Flesh-Eating Bacteria Outbreak in Japan: A Deadly Threat That Can Kill in Two Days

Japan is currently grappling with a severe health crisis as a rare and deadly bacterial infection, known as Streptococcal Toxic Shock Syndrome (STSS), spreads rapidly across the country. This “flesh-eating” bacteria can lead to fatal outcomes within just 48 hours of infection, causing widespread alarm among health officials and the general public.

The outbreak has already resulted in nearly 1,000 cases by June 2, 2024, surpassing the total number of cases reported in the previous year. This article get you into the details of the STSS outbreak, its causes, symptoms, and the measures being taken to control its spread.

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Understanding Necrotizing Fasciitis

Necrotizing fasciitis, commonly known as “flesh-eating disease,” is a rare but aggressive bacterial infection that rapidly destroys soft tissue and fascia. It typically occurs when bacteria enter the body through a break in the skin, such as a cut, scrape, or surgical wound. The infection spreads quickly along the fascial planes, causing extensive tissue death and sepsis.

The most common bacteria responsible for necrotizing fasciitis are Group A Streptococcus (GAS) and methicillin-resistant Staphylococcus aureus (MRSA). However, other bacteria, including Clostridium, Escherichia coli, and Klebsiella, can also cause the condition.

Symptoms of necrotizing fasciitis include severe pain disproportionate to the visible wound, swelling, redness, and warmth in the affected area. As the infection progresses, the skin may develop blisters, ulcers, or black spots. Patients may also experience fever, chills, fatigue, and confusion.

Early diagnosis and prompt treatment are crucial for survival. Imaging techniques such as CT scans and MRI can aid in diagnosis, but surgical exploration remains the gold standard. Treatment involves aggressive surgical debridement of necrotic tissue, broad-spectrum antibiotics, and supportive care.

Recent studies have focused on improving diagnostic methods and treatment strategies. A 2024 review highlighted the potential of various imaging techniques, including MRI and CT scans, in the early diagnosis of necrotizing fasciitis. Another study published in 2024 provided a comprehensive practical review of necrotizing fasciitis, discussing classification, comorbidities, clinical presentation, and management principles.

The Threat of Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a life-threatening condition caused by toxins produced by certain strains of Staphylococcus aureus or Streptococcus pyogenes bacteria. These toxins trigger an overwhelming immune response, leading to rapid shock, multiple organ failure, and potentially death.

Historically, TSS was associated with the use of super-absorbent tampons in menstruating women. However, non-menstrual cases have become more prevalent, affecting individuals with surgical wounds, skin infections, or those using contraceptive devices.

Symptoms of TSS include high fever, low blood pressure, rash resembling a sunburn, vomiting, diarrhea, muscle aches, and confusion. Prompt medical attention is essential, as the condition can progress rapidly and become fatal.

Treatment involves immediate hospitalization, removal of the source of infection, administration of antibiotics, and supportive care. Intravenous immunoglobulin (IVIG) therapy has shown promise as an adjunctive treatment, but further research is needed.

A 2024 literature review published in the journal Antibiotics provided a comprehensive overview of the pathophysiology, epidemiology, clinical presentation, microbiological features, management, and outcome of TSS. The review highlighted the need for early detection, immediate resuscitation, source control, and appropriate antibiotic therapy.

Symptoms of STSS.

The symptoms of STSS can escalate rapidly, making early detection and treatment crucial. Initial symptoms include:

  • High fever
  • Chills
  • Muscle aches
  • Nausea and vomiting

As the infection progresses, more severe symptoms can develop, such as:

  • Low blood pressure (hypotension)
  • Rapid heart rate
  • Confusion or altered mental state
  • Difficulty breathing
  • Kidney failure
  • Liver dysfunction
  • Skin rash resembling a sunburn
  • Severe pain and swelling in the affected area

In some cases, the infection can lead to necrotizing fasciitis, a condition where the bacteria destroy the tissue surrounding muscles, leading to rapid tissue necrosis (flesh-eating).

The Current Outbreak in Japan.

The current outbreak of STSS in Japan has reached alarming levels, with 977 cases reported by June 2, 2024. This number has already surpassed the total cases reported in 2023, which stood at 941. The mortality rate for STSS is approximately 30%, meaning that out of every 10 infected individuals, three may succumb to the disease despite receiving treatment.

Health experts attribute the surge in cases to several factors, including the easing of COVID-19 restrictions, which has led to increased social interactions and a subsequent rise in infections. During the COVID-19 pandemic, measures such as masking and social distancing helped curb the spread of various infections, including GAS. However, with the relaxation of these measures, the incidence of STSS has spiked.

Causes and Transmission.

