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Streptococcus suis infection in Hong Kong
Abstract
Twenty-five patients were admitted to two hospitals in Hong Kong for Streptococcus suis infection between 1984 and 1993. Among them, 15 (60%) had an occupational exposure to pigs or pork, and four had a clear history of skin injury up to 16 days before admission. Examination of the cerebrospinal fluid of 21 patients confirmed the presence of meningitis in every case; the remaining four patients who did not have lumbar punctures had each presented with arthritis, bronchopneumonia, endocarditis and pyrexia without neck stiffness. The only fatality was a patient admitted in septicaemic shock with evidence of meningitis and disseminated intravascular coagulation. Of the 24 survivors, 16 (67%) acquired varying degrees of hearing loss as a result of meningitic involvement. All the isolates of S. suis were sensitive to penicillin or ampicillin, which was used alone or in combination with other antibiotics for every patient. Two patients had a relapse of symptoms when penicillin was stopped, but were successfully treated after the antibiotic was resumed for a total of 6 weeks. Over 100 cases of S. suis infection have been described previously, with a geographic distribution heavily biased towards Northern Europe and Southeast Asia. Lack of awareness of this unique zoonosis may be a reason why it is not diagnosed more readily elsewhere.
... While pig-related occupation is a main risk factor for human S. suis infection, pig exposure is not present in all cases of S. suis infection 1 . In Western countries, S. suis infection normally occurs among certain risk population particularly farmers and abattoir works involving meat processing 8,9 whereas there were less than 50% of occupational exposure cases documented in Asian countries 10,11 . A lower proportion rates of occupational exposure to pigs were found in Thailand and Vietnam among S. suis infected patients 4 . ...
... There were 682 records remaining after removing duplicates in which 636 citations that were proceedings or did not contain risk factors were excluded upon title and abstract screening. There were 32 articles included in systematic review 5,[9][10][11] and 3 case-control studies 19,37,38 in the meta-analysis after full texts evaluation. The PRISMA flow chart describing the study selection process was shown in Fig. 1. ...
... Included studies with different study designs were conducted in 9 distinctive countries. Among these, there were 1 randomized double-blind, placebo-controlled trial 10 , 3 case-control studies in which there were 1 matched case-control 37 , 1 retrospective case-control 38 and 1 prospective case-control studies 19 , 28 descriptive studies including 3 public health surveillance studies 27,40,41 , 2 outbreak investigations 36,39 and 1 epidemiological analysis in China 23 , a population-based study on a food safety campaign 30 and a retrospective cohort identifying risk factor for S. suis mortality 34 , 3 retrospective reviews 16,20,21 and 17 case reports or case series 9,11,[13][14][15]17,18,22,[24][25][26]28,29,[31][32][33]35 . There were 27 articles in English and 5 in other languages; 3 in Chinese 23,24,37 , and 1 each in Croatian 17 and Thai 40 . ...
Streptococcus suis (S. suis) is a gram-positive bacterial pathogen in pigs which can cause serious infections in human including meningitis, and septicaemia resulting in serious complications. There were discrepancies between different data and little is known concerning associated risk factors of S. suis. A systematic review and meta-analysis was conducted to investigate on S. suis infection risk factors in human. We searched eight relevant databases using the MeSH terms "Streptococcus suis" OR "Streptococcus suis AND infection" limited in human with no time nor language restriction. Out of 4,999 articles identified, 32 and 3 studies were included for systematic review and meta-analysis respectively with a total of 1,454 Streptococcus suis cases reported. S. suis patients were generally adult males and the elderly. The mean age ranged between 37 to 63 years. Meningitis was the most common clinical manifestation, and deafness was the most common sequelae found among survivors followed by vestibular dysfunction. Infective endocarditis was also noted as among the most common clinical presentations associated with high mortality rate in a few studies. Meta-analyses categorized by type of control groups (community control, and non-S. suis sepsis) were done among 850 participants in 3 studies. The combined odd ratios for studies using community control groups and non-S. Suis sepsis as controls respectively were 4.63 (95% CI 2.94-7.29) and 78.00 (95% CI 10.38-585.87) for raw pork consumption, 4.01 (95% CI 2.61-6.15) and 3.03 (95% CI 1.61-5.68) for exposure to pigs or pork, 11.47, (95% CI 5.68-23.14) and 3.07 (95% CI 1.81-5.18) for pig-related occupation and 3.56 (95% CI 2.18-5.80) and 5.84 (95% CI 2.76-12.36) for male sex. The results were found to be significantly associated with S. suis infection and there was non-significant heterogeneity. History of skin injury and underlying diseases were noted only a small percentage in most studies. Setting up an effective screening protocol and public health interventions would be effective to enhance understanding about the disease.
... Streptococcal meningitis in humans is most commonly caused by Streptococcus pneumoniae in adults, and by S. agalactiae in neonates. S. suis may be the next most common cause of adult streptococcal meningitis (Zanen and Engel, 1975; Lutticken et al, 1986; Arends and Zanen, 1988; Arend et al, 1995; Kay et al, 1995 ). It is a grampositive alpha-or gamma-hemolytic Streptococcus , and is present as a commensal in the tonsils of pigs (Williams et al, 1993). ...
... suis meningitis who were admitted to Chulalongkorn University Hospital, Bangkok, during a 6-year period between 1997 and 2002. The clinical and epidemiological data of case reports of S. suis meningitis from Thailand, Hong Kong, (Kay et al, 1995) and the Netherlands (Arends and Zanen, 1988) are also compared. MATERIALS AND METHODS All S. suis isolates were collected at the National Streptococcal Reference Center, Department of Microbiology, Chulalongkorn University from January 1, 1997 to May 31, 2002. ...
... Four of twelve patients (33.3%) had a definite history of pig exposure. The association between human infection and pig exposure has been well noted since the early description of this disease (Arends and Zanen, 1988; Kay et al, 1995; Lutticken et al, 1986 ). The annual risk of developing S. suis infection between 1968 and 1984 was calculated to be 3/100,000 among pig breeders and butchers in the Netherlands (Arends and Zanen, 1988). ...
The Infectious Diseases Society of America (IDSA) Standards and Practice Guidelines Committee collaborated with partner organizations to convene a panel of 10 experts on healthcare-associated ventriculitis and meningitis. The panel represented pediatric and adult specialists in the field of infectious diseases and represented other organizations whose members care for patients with healthcare-associated ventriculitis and meningitis (American Academy of Neurology, American Association of Neurological Surgeons, and Neurocritical Care Society). The panel reviewed articles based on literature reviews, review articles and book chapters, evaluated the evidence and drafted recommendations. Questions were reviewed and approved by panel members. Subcategories were included for some questions based on specific populations of patients who may develop healthcare-associated ventriculitis and meningitis after the following procedures or situations: cerebrospinal fluid shunts, cerebrospinal fluid drains, implantation of intrathecal infusion pumps, implantation of deep brain stimulation hardware, and general neurosurgery and head trauma. Recommendations were followed by the strength of the recommendation and the quality of the evidence supporting the recommendation. Many recommendations, however, were based on expert opinion because rigorous clinical data are not available. These guidelines represent a practical and useful approach to assist practicing clinicians in the management of these challenging infections.
