Jesse Brown, a healthy fifth-grader in Winter Park, Fla., was using a treadmill at a gym when he rolled his ankle. The boy was healing but soon developed a red and purple rash on his leg, Good Morning America reported Feb 19.

He was rushed to the ER and admitted to the ICU, where testing revealed that he had developed an invasive strep A infection. He died a few days after being hospitalized, his cousin told the news program.

U.K. health officials issued a warning last week about sustained high levels of strep A infections—among children, but also among adults.

What is strep A?

Group A streptococcal infections usually cause a mild illness like tonsillitis, sore throat, or skin infection. But when the bacteria infects areas of the body that are usually sterile—like blood, deep muscles, fat, and the lungs—it can cause more severe invasive illnesses, including necrotizing fasciitis and streptococcal toxic shock syndrome—potentially deadly bacterial infections—and diseases like acute rheumatic fever and rheumatic heart disease, which cause the immune system to damage healthy tissue.

In mid-December, the World Health Organization warned of a rise in severe strep A cases and deaths in many countries, including France, Ireland, the Netherlands, Sweden, the U.K., and Northern Ireland, according to a Dec. 15 situation report. And the U.S. Centers for Disease Control and Prevention said it was looking into a “possible increase” in such cases among children.

Strep A season got off to an early start last fall, and the spread of the pathogen has returned to pre-pandemic levels, the CDC said in a Feb. 2 website update. Flu and RSV also started to spread earlier this cold-and-flu season, and because respiratory viruses can lead to co-infection with strep A, the rise in the former might have led to the rise in the latter, experts say.

Dr. Sandy Arnold, chief of infectious diseases at Le Bonheur Children’s and the University of Tennessee Health Sciences Center in Memphis, says that pediatric infectious disease doctors around the country began noticing an uptick in strep A cases this fall.

“We definitely all sat up and took notice,” she says, adding that email traffic on a listserv was what prompted the CDC to issue a health alert to clinicians in December.

Dr. Marcos Mestre, vice president and chief medical officer of Nicklaus Children’s Hospital in Miami, agrees with the CDC, saying that the rise in cases compared to the past three years is a result of increased socialization after pandemic restrictions. 

Arnold thinks more cases are being seen when compared to pre-pandemic years, though she notes that “these things do wax and wane on their own.”

“Is there a strain in the community that has more invasive potential than what we’re used to seeing?” she asks. “To me, it feels like there’s definitely something different going on, and that it isn’t just due to the pandemic.”

‘Worry about what you can control’

As for the case of the Florida boy who died as a result of strep A after rolling his ankle at a gym, Arnold says it’s likely that the bacteria was in his blood—either because he was a carrier or because he contracted it in the community—and that it infected his skeleton after his ankle injury, in a case of hematogenous osteomyelitis.

“It doesn’t mean he picked up the bacteria at the gym” or from a scratch, as was suggested in other media reports, Arnold says. “What he got at the gym was an injury.”

Experts like Arnold and Meste caution parents to watch for minor injuries with pain that worsens over time, or if the child develops a rash or fever.

“These things can pop up very quickly—so quickly that you don’t have time to wait and see the doctor the next day,” she says.

Cases of infectious strep A are “thankfully not very common,” she adds. “It sounds a bit fatalistic, but if something like this is going to happen, it’s going to happen.”

“Worry about what you can control,” she advises parents. “We can’t control everything, unfortunately.”