Over 500 people were infected with a deadly flesh-eating disease in Japan this year, local media report. The virus ravages limbs and internal organs and can kill its victims in a matter of hours.

Some 525 patients – the highest number since records began in 1999 – have been afflicted with streptococcal toxic shock syndrome (STSS), the Asahi Shimbun newspaper reported, citing data from the National Institute of Infectious Diseases. Of these, 66 were in Tokyo followed by 40 in Kanagawa, 32 in Aichi, 31 in Fukuoka and 28 in Hyogo. Most of the victims were over the age of 30.

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Streptococcal toxic shock syndrome, or toxic shock syndrome (TSS) for short, recently made headlines after former American model and athlete Lauren Wasser shared her story about suffering from the flesh-eating disease after leaving in her tampon too long. It led to her right leg being amputated. The disease typically spreads through contact with an infected wound and starts with a fever, swelling and pain in the hands and feet. As it spreads throughout the body via the bloodstream, the bacteria start eating away at the organs and flesh, leading to delirium, confusion and ultimately, death.

The illness has a high mortality rate, with the US Center for Disease Control giving a survival rate of less than fifty percent. However, it can be treated early on through antibiotics or failing that, amputation.

“The signs of an STSS-infected area likely appear from the feet,” Ken Kikuchi of the Tokyo Women’s Medical University told the Asahi Shimbun. “The elderly should be careful about swelling of their feet and go see a doctor immediately when swelling appears.”