Keywords. ventriculitis; meningitis; cerebrospinal fluid shunts; cerebrospinal fluid drains; central nervous system infections.
... Blood cultures were positive in 288 of 435 cases (66%, 95% CI 62-70%). Results of cranial CT were noted in 3 studies describing 27 patients [23,28,32] and consisted of cerebral edema in 8 of 27 patients (30%, 95% CI 10-50%). ...
... According to a study describing 41 patients with hearing loss in S. suis meningitis, 38 had hearing loss on admission and 3 developed hearing loss during admission [23]. Another study described 16 patients with S. suis meningitis and hearing loss, with hearing loss persisting in 7 patients (44%) [28]. Other neurological sequelae were present in 35 of 286 patients (12%, 95% CI 8-16%) and consisted of ataxia in 19 patients, cognitive impairment in 2, tinnitus in 2, and were not specified in 12. ...
... The most common sequel is hearing loss occurring in 53% of the patients; variable rates of hearing loss have been reported in other types of bacterial meningitis, with 8% in meningococcal meningitis and 22% in pneumococcal meningitis [2]. Hearing loss in S. suis meningitis may be a presenting symptom or develop during admission [23], and does not always persist [28]. Different hypotheses for hearing loss in S. suis meningitis are described in the literature such as direct infection of the auditory nerve and suppurative labyrinthitis [42]. ...
Background:
Streptococcus suis is the most common cause of meningitis in pork consuming and pig rearing countries in South-East Asia. We performed a systematic review of studies on S. suis meningitis to define the clinical characteristics, predisposing factors and outcome.
Methodology:
Studies published between January 1, 1980 and August 1, 2015 were identified from main literature databases and reference lists. Studies were included if they were written in West-European languages and described at least 5 adult patients with S. suis meningitis in whom at least one clinical characteristic was described.
Findings:
We identified 913 patients with S. suis meningitis included in 24 studies between 1980 and 2015. The mean age was 49 years and 581 of 711 patients were male (82%). Exposure to pigs or pork was present in 395 of 648 patients (61%) while other predisposing factors were less common. 514 of 528 patients presented with fever (97%), 429 of 451 with headache (95%), 462 of 496 with neck stiffness (93%) and 78 of 384 patients (20%) had a skin injury in the presence of pig/pork contact. The case fatality rate was 2.9% and hearing loss was a common sequel occurring in 259 of 489 patients (53%). Treatment included dexamethasone in 157 of 300 (52%) of patients and was associated with reduced hearing loss in S. suis meningitis patients included in a randomized controlled trial.
Conclusion:
S. suis meningitis has a clear association with pig and pork contact. Mortality is low, but hearing loss occurs frequently. Dexamethasone was shown to reduce hearing loss.
... Geographic distribution of human SS2 infections As a swine pathogen, S. suis was first reported by a vegetarian in 1954, 2 while its zoonotic role could be traced to a human SS2 meningitis case in Denmark, in 1968. 1 In light of the available literature with human S. suis infection recorded thus far, we expect that S. suis infections have been involved in no less than 30 countries and/or regions (Fig. 1), and resulted in around 1600 cases of severe human infections. 2,8,48 In North America (United States 49,50 and Canada 51,52 ) and the South American countries (Argentina, 53,54 Chile, 55 58 Belgium, 3 Poland, 61 Sweden, 3 Denmark, 1 Germany, 62 Hungary, 3 Austria, 63 Croatia, 64 Italy 65-67 , Greece, 68 and Portugal 1 ), some Asian countries (Laos, 1 Singapore, 33,69 India, 2,3,70 Korea, [71][72][73] Japan, 74 Hong Kong, [75][76][77][78][79][80] Taiwan, 33,81,82 and Philippine 2,3 ), Australia, 83,84 and New Zealand. 85,86 So far, endemics of human SS2 infections was only observed in two Asian counties Vietnam 2,7,16,37,38 and Thailand. ...
... 6,14,87 Of being noteworthy, SS2 has been recognized as a pathogen with the mostly-relevance to human bacterial meningitis in southern Vietnam. 16 In Hongkong, the specialized administrative region of China, the first human case of S. suis infection was recorded in 1983, 78,80 and the accumulated number of S. suis infections were estimated to be about 60 cases. 75,78 In particular, two big outbreaks of human SS2 infections in China (1998 and 2005) seriously challenged public health. ...
... 16 In Hongkong, the specialized administrative region of China, the first human case of S. suis infection was recorded in 1983, 78,80 and the accumulated number of S. suis infections were estimated to be about 60 cases. 75,78 In particular, two big outbreaks of human SS2 infections in China (1998 and 2005) seriously challenged public health. 9,18 In the 1998 epidemic, 14 out of 25 SS2infected persons died along with an estimated 80 000 pigs. 18 In the 2005 epidemic, totally 215 patients had SS2 infections, 38 of which are dead. ...
Streptococcus suis (S. suis) is a family of pathogenic gram-positive bacterial strains that represents a primary health problem in the swine industry worldwide. S. suis is also an emerging zoonotic pathogen that causes severe human infections clinically featuring with varied diseases/syndromes (such as meningitis, septicemia, and arthritis). Over the past few decades, continued efforts have made significant progress toward better understanding this zoonotic infectious entity, contributing in part to the elucidation of the molecular mechanism underlying its high pathogenicity. This review is aimed at presenting an updated overview of this pathogen from the perspective of molecular epidemiology, clinical diagnosis and typing, virulence mechanism, and protective antigens contributing to its zoonosis.
... SS is one of the major bacterial meningitides in Hong Kong. 4 A total of 10 patients were reported in the past decade. 5 About 70% of the cases occurred during the summer season. ...
... 5 About 70% of the cases occurred during the summer season. 4 Sporadic SS infection occurs worldwide, for example, in Belgium, China, Croatia, France, Hong Kong, Greece, Germany, the Netherlands, Sweden, Thailand, Taiwan and the United Kingdom. 4,[6][7][8][9][10][11][12][13] The occupations of the victims included butchers, cooks, farmers, housewives, meat transporters, poachers and even waiters. ...
