original infection goes untreated or the bacteria gets into wounds or sores on the skin, according to Ahmed and the CDC.

The spread of all GAS infections can be reduced by washing your hands, especially after coughing and sneezing or before touching foods.

If people test positive for strep throat, they should stay home for at least 24 hours after taking an antibiotic, the CDC said.