<b>Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles</b>

Streptococcus pyogenes is responsible for the severe clinical condition known as type 2 necrotizing fasciitis and toxic shock syndrome (TSS), which are linked to extremely high morbidity and death in both developed and developing countries. It can also be caused by Staphylococcus aureus and S. pyogenes B and G strains. The bacteria rapidly spread into deep tissues, tendons, fascia, and muscles leading to this devastating condition, called type 2 necrotizing fasciitis, from which the bacteria get its name "flesh-eating bacterium". TSS can develop as a result of S. pyogenes infection, typically after the bacteria enter the bloodstream. The bacteria in the bloodstream produce streptococcal pyrogenic exotoxins (A, B, and C). These pyrogenic exotoxins are the cause of streptococcal TSS. TSS and type-2-necrotizing fasciitis patients may have rash, fever, chills, hypotension, necrosis, desquamation, multi-organ failure, and sudden death. Following COVID-19, there was a significant increase in TSS and type-2 necrotizing fasciitis cases around the world. Over 800 instances of streptococcal TSS have been reported in Japan this year alone. The higher prevalence of post-COVID-19 TSS and type-2 necrotizing fasciitis could be related to changed immunological status, a lack of hygiene measures, overcrowding, and enhanced bacterial virulence. Natural COVID-19 infection and COVID-19 vaccination has probably altered the immune status thereby increasing streptococcal TSS cases.