... 4 Sporadic SS infection occurs worldwide, for example, in Belgium, China, Croatia, France, Hong Kong, Greece, Germany, the Netherlands, Sweden, Thailand, Taiwan and the United Kingdom. 4,[6][7][8][9][10][11][12][13] The occupations of the victims included butchers, cooks, farmers, housewives, meat transporters, poachers and even waiters. 4,6 Most of the victims had been exposed to pork at work, either while handling unprocessed pork without gloves or after sustaining minor injuries like superficial abrasions during handling. ...
Streptococcus suis (SS) infection has aroused tremendous attention recently. We report a restaurant worker who suffered acute confusion due to SS meningitis. Sporadic cases have been reported in Hong Kong since 1981. Little was known in the past about its characteristic fulminant clinical deterioration. We explored the literature and discuss the epidemiology, pathogenesis, clinical manifestations and management of this disease. (Hong Kong j.emerg.med. 2006;13:46-49)
... Elsewhere, Laribacter hongkongensis have been linked with community-acquired gastroenteritis and travelers' diarrhea from minced freshwater fish meat [10]. Furthermore, skin injuries, such as cuts, during meat preparation have been shown to be potential entrance points for pathogens such as Streptococcus suis and Streptococcus iniae [11][12][13]. In recent years Hong Kong has witnessed noticeable increases in Vibrio parahaemolyticus food poisoning cases [14]. ...
... Earlier reports in Hong Kong have shown that S. suis is a key bacterial pathogen responsible for various human infections in Hong Kong [42]. Although S. suis is enteric and nonpathogenic in pigs, its spread when handling raw pork products through cross-contamination increases the likelihood and risk of infections [12]. In 2019, the Hong Kong Centre for Health Protection (CHP) investigated an S. suis infection in a patient who died following fever, abdominal pain, vomiting, and diarrhea [43]. ...
In this study, a phylogenic analysis was performed on pathogens previously identified in Hong Kong wet markets' cutting boards. Phylogenetic comparisons were made between phylotypes obtained in this study and environmental and clinical phylotypes for establishing the possible origin of selected bacterial species isolated from wet market cutting board ecosystems. The results reveal a strong relationship between wet market bacterial assemblages and environmental and clinically relevant phylotypes. However, our poor knowledge of potential cross-contamination sources within these wet markets is further exacerbated by failing to determine the exact or presumed origin of its identified pathogens. In this study, several clinically relevant bacterial pathogens such as Klebsiella pneumoniae, Streptococcus suis and Streptococcus porcinus were linked to cutting boards associated with pork; Campylobacter fetus, Staphylococcus aureus, Escherichia coli, and A. caviae in those associated with poultry; and Streptococcus varanii, A. caviae, Vibrio fluvialis, and Vibrio parahaemolyticus in those associated with seafood. Identifying non-foodborne clinically relevant pathogens in wet market cutting boards in this study confirms the need for safety approaches for wet market meat, including cold storage. The presented study justifies the need for future systematic epidemiological studies to determine identified microbial pathogens. Such studies should bring about significant improvements in the management of hygienic practices in Hong Kong's wet markets and work towards a One Health goal by recognizing the importance of wet markets as areas interconnecting food processing with animal and clinical environments.
... The disease is considered to be an occupational hazard via percutaneous exposure in Western countries 3,4 whereas oral route transmission through ingestion of raw/ undercooked pork including fresh pig's blood, intestines, and other internal organs have been noted in the Asia region. [5][6][7][8] A recent systematic review and meta-analysis demonstrated the main risk factors in acquiring S. suis infection including eating raw/ undercooked pork, exposure to pigs or raw pork, male sex, and pig-related occupation. 9 There is a high prevalence rate in Southeast Asia, particularly in Thailand and Vietnam. ...
... The underlying disease would probably make the patient more susceptible to infection. The frequent occurrence of the disease in summer and rainy season is consistent with previous findings 2, 5,6,8,11,23,[35][36][37] that these weather conditions precipitate the pathogen's infectivity and proliferation. 35 A relatively high number of cases in April may be related to Songkran's festival or Thai New Year which is one of the biggest social events among locals. ...
Purpose
Streptococcus suis (S. suis) is an emerging zoonotic disease mainly in pigs, causing serious infections in humans with high prevalence in Southeast Asia. Despite a relatively high mortality rate, there are limited data regarding the risk factors of this life-threatening infection. Therefore, a 13-year retrospective cohort study in Chiang Mai, Thailand during 2005–2018 was conducted to explore risk factors associated with S. suis mortality and to update the outcomes of the disease.
Patients and methods
S. suis positive cases were derived from those with positive S. suis isolates from microbiological culture results and Matrix-Assisted Laser Desorption Ionization Time of Flight (MALDI-TOF). Potential risk factors of mortality were identified using univariate and multivariate logistic regression.
Results
Of 133 patients with culture-proven S. suis infection identified, there were 92 males and 41 females. The mean age was 56.47 years. Septicemia (55.64%) was the most common clinical manifestation followed by meningitis (37.59%) and infective endocarditis (25.56%). Alcohol drinking and raw pork consumption were documented in 66 (49.62%) and 49 (36.84%) cases respectively. The overall mortality rate was 12.03% (n=16). According to the multivariate analysis, the independent risk factors for mortality were prolonged bacteremia ≥ 6 days (OR = 43.57, 95% CI = 2.46–772.80, P =0.010), septic shock (OR = 13.34, 95% CI = 1.63–109.03, P =0.016), and direct bilirubin > 1.5 mg/dL (OR = 12.86, 95% CI = 1.91–86.59, P =0.009).
Conclusion
S. suis is not infrequent in Northern Thailand, where the cultural food habit of raw pork eating is still practiced. To the best of our knowledge, this is the largest series focusing on risk factors of S. suis mortality which has been conducted in Thailand. Prolonged bacteremia ≥ 6 days, septic shock, and direct bilirubin > 1.5 mg/dL were strong predictors associated with S. suis mortality. The mortality risk factors identified may be further utilized in clinical practice and future research to improve patient outcomes.
... Epidemiology of S. suis Infections S. suis was first identified as an etiological factor of human infections in 1968 ( , and since then a total of *1600 cases of zoonoses caused by this pathogen have been reported in *30 countries in Europe (Austria, Belgium, Croatia, Denmark, France, Germany, Greece, Hungary, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, Sweden, and United Kingdom), Asia (China, Hong Kong, India, Japan, Korea, Laos, Philippines, Singapore, Taiwan, Thailand, and Vietnam), North America (Canada and United States), South America (Argentina, Chile, and French Guiana), Australia, and New Zealand ( Shneerson et al. 1980, Robertson 1986, Yen et al. 1994, Kay et al. 1995, Michaud et al. 1996, Staats et al. 1997, Spiss et al. 1999, GeffnerSclarsky et al. 2001, KopicétKopicét al. 2002, Ibaraki et al. 2003, Rosenkranz et al. 2003, Teekakirikul and Wiwanitkit 2003, Suankratay et al. 2004 ). Although a majority of these cases were sporadic infections, two outbreaks of S. suis SS2 epidemics were reported from China ( Huang et al. 2005, Ye et al. 2006, Yu et al. 2006, Lun et al. 2007, 2010, Ma et al. 2009), and this bacterium was shown to occur endemically in Thailand and Vietnam (Teekakirikul and Wiwanitkit 2003, Suankratay et al. 2004, Mai et al. 2008, Wertheim et al. 2009a, 2009b, Kerdsin et al. 2009, Ngo et al. 2011). ...