STSS is primarily caused by the invasion of GAS bacteria into the bloodstream and deep tissues. The bacteria can enter the body through:

  • Open wounds or cuts
  • Surgical incisions
  • Skin infections such as impetigo or cellulitis
  • Viral infections that cause open sores

Once inside the body, the bacteria produce toxins that trigger a severe inflammatory response, leading to the rapid onset of symptoms. Individuals with weakened immune systems, such as those with chronic illnesses like diabetes or cancer, are at a higher risk of developing STSS. The elderly, particularly those over 50, are also more susceptible to severe outcomes.

Recent Studies and Findings.

Recent studies have highlighted the virulence and infectivity of the strains of GAS responsible for the current outbreak in Japan. According to the National Institute of Infectious Diseases (NIID), the strains circulating in Japan have high virulence, making them particularly dangerous. The NIID has been monitoring STSS cases since 1999 and has noted a significant increase in cases following the relaxation of COVID-19 restrictions.

Professor Ken Kikuchi from Tokyo Women’s Medical University emphasized the importance of maintaining personal hygiene, particularly hand washing, as a preventative measure against STSS. He also pointed out that the low immunity levels among the population, due to reduced exposure to bacteria during the pandemic, could be contributing to the rise in cases.

Global Concerns and Comparisons.

The outbreak of STSS in Japan is not an isolated incident. Similar outbreaks have been reported in other countries, particularly following the lifting of COVID-19 restrictions. In late 2022, at least five European nations reported an increase in invasive group A streptococcus (iGAS) cases to the World Health Organization (WHO). The WHO noted that the rise in cases correlated with the end of COVID-19 restrictions, which had previously helped limit the spread of infections.

The U.S. Centers for Disease Control and Prevention (CDC) has also issued warnings about the increased risk of STSS, particularly among older adults and individuals with open wounds. The CDC emphasizes the importance of good hygiene practices and prompt treatment of any skin injuries to prevent the spread of GAS infections.

Preventive Measures and Public Health Response.

In response to the outbreak, Japanese health authorities have intensified efforts to curb the spread of STSS. Public awareness campaigns are being conducted to educate people about the symptoms and severity of the disease, encouraging prompt medical care if symptoms appear. Hospitals are on high alert to diagnose and treat STSS cases swiftly, and enhanced hygiene practices are being promoted.

Key preventive measures include:

  • Regular hand washing with soap and water
  • Proper care and cleaning of wounds and cuts
  • Prompt treatment of any skin infections
  • Avoiding close contact with individuals who have strep throat or other GAS infections
  • Maintaining good personal hygiene, especially after using the restroom or handling food

Treatment and Prognosis.

Treatment for STSS involves high-dose intravenous (IV) antibiotics to kill the bacteria. Supportive care, such as fluids to stabilize blood pressure and help organs function properly, is also crucial. In severe cases, surgery may be required to remove infected tissue and prevent further complications.

Early medical intervention is essential to improve the chances of recovery and reduce the risk of serious complications or death. Despite treatment, the mortality rate for STSS remains high, underscoring the importance of early detection and prompt medical care.

Summing Up.

The outbreak of Streptococcal Toxic Shock Syndrome (STSS) in Japan is a stark reminder of the potential dangers posed by bacterial infections, particularly in the post-pandemic era. With nearly 1,000 cases reported by June 2, 2024, and a mortality rate of 30%, the situation is dire. Health officials are urging the public to maintain good hygiene practices, seek prompt medical attention for any signs of infection, and remain vigilant in the face of this deadly disease.

As the world continues to navigate the aftermath of the COVID-19 pandemic, it is crucial to remain aware of other emerging health threats and take proactive measures to protect public health. The lessons learned from the pandemic, such as the importance of hygiene and early intervention, can help mitigate the impact of future outbreaks and save lives.


This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this article.


Hi there!I'm C.K. Gupta, the founder and head writer at With a passion for health and wellness, I created FitnTip to share practical, science-backed advice to help you achieve your fitness goals.Over the years, I've curated valuable information from trusted resources on topics like nutrition, exercise, weight loss, and overall well-being. My aim is to distill this knowledge into easy-to-understand tips and strategies you can implement in your daily life.Whether you're looking to get in shape, eat healthier, or simply feel your best, FitnTip is here to support and guide you. I believe that everyone has the potential to transform their health through sustainable lifestyle changes.When I'm not researching the latest health trends or writing for FitnTip, you can find me trying out new fitness routines, experimenting with nutritious recipes, and spending quality time with loved ones.I'm excited to have you join our community as we embark on this wellness journey together. Let's make positive, lasting changes and unlock a healthier, happier you!

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