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Saturday, August 8 2015 THE NEW PAPER
WhAt
IS GBS?
GBS stands for Group B
streptococcus, a bacteria which
is commonly found in our gut
and urinary tract without causing
disease. GBS is also found in fish,
but usually does not pose any risk.
Who is more at risk of GBS
infections?
GBS is known to affect
mainly newborn babies, the
elderly, and people who are
immunocompromised, such as
patients with cancer. It can infect
healthy young and middle-aged
adults as well, but this is rare.
What are the signs and
symptoms of GBS infections?
The most common symptom is a
fever. Other signs and symptoms
depend on the site of the bacterial
infection.
Man gets Group B streptococcus infection
after eating yusheng. His condition so
severe that he undergoes...
swollen
knee
When his left knee swelled up, he
thought it was a muscle pull from
cycling.
But when the pain gave him sleepless
nights, and bouts of fever started to
hit him, Mr Howard Kuay realised it
was far more serious.
The 30-year-old tuition agency
owner was eventually diagnosed with
a Group B streptococcus (GBS) infection.
He had to go through an operation
to cut his ligament and move his knee
cap to the side to drain the pus out.
And the most likely cause of the infection?
Eating raw fish.
“There is a 99 per cent possibility
(of that being the cause),” Dr Leong
Hoe Nam, who treated Mr Kuay, told
The New Paper.
Mr Kuay eats yusheng (raw fish)
only once or twice a year. But after he
ate it at a hawker centre last month,
he was hit by the GBS infection within a week.
Yusheng sold at hawker centres
consists of thinly sliced strips of raw
fish drenched in sesame oil and light
Can I still eat raw fish (like
sashimi) other than the types
identified by the Ministry of
Health?
Vulnerable groups of people,
especially young children, pregnant
women, the elderly, and people with
chronic illness such as diabetes,
Then, he thought he had merely
pulled a muscle or a ligament as he
had been cycling. A Chinese physician he saw on the same day told him
the same thing.
But he started getting bouts of fever on top of the pain. “I have broken
a bone before, and I can tell you — it
hurt more than that,” he said.
The first time he heard the words
“Group B Streptococcus” was from
his physiotherapist, whom he sought
help from after the fever spells.
The physiotherapist referred him
to an orthopaedic doctor as Mr
Kuay’s condition went beyond physical disability.
By then, Mr Kuay’s left knee had
swollen to twice its size due to the infection.
On July 15, he underwent the operation to drain out the pus in his swollen knee.
“I immediately texted my friends
and said, ‘If you’ve (read a report
about GBS), please send it to me.’
The reports already linked (GBS infections) to raw fish. Only then did I
backtrack and realised I did eat raw
fish.
Op to drain
pus from
Reports by FOO JIE YING
[email protected]
news 3
THE NEW PAPER Saturday, August 8 2015
should avoid raw food, such as raw
oysters and sashimi.
It is important to let the
relevant authorities conduct
proper investigations to determine
the source and extent of this
rise in invasive GBS infections in
Singapore.
Source: Dr Jolene Oon,
associate consultant from
the division of infectious
diseases at the National
University Hospital
More
virulent
strain of GBS
RISKY: Do abstain from eating Song
fish and Toman fish yusheng for the
time being. TNP PHOTO:GAVIN FOO
RAISE AWARENESS
YUSHENG WOE: Mr Howard Kuay, who was diagnosed with a Group B streptococcus
infection last month, flashing a brave smile. His knee swelled up so badly that he had
to go for an operation to drain out the pus. PHOTOS COURTESY OF HOWARD KUAY
soy sauce, and topped with ginger
and chilli.
Said Dr Leong, an infectious diseases specialist in private practice:
“He fits nicely into the GBS cohorts
that we have been seeing.
“There is a temporal relationship
(between eating raw fish and being
infected) of within a week, and the
progress of the disease is rapid and at
the typical sites.”
GBS is a common bacterium found
in the human gut and urinary tract
of about 15 to 30 per cent of adults
without causing disease, according to
the Ministry of Health (MOH). (See report, right.)
It may, however, occasionally cause
infection of the skin, joints, heart and
brain.
Figures from MOH show that in the
first half of the year alone, there have
been 238 cases of GBS infections in
public hospitals — a spike from the
annual average of 150 cases in the
past four years.
Mr Kuay was shocked to find out
that the most likely cause of the infection was raw fish.
He recounted that his left knee
started to swell on July 13.
He had to be hospitalised for a week
before going to Dr Leong for his daily
dose of antibiotics, administered intravenously.
At Dr Leong’s encouragement to
raise awareness of GBS infections, Mr
Kuay shared what he went through
on Facebook.
After connecting with both friends
and strangers about GBS infections,
he realised he was one of the luckier sufferers.
“Someone I know had multiple
joint pains and was vomiting profusely. Another was infected in the brain
and developed meningitis.
“An oncologist friend told me,
‘Luckily you don’t have to amputate.’
He wasn’t joking,” Mr Kuay said.
Dr Leong also told him that one of
his patients died within three days
of being affected. (See report at far
right.)
Mr Kuay said: “I felt grateful that
my infection wasn’t as bad. I also
thought about those who did get it
bad.”
He added that the level of awareness of GBS infections should be
raised so people can seek help fast if
they suspect they are infected.
Though Mr Kuay is finally cleared
of his GBS infection (as confirmed by
a blood test on Wednesday), the recovery process is a long and arduous
one. It will take another two months
of physiotherapy sessions twice a
week before Mr Kuay gains strength
in his left knee again.
Avoid raw
Song fish,
toman fish
for now
The Ministry of Health launched
a probe last month to find if
there is any link between Group
B streptococcus (GBS) and raw
fish consumption. This came after
a message, claiming there is a
bacteria outbreak linked to eating
contaminated raw fish, started
circulating online.
Later, the ministry said in a
statement that the interim analysis
of its investigation on a limited
number of identified cases found
an association between raw fish
consumption and GBS infections.
More cases will need to be
studied for a more definite
conclusion, the ministry said.
As a precautionary measure,
food stalls are advised to stop
selling raw dishes using Asian
Bighead Carp (Song fish) and
Toman fish (Snakehead fish), which
are the two types linked to GBS.
Group B streptococcus (GBS)
infections used to hit mostly
those with chronic diseases or
the elderly.
Now, it seems that the young and
healthy can be infected as well,
thanks to a more virulent strain of the
bacteria, said infectious diseases specialist Leong Hoe Nam.
“Everyone has an equal chance.
There’s no running away.
“This is an unusual strain (of bacteria). We don’t know why it’s causing more aggressive infections. We
haven’t worked out the reasons,”
said Dr Leong, who works at Rophi
Clinic at Mount Elizabeth Novena
Specialist Centre.
He told The New Paper about one
of his earliest GBS-infected patients,
who was hospitalised on Chinese
New Year’s Eve.
She had showed up with nausea
and vomiting. The next morning, she
appeared dull and listless. By afternoon, she needed a machine to help
her breathe and her blood pressure
was falling.
DIED
“She died in the hospital within 36
hours. There was no chance to fight,”
said Dr Leong.
While the bacteria usually likes
to go to the joints, the back and the
blood stream, there is no telling
where the bacteria will infect, said Dr
Leong.
With so much that is unknown
about GBS — like why is it found in
fish and whether the GBS found in
fish and gut are the same strain — the
infectious diseases specialist suggested the age-old adage: Prevention is
better than cure.
“Stay away from uncooked fish and
if you’ve eaten it, go see a doctor,” he
advised.