... Clinical manifestation of relapsing S. suis meningitis varies. According to the authors of one review article, a considerable proportion of patients with S. suis meningitis (50.5% from Europe and 51.9% from Asia) develop deafness after a temporary improvement of their clinical status ( Huang et al. 2005), and data from other centers imply that the prevalence of secondary deafness in subjects with S. suis meningitis may be even higher, up to 80% ( Kay et al. 1995, Mai et al. 2008, Wertheim et al. 2009a). The authors of another review article showed that hearing loss in S. suis meningitis is sensorineural, involves highfrequency range, and can be profound (>80 dB) (Wertheim et al. 2009a). ...
Streptococcus suis, a prevalent porcine pathogen, may sporadically cause infections in humans, and has recently emerged as a cause of zoonoses in some professionals. The aim of this article was to review available data on epidemiology, etiopathogenesis, diagnostics, and management of the most common form of S. suis infection, purulent meningitis. Literature data show that S. suis is an important etiological factor of purulent meningitis, especially in subjects being occupationally exposed to contact with pigs and/or pork meat. Owing to growing incidence of S. suis meningitis, a history of such exposure should be verified in each patient presenting with typical meningeal symptoms. Whenever S. suis was confirmed as the etiological factor of purulent meningitis, therapeutic protocol should be adjusted appropriately, to avoid patient's exposure to potentially ototoxic antimicrobial agents and corticosteroids. Considering the biphasic character of S. suis meningitis and its frequently atypical outcome, all individuals with this condition should be optimally supervised by a multidisciplinary team, including an ENT specialist.
... S. suis is mostly sensitive to penicillin; resistance was reported in only 2 patients (21,27). After cessation of antimicrobial drug treatment, infection relapsed in a small proportion of patients, including those for whom the organism tested highly sensitive to penicillin (28,29). The pooled relapse rate was 4.4% (Table 3). ...
... Eight of 25 large studies reporting hearing loss indicated whether hearing loss was permanent after hospital discharge. Only 4 described their follow-up processes; follow-up time ranged from 2 months to 30 months (4,8,28,31). On the basis of these limited data, we estimated a comparatively low median rate of recovery from hearing loss of 5.0% (range 0%-52.3%) ...
Streptococcus suis, a bacterium that affects pigs, is a neglected pathogen that causes systemic disease in humans. We conducted a systematic review and meta-analysis to summarize global estimates of the epidemiology, clinical characteristics, and outcomes of this zoonosis. We searched main literature databases for all studies through December 2012 using the search term "streptococcus suis." The prevalence of S. suis infection is highest in Asia; the primary risk factors are occupational exposure and eating of contaminated food. The pooled proportions of case-patients with pig-related occupations and history of eating high-risk food were 38.1% and 37.3%, respectively. The main clinical syndrome was meningitis (pooled rate 68.0%), followed by sepsis, arthritis, endocarditis, and endophthalmitis. The pooled case-fatality rate was 12.8%. Sequelae included hearing loss (39.1%) and vestibular dysfunction (22.7%). Our analysis identified gaps in the literature, particularly in assessing risk factors and sequelae of this infection.
... It is hypothesized that patients may be infected through minor cuts or abrasions on their skin [2,6]. However, whilst occupational exposure to pigs or pork was documented in 88% of the European patients described, it was reported in less than 50% of Asian cases [4,7], suggesting the contribution of other behavioural or exposure related risk factors in Asian populations, such as culinary habits or close proximity of pigs within households. In addition, whilst it is known that pigs can carry S. suis asymptomatically, it is not known if there is asymptomatic carriage of S. suis in humans, which could potentially contribute to an increased risk of infection, and to the possibilitiy of person-to-person transmission. ...
... Significant skin injury was evident in 5/35 (14%) of people with S. suis in the UK, 4/15 cases (16%) in Hong Kong and 104/215 cases (48%) in Sichuan province's outbreak [2,7,15]. In our study, skin injuries were reported in 33/101 (33%) of S. suis patients compared to 18/303 (6%) of hospital controls and 11/300 (4%) of community controls (Table 3). ...
Background: Streptococcus suis infection, an emerging zoonosis, is an increasing public health problem across South East Asia and the most common cause of acute bacterial meningitis in adults in Vietnam. Little is known of the risk factors underlying the disease.
... In 1995, Kay et al. (12) confirmed the diagnosis of 21 patients with S. suis meningitis by examination of their CSF in Hong Kong. The first case of S. suis infection within China was reported in Jilin Province, Northern China, in 2019, involving a 12-year-old girl who suffered from fever, rash, and hepatosplenomegaly. ...
Introduction
Streptococcus suis is one of the porcine pathogens that have recently emerged as a pathogen capable of causing zoonoses in some humans. Patients infected with S. suis can present with sepsis, meningitis, or arthritis. Compared to common pathogens, such as Meningococcus, Streptococcus pneumoniae, and Haemophilus influenzae, S. suis infections in humans have been reported only rarely.
Methods
This case report described a 57-year-old man who presented with impaired consciousness and fever following several days of backache. He was a butcher who worked in an abattoir and had wounded his hands 2 weeks prior. The patient was dependent on alcohol for almost 40 years. S. suis was detected in the cerebrospinal fluid by metagenomic next-generation sequencing. Although he received adequate meropenem and low-dose steroid therapy, the patient suffered from bilateral sudden deafness after 5 days of the infection. The final diagnosis was S. suis meningitis and sepsis.
Results
The patient survived with hearing loss in both ears and dizziness at the 60-day follow-up.
Discussion
We reported a case of S. suis infection manifested as purulent meningitis and sepsis. Based on literature published worldwide, human S. suis meningitis shows an acute onset and rapid progression in the nervous system. Similar to bacterial meningitis, effective antibiotics, and low-dose steroids play important roles in the treatment of human S. suis meningitis.
... This type of hearing loss is usually bilateral, severe, and permanent. 13,14 Deafness with or without vestibular dysfunction is considered to be caused by direct infection of the cochlea. S. suis is thought to enter the inner ear through the aqueduct of the cochlea via the lytic action of its exotoxin, causing suppurative labyrinthitis. ...
