Ontario toddler dies suddenly of invasive Strep A — 'red flags' parents should know
Two-year-old Nevaeh Muley suddenly died of a Strep A bacterial infection after her siblings had a common cold. What are the symptoms of Strep A?
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On March 2, 2023, Nevaeh Muley was a healthy and happy two-year-old who was "full of funny faces" and "loved to colour." On March 3, she came down with a fever. On March 4, Nevaeh went into cardiac arrest and died of a Strep A bacterial infection.
"Nevaeh is heaven backwards; it's ironic, you know?" Her father, Eric Muley, told Yahoo Canada.
"She was coherent the day before. It didn't make sense; it still doesn't make sense."
A week before the Hamilton, Ont. toddler died, Nevaeh's three older siblings each had a cold and "they all got better."
When it was Nevaeh's turn for the bug, "we just thought, 'OK, you're next.' Everyone else was sick; everyone else got better," Eric said.
Her parents said the toddler's half-day fever was her "only sign" of illness. "She didn't have a runny nose; she didn't have a cough."
"Even when she had her fever, she was eating and drinking. She just looked like a normal kid who wasn't feeling good."
Her mother, Donna Johnson, brought her fever down with Children's Tylenol. She put the toddler to bed, but by the next morning, her symptoms had worsened.
"Our daughter loved to cuddle and would wrap her arms and legs around you when you picked her up," Eric said. However, on the morning of March 4, she didn't.
'Red flags are going off'
"She was weak. She couldn't wrap her legs around mom. So right then, red flags are going off."
Donna noticed her daughter seemed "disorientated" and, when she changed her diaper, saw "red and purple blotchiness around her groin area."
By ambulance, Donna and Nevaeh travelled to McMaster Children's Hospital, where the two-year-old was diagnosed with Strep A pneumonia. She went into cardiac arrest, was revived, but died of a second cardiac arrest hours later.
What is Strep A?
Group A Strep (short for Group A streptococcus) is a common bacterial infection that grows inside the nose, throat and sometimes on the skin.
Group A Strep (GAS) tends to infect the upper respiratory tract, causing strep throat and sinus infections. However, it can also cause skin and soft tissue infections such as impetigo and cellulitis or scarlet fever.
What is invasive Group A streptococcus?
Group A Strep infections typically result in strep throat. GAS are called "non-invasive" because the infection is on the parts of the body that are exposed to the outside world, like the throat or skin, according to the government of Canada.
"Although Group A Strep can be easily treated with antibiotics, infections can become very dangerous if they become 'invasive,'" says Irene Martin, the head of the Streptococcus and STI Unit at the Public Health Agency of Canada's National Microbiology Laboratory.
"Group A Strep becomes invasive when it infects blood or internal body tissues, and it can cause illnesses such as meningitis or flesh-eating disease."
Doctors had diagnosed Nevaeh with invasive Group A streptococcal, an infection that killed at least three children in Canada late last year.
"It happened within days," the family wrote on their GoFundMe. "By the time it shows symptoms, sometimes it's already too late."
How does Strep A spread?
Strep A is highly contagious and easily spreads from person to person. GAS bacteria can spread through close contact with someone with strep, sharing food and drinks, or breathing in their respiratory droplets. As the bacteria transmits via person-to-person contact, it easily spreads among family or household members.
Strep throat is most common in children ages five to 15; however, anyone can get it.
What are symptoms of Strep A?
While symptoms vary depending on the type of infection, Health Canada says the main signs of non-invasive Group A streptococcus (GAS) include fever, a sore throat and mild skin conditions such as a rash, sores, bumps and blisters.
Invasive infections (iGAS) can include severe symptoms like trouble breathing (pneumonia), a breakdown of the skin and connective tissues (necrotizing fasciitis), a fever, a drop in blood pressure, vomiting and diarrhea (toxic shock syndrome).
Strep A cases rising in Canada
Some Canadian officials reported an uptick in invasive Group A streptococcus infections in Dec. 2022, echoing rising case numbers in the U.S. and Europe.
According to a Public Health Ontario report, the number of iGAS infections between October and November 2022 was "higher than the number of cases reported in this age group during the same months between the 2016-17 and 2019-20 seasons."
As of Feb. 28, 2023, the "incidence rate is higher across all age groups in the current season."
The rise in iGAS cases is likely linked to the increase in RSV and flu viruses hitting kids, the World Health Organization said in a December 2022 news release.
'It's better to be safe than sorry'
"You have to watch for everything because these symptoms are so similar to the common cold" that you may now know it's Strep A, Eric Muley said. "There was never anything that said, 'hey, that's Strep A.'"
"How can you determine a common cold from something that's actually killing you?"
The grieving father tells parents, "if they look sick, get them checked out. It's better to be safe than sorry."
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