Background
Streptococcus suis (S. suis) is a common gram-positive bacterium in pigs. Its natural infection sites are the upper respiratory tract (especially tonsils and nasal cavity), reproductive tract and digestive tract of pigs. It is a new emerging human and animal disease. A co-morbid pathogen that can cause serious infections in humans, including meningitis, sepsis, septic arthritis, and sometimes deafness. No cases have been reported in Huzhou City, Zhejiang Province, China.
Case Presentation
A 50-year-old male patient who had Worked as a butcher in a slaughterhouse for 20 years. Admitted to the hospital due to abdominal pain, joint pain, fever, and headache.His condition rapidly worsened causing altered consciousness, drowsiness and developed hearing loss. S. suis induced pyogenic meningitis complicated by arthritis was suspected based on the results of biochemical and culture analysis of the cerebrospinal fluid, and metagenomic next-generation sequencing, The patient’s symptoms significantly improved after treatment with antibiotics such as ceftriaxone, meropenem, and linezolid, as well as supportive therapies including steroids and hyperbaric oxygen therapy, and his hearing improved significantly.After about 2 years of follow-up, the hearing was significantly better than before, but hearing impairment still remained.
Conclusion
Streptococcus suis is endemic in pork-consuming and pig-raising countries, but can occur throughout the world, especially among individuals with occupational exposure to pigs and/or pork, such as slaughterhouse workers, butchers, farmers, etc. Strengthen science education among key groups. This case was diagnosed as Streptococcus suis meningitis combined with arthritis. However, abdominal pain in the early stage of the disease is very rare and is easy to be misdiagnosed. It is necessary to identify whether it is complicated by peritonitis. For hearing loss caused by Streptococcus suis infection, the use of hyperbaric oxygen chamber treatment has obvious therapeutic effects.
... Kejadian Streptokokosis pada manusia berhubungan erat dengan infeksi pada babi. Di Hongkong, sebanyak 25 orang terinfeksi streptokokosis berkaitan dengan kasus infeksi S. suis pada babi (Kay et al., 1995). Kejadian tingginya infeksi kasus Streptokokosis pada manusia di Pulau Bali berkaitan erat dengan kontak langsung dengan babi atau mengkonsumsi makanan yang berasal dari babi (Tarini et al., 2022). ...
Streptokokosis yang disebabkan oleh Streptococcus suis merupakan penyakit bakteri yang memiliki arti penting karena berpotensi zoonotik dan mampu menimbulkan wabah serius baik pada babi maupun manusia. Gejala utamanya adalah meningitis, ketulian, keradangan pada mata hingga kebutaan. Penelitian ini bertujuan untuk menemukan adanya infeksi S. suis pada babi-babi yang dipotong di Rumah Pemotongan Hewan khusus babi di Denpasar. Sebanyak 200 sampel tonsil babi diambil dengan 20 kali pengambilan. Setiap pengambilan sampel diambil sebanyak 10 sampel. Sampel ditumbuhkan pada sheep blood agar 5%, pewarnaan Gram, uji katalase, oksidase, dan koagulase. Hasil yang dicurigai pada masing-masing pengambilan dilanjutkan dengan uji Polymerase Chain Reaction primer SSRecN-F dan SSRecN-R. Hasil pengujian terhadap 200 sampel tonsil babi didapatkan sebanyak 2,5% sampel positif terinfeksi S. suis. Berdasarkan hasil penelitian dapat disimpulkan bahwa sampel tonsil babi yang dipotong di Rumah Pemotongan Hewan khusus babi di Denpasar terinfeksi S. suis.
... Hearing loss in porcine streptococcal meningitis may be a presenting symptom or develop on admission(21) and does not always persist (22). Different hypotheses for hearing loss in porcine streptococcal meningitis have been Our study has several limitations. ...
To describe the detailed clinical characteristics and outcomes of patients with Streptococcus suis (S. suis) meningitis in Liuzhou, China.We described the chief clinical manifestations, auxiliary examination results, treatment strategies,treatment efficacy, and follow-up results of 17 consecutive patients with S. suis meningitis, to improve the diagnosis and reduce the misdiagnosis of S. suis meningitis. The study included 17 patients of S. suis meningitis. The most common clinical presentations were fever (88.2%), sensorineural hearing loss (76.47%), headache (64.70%) , and altered mental status (47.06%). 64.71% had residual symptoms of sensorineural hearing loss at discharge, and moderate disabilities occurred in 68.75% of patients in the form of sensorineural deafness (11 patients) and hemiparesis (1 patients). Metagenomic analysis using next generation sequencing of cerebrospinal fluid (CSF) were S.suis in 9 patients. After 6-month follow-up, the average modified Rankin Scale (mRS) and Activities of Daily Living (ADL) score at follow-up was significantly better than that at admission (P < 0.05). The clinical characteristics of S. suis meningitis were fever, headache, altered mental status and sensorineural hearing loss. Early antibiotic drugs are crucial for the treatment of sensorineural hearing loss. Clinicians should improve the diagnosis and treatment of S. suis meningitis and prevent misdiagnosis or non-diagnosis. Early CSF culture or metagenomic analysis is effective, and most of the patients in our study had favorable outcomes.
... SNHL is usually irreversible despite adequate treatment upon the sign of hearing loss occurs. Majority of patients experience persistent hearing loss upon acquiring the infection which is mainly bilateral [3,4]. This may cause physical and emotional distress as well as constraint the economics of a nation. ...
Background
Streptococcus suis (S.suis) is an emerging zoonosis disease with a high prevalence in Southeast Asia. There are over 1,500 cases reported globally in which majority of cases are from Thailand followed by Vietnam. The disease leads to meningitis in human with sensorineural hearing loss (SNHL) as the most common complication suffered by the patients. Early diagnosis and treatment is important to prevent severe neurological complication. In this study, we aim to develop an easy-to-use risk score to promote early diagnosis and detection of S.suis in patients who potentially develop hearing loss.
Methods
Data from a retrospective review of 13-year S.suis patient records in a tertiary hospital in Chiang Mai, Northern, Thailand was obtained. Univariate and multivariate logistic regressions were employed to develop a predictive model. The clinical risk score was constructed from the coefficients of significant predictors. Area under the receiver operator characteristic curve (AuROC) was identified to verify the model discriminative performance. Bootstrap technique with 1000-fold bootstrapping was used for internal validation.
Key Results
Among 133 patients, the incidence of hearing loss was 31.6% (n = 42). Significant predictors for S. suis hearing loss were meningitis, raw pork consumption, and vertigo. The predictive score ranged from 0–4 and correctly classified 81.95% patients as being at risk of S.suis hearing loss. The model showed good power of prediction (AuROC: 0.859; 95%CI 0.785–0.933) and calibration (AuROC: 0.860; 95%CI 0.716–0.953).
Conclusions
To our best knowledge, this is the first risk scoring system development for S.suis hearing loss. We identified meningitis, raw pork consumption and vertigo as the main risk factors of S.suis hearing loss. Future studies are needed to optimize the developed scoring system and investigate its external validity before recommendation for use in clinical practice.
... In Vietnam, some studies showed that significantly more cases of S. suis were observed in a district adjacent to a PRRS district [31,32]. S. suis infection is a zoonotic disease of growing importance in Asia that causes acute meningitis, septicemia and arthritis in humans [33,34]. More investigations are needed to evaluate the association between the two diseases in Vietnam. ...
Background:
In Vietnam, lack of animal health information is considered a major challenge for pig production. The main objective of this study was to assess the seroprevalences of five pathogens [porcine circovirus type 2 (PCV2), porcine reproductive and respiratory syndrome virus (PRRSV), mycoplasma hyopneumoniae (M. hyo), Japanese encephalitis virus (JEV) and leptospirosis] and to better characterize the farm movements through a survey.
Results:
A total of 600 samples were collected from 120 farms from Bac Giang and Nghe An. Among unvaccinated herds, the highest seroprevalence was found for JE with 73.81% (95% CI: 68.39-78.74) in Bac Giang and 53.51% (95% CI 47.68-59.27) in Nghe An. Seroprevalences for PCV2 and M.hyo were 49.43% (95% CI: 45.06-53.80) and 46.06% (95% CI: 41.48-50.69) among unvaccinated animals. Accumulative co-infections for JE (86.25%) showed the highest level followed by M. hyo (66.25%) and PCV2 (62.50%). Three co-infections with JE had the highest positive rate (28.75%) followed by four co-infections (25.0%). Medium farms had relatively higher herd prevalences for all pathogens, except from leptospirosis. Overall, farmers exported/imported their pigs at the most 1-2 times every 6 months. Some respondents (5% for exportation and 20% for importation) had moved pigs more than 6 times over the last 6 months.
Conclusions:
Our study provided another pool of evidence that showed that PCV2, PRRS and H. hyo are endemic in pigs in Vietnam. Given the economic impacts of these pathogens elsewhere, the findings confirm the need for studies to evaluate the association between antibody response and clinical relevance as well as to assess the economic impact of co-infections at farm level. We also found that high seroprevalences of JE and leptospirosis were detected in pigs. From a pubic health point of view, it is crucial to raise public awareness especially for high risk occupations (mainly pig farm workers).
... Our previous study also revealed that peaks of S. suis human cases occurred during the rainy season between 2006 and 2008 [8], which had also been described in China [22] and Northern Vietnam [23]. The peak in this study changed between years with no clear pattern; however, human cases seem to increase in accordance with rising rainfall, although no cause-effect explanation of such observations could be found. ...
The purpose of this study is to characterize Streptococcus suis isolates recovered from human infections regarding serotype distribution, genotypic profile, clinical manifestations, and epidemiology. A total of 668 S. suis isolates recovered from human infections in Thailand were characterized based on serotyping by multiplex PCR and co-agglutination, genotypic profiles by multilocus sequence typing, and PCR for virulence-associated genes, as well as review of medical records. Serotype 2 (94.6%) was predominant, followed by serotype 14 (4.5%), 24 (0.45%), 5 (0.3%), and 4 (0.15%). Multilocus sequence typing analyses revealed seven clonal complexes (CC): CC1 (56.43%), CC104 (31.74%), CC233/379 (5.4%), CC25 (4.5%), CC28 (0.9%), CC221/234 (0.6%), CC94 (0.15%), and two singletons. The CC1 group contained serotype 2 and 14 isolates, while CC25, 28, 104, and 233/379 consisted of serotype 2 isolates only. CC221/234 contained serotype 5 and 24 isolates, whereas the single serotype 4 isolate belonged to CC94. Two singletons contained serotype 5 (ST235) and 2 (ST236) isolates. Our data showed that ST1 isolates were more associated with meningitis than those of other STs (p < 0.001). The major route of infection was shown to be close contact with infected pigs or contaminated raw pork-derived products, including occupational exposure and recent consumption of raw pork products. This study revealed a relatively large number of CCs of S. suis causing human infection in Thailand. Among them, CC1 followed by CC104, with serotype 2 isolates, are predominant. Food safety campaigns and public health interventions would be important for controlling the S. suis infection in humans.
... tel.: +86 18 838 765 510 ly-occurring bacterial infection (Wertheim et al. 2009, Gottschalk et al. 2007). Humans S. suis infections have been reported sporadically worldwide (Kay et al. 1995, Tarradas et al. 2001, Tang et al. 2006). However, two large-scale outbreaks of lethal human SS2 infections with a hallmark of streptococcal toxic shock-like syndrome (STSLS) occurred in China (Tang et al. 2006, Ye et al. 2006). ...
Streptococcus suis serotype 2 (SS2) is considered as a major pathogen that causes sepsis and meningitis in piglets and humans, but knowledge of its antigenic proteins remains limited so far. The surface-related proteins of pathogens often play significant roles in bacterium-host interactions and infection. Here, we obtained the elongation factor Tu (EF-Tu) gene of Streptococcus suis and constructed the recombinant expression plasmid successfully. The target recombinant plasmid was then expressed in Escherichia coli and the immuno-protection of the recombinant protein was subsequently evaluated as well. The EF-Tu gene of Streptococcus suis is 1197 bp in length, encodes 398 amino acids. The target recombinant EF-Tu (rEF-Tu) protein can recognize the antiserum of Streptococcus suis and can provoke obvious humoral immune responses in rabbits and conferred protection to rabbits against Streptococcus suis ear-vein challenge, implying that the EF-Tu may be used as an attractive candidate antigen for a component of subunit vaccine.
... Pigs are the most important source of infection, as the pathogen is transmitted mainly via fomites, such as dust in the air or other insect vectors [2][3][4][5][6][7]. Porcine streptococcosis may cause death in animals and humans [8,9]. Up to now, at least 832 human cases of porcine streptococcosis have been reported, with a mortality rate of approximately 10% [5,10]. ...
... In many cases, biofilms are surface-attached microbial communities that are protected by a self-generated organic polymer matrix, which can act as a diffusion barrier and limit the penetration of antimicrobials to the innermost cells (19). In S. suis, biofilm formation is recently reported to Biofilm in S. suis be prevalent especially in field isolates, suggesting possible role of biofilm in S. suis pathogenesis (11,14). Previous studies have indicated that the nutritional content of the growth medium can regulate biofilm formation (7,16). ...
Streptococcus suis is a swine pathogen and also a zoonotic agent. The formation of biofilms allows S. suis to become persistent colonizers and resist clearance by the host immune system and antibiotics. In this study, biofilm forming potentials of various S. suis strains were characterized by confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM) and tissue culture plates stained with crystal violet. In addition, the effects of five antimicrobial agents on biofilm formation were assayed in this study. S. suis produced biofilms on smooth and rough surface. The nutritional contents including glucose and NaCl in the growth medium modulated biofilm formation. There was a significant difference in their biofilm-forming ability among all 46 S. suis strains. The biofilm-forming potential of S. suis serotype 9 was stronger than type 2 and all other types. However, biofilm formation was inhibited by five commonly used antimicrobial agents, penicillin, erythromycin, azithromycin, ciprofloxacin, and ofloxacin at subinhibitory concentrations, among which inhibition of ciprofloxacin and ofloxacin was stronger than that of other three antimicrobial agents.Our study provides a detailed analysis of biofilm formation potential in S. suis, which is a step towards understanding its role in pathogenesis, and eventually lead to a better understanding of how to eradicate S. suis growing as biofilms with antibiotic therapy.
... The clinical manifestations of invasive infection with S. suis are similar in pigs and humans with infective endocarditis, meningitis and sepsis being the most common [19][20][21]. Hearing loss is also a common after-effect of meningitis caused by S. suis. Among the Dutch cases, hearing loss has been developed in 28 out of 43 1 studies have reported the capacity of S. suis to adhere to human and pig epithelial cell lines [28][29][30]. ...
... Streptococcus suis (SS) is an important pathogen in swine and human that causes septicemia, meningitis, arthritis, and pneumonia (Gottschalk and Segura, 2000). It is also a potential threat of significance to public health, for humans can be infected with the bacteria through skin wounds or the consumption of raw pork (Kay et al., 1995;Yu et al., 2005;Gottschalk et al., 2007). Among the 33 serotypes, serotype 2 is the most commonly isolated and the most closely associated with the diseases (Gottschalk and Segura, 2000;Higgins and Gottschalk, 2000). ...
Bacterial cell wall (CW) and extracellular (EC) proteins are often involved in interactions with extracellular matrix (ECM) proteins such as laminin (LN) and fibronectin (FN), which play important roles in adhesion and invasion. In this study, an efficient method combining proteomic analysis and Far-Western blotting assays was developed to screen directly for bacterial surface proteins with LN- and FN-binding capacity. With this approach, fifteen potential LN-binding proteins and five potential FN-binding proteins were identified from Streptococcus suis serotype 2 (SS2) CW and EC proteins. Nine newly identified proteins, including oligopeptide-binding protein OppA precursor (OppA), elongation factor Tu (EF-Tu), enolase, lactate dehydrogenase (LDH), fructose-bisphosphate aldolase (FBA), 3-ketoacyl-ACP reductase (KAR), Gly ceraldehyde-3-phosphate dehydrogenase (GAPDH), Inosine 5′-monophosphate dehydrogenase (IMPDH), and amino acid ABC transporter permease (ABC) were cloned, expressed, purified and further confirmed by Far-Western blotting and ELISA. Five proteins (OppA, EF-Tu, enolase, LDH, and FBA) exhibited specifically binding activity to both human LN and human FN. Furthermore, seven important recombinant proteins were selected and identified to have the ability to bind Hep-2 cells by the indirect immunofluorescent assay. In addition, four recombinant proteins, and their corresponding polyclonal antibodies, were observed to decrease SS2 adhesion to Hep-2 cells, which indicates that these proteins contribute to the adherence of SS2 to host cell surface. Collectively, these results show that the approach described here represents a useful tool for investigating the host-pathogen interactions.
... 12 However, Streptococcus suis, a gram positive cocci is being increasingly reported from not just South east Asia but also from Northern Europe. 13,20 Three uncommon bacteria were also isolated during the course of the study namely S. mucilaginosus, R. equii and C. aquaticum. Few cases of meningitis caused by R. equii and C. aquaticum have been reported. ...
Background: Acute bacterial meningitis is a medical emergency which warrants early diagnosis and aggressive therapy. It is important to know the regional bacterial etiology in semitropical countries like India along with their sensitivity profile to allow optimum management of such patients with least possible mortality. This study was undertaken to study the trends in etiology and the antimicrobial resistance pattern of the pathogens prevalent in North India over a period of 8 years. Methods: The study was performed from June 2001 to June 2009. CSF and blood samples were collected from all patients suspected of meningitis and inoculated on chocolate agar, blood agar and MacConkey agar. Antimicrobial susceptibility testing was done using Kirby Bauer disc diffusion method. Detection of methicillin resistant Staphylococcus aureus (MRSA), high level aminoglycoside resistance (HLAR) in Enterococcus species, extended spectrum β lactamases (ESBL), Amp C and metallo-betalactamases was also done. Results: 403 samples were positive on culture. S. aureus was the most common pathogen. Among the gram positive cocci as well as the gram negative bacilli, a gradual decline in the antimicrobial susceptibility was seen. The aminoglycosides had the best spectrum of antimicrobial activity. Towards the end of the study, an alarming rise of MRSA to 69.4%, HLAR among the Enterococci to 60% was noted. Among the Enterobacteriaceae, ESBL and Amp C production was found to be 16.7% and 42% respectively. No vancomycin and imipenem resistance was observed. Conclusion: An entirely different trend in etiology in bacterial meningitis was observed in the semitropical region of North India. The high prevalence of drug resistant pathogens is a cause for worry and should be dealt with by rational use of antimicrobials. Frequent revision in drug policy may be necessitated for optimum management of patients.
... Pigs are the most important source of infection, as the pathogen is transmitted mainly via fomites, such as dust in the air or other insect vectors [2][3][4][5][6][7]. Porcine streptococcosis may cause death in animals and humans [8,9]. Up to now, at least 832 human cases of porcine streptococcosis have been reported, with a mortality rate of approximately 10% [5,10]. ...
Streptococcosis is one of the major infectious and contagious bacterial diseases for swine farm in southern China. The influence of various control measures on the outbreaks and transmission of S. suis is not currently known. In this study, in order to explore effective control and prevention measures we studied a deterministic dynamic model with stage structure for S. suis. The basic reproduction number is identified and global dynamics are completely determined by . It shows that if , the disease-free equilibrium is globally stable and the disease dies out, whereas if , there is a unique endemic equilibrium which is globally stable and thus the disease persists in the population. The model simulations well agree with new clinical cases and the basic reproduction number of this model is about 1.1333. Some sensitivity analyses of in terms of the model parameters are given. Our study demonstrates that combination of vaccination and disinfection of the environment are the useful control strategy for S. suis.
... This has achieved a high cure rate of 97.0% [20], [21]. Penicillin G (24 million U over 24 h for at least 10 days) has been used successfully for the treatment of S. suis meningitis [22]. Nonetheless, 13 years later, it was noted from the present study that penicillin G is now approaching 50.0% ...
Abstract— To isolate Streptococcus suis serotype 2 from minced pork, pork meat, fresh pig blood, liver and other offal, 320 samples were collected from 8 sub-districts in Khon Kaen province from January to May, 2013. Isolation was done by direct plating technique using selective media with antibiotic supplement. S. suis serotype 2 isolates were examined to species level by multiplex PCR. Forty one isolates were identified as S. suis serotype 2. Prevalent rate did not depend on areas (p>0.05). Overall prevalent rate was moderate at 12.8%. The occurrence in fresh pig blood were highly significant different (p<0.01) from other tissue types, and heavily contaminated at 24.6%. Minced pork samples, were least contaminated at 2.7%. This is the first report in fresh pork and pork related samples in northeastern Thailand. Traditional custom of consuming raw pork dishes which included fresh pig blood were normally practiced among Thai popular in the northeastern region. Therefore, control measure must be strengthened. In addition, antimicrobial susceptibilities of the isolates were tested using disk diffusion technique. Inhibitory zone diameters in millimeter for amoxicillin (AML), cephalexin (CL), gentamycin (CN), penicillin G (P), and tetracycline (TE) were measured. It is noted that CN is the most susceptible drug (93.6%) compared with 4 other drugs tested against S. suis serotype 2, followed by AML (90.3%), CL (67.7%), P (51.6%), and TE (16.3-35.5%) by in vitro technique. There was significant different between resistance and non-resistance (p<0.01) where majority of the isolates were susceptible to the tested drugs.
... Exposure to S. suis may lead to subclinical infections, induction of antibodies, serious disease, as was the case in the human cases discussed previously, or just an insignificant and transitory atypical colonization of the mucosal membranes within the respiratory route. 110,181 The annual risk of developing meningitis due to S. suis in the Netherlands was estimated to be 3.5/100 000 for slaughterhouse workers, 2.7/100 000 for pig breeders and 1.2/100 000 for butchers. 14 Compared to the non-exposed general population (0.002/100 000), the risk for slaughterhouse workers is 1500 times higher. ...
Streptococcus suis is an important pathogen causing economic problems in the pig industry. Moreover, it is a zoonotic agent causing severe infections to people in close contact with infected pigs or pork-derived products. Although considered sporadic in the past, human S. suis infections have been reported during the last 45 years, with two large outbreaks recorded in China. In fact, the number of reported human cases has significantly increased in recent years. In this review, we present the worldwide distribution of serotypes and sequence types (STs), as determined by multilocus sequence typing, for pigs (between 2002 and 2013) and humans (between 1968 and 2013). The methods employed for S. suis identification and typing, the current epidemiological knowledge regarding serotypes and STs and the zoonotic potential of S. suis are discussed. Increased awareness of S. suis in both human and veterinary diagnostic laboratories and further establishment of typing methods will contribute to our knowledge of this pathogen, especially in regions where complete and/or recent data is lacking. More research is required to understand differences in virulence that occur among S. suis strains and if these differences can be associated with specific serotypes or STs.
... Streptococcus suis (S. suis) is an emerging zoonotic pathogen that causes life-threatening diseases, including septicemia, meningitis, and endocarditis (Kay et al., 1995;Mazokopakis et al., 2005), with more than 750 reported human cases of infection worldwide (Feng et al., 2010). Amongst the 35 known serotypes of S. suis, serotype 2 (SS2) is considered to be the most pathogenic and prevalent form in both pigs and humans (Nghia et al., 2008). ...
Bacterial cell division is strictly regulated in the formation of equal daughter cells. This process is governed by a series of spatial and temporal regulators, and several new factors of interest to the field have recently been identified. Here, we report the requirement of gluconate 5-dehydrogenase (Ga5DH) in cell division of the zoonotic pathogen Streptococcus suis. Ga5DH catalyzes the reversible reduction of 5-ketogluconate to D-gluconate and was localized to the site of cell division. The deletion of Ga5DH in S. suis resulted in a plump morphology with aberrant septa joining the progeny. A significant increase was also observed in cell length. These defects were determined to be the consequence of Ga5DH deprivation in S. suis causing FtsZ delocalization. In addition, the interaction of FtsZ with Ga5DH in vitro was confirmed by protein interaction assays. These results indicate that Ga5DH may function to prevent the formation of ectopic Z rings during S. suis cell division.
... Desde el primer caso descrito en 1968 en Dinamarca, el número de infectados se ha incrementado en diferentes países de Asia y Europa (4,9,11,14). En América Latina el primer caso se publicó en el año 2005, en Argentina (10). ...
Se describe un caso de meningitis por Streptococcus suis en un paciente inmunocompetente. Presentaba astenia, debilidad generalizada, fiebre (39 °C), vómitos, deterioro del sensorio y desorientación témporo-espacial. Los cultivos de sangre (2/2) y de líquido cefalorraquídeo fueron positivos. La identificación preliminar se realizó utilizando las pruebas bioquímicas convencionales y fue completada en el Servicio Bacteriología Especial del INEI-ANLIS "Dr. Carlos G. Malbrán". Se comenzó el tratamiento con ampicilina y ceftriaxona. El microorganismo aislado demostró sensibilidad a ampicilina, cefotaxima y vancomicina. El paciente evolucionó favorablemente, pero se comprobó leve hipoacusia. Reingresó a los 4 meses con marcha atáxica, anacusia en oído izquierdo e hipoacusia en oído derecho. Continúa con seguimiento neurológico y audiométrico. Retrospectivamente se constató el contacto del paciente con cerdos. Se destaca la importancia de la anamnesis para alertar la sospecha de este agente etiológico en meningitis y bacteriemias.A case of Streptococcus suis meningitis is described in an immunocompetent patient presenting asthenia, general weakness, fever, vomiting, sensory deterioration and temporospatial disorder. The cerebrospinal fluid and two blood cultures (2/2 bottles) were positive. The isolate was preliminary identified by conventional biochemical tests, and the identification was completed at the Special Bacteriology Service of INEI-ANLIS "Dr. Carlos G. Malbrán". Ampicillin and ceftriaxone treatment was initiated. The isolate was susceptible to ampicillin, cefotaxime and vancomycin. The patient experienced a good outcome but suffered hearing loss. However, after four months he returned with walking ataxia, deafness in his left ear, and hearing loss in the right ear. The patient’s retrospective exposure to pigs had been verified. It is important to evaluate predisposing and epidemiologic factors in order to alert about the possible presence of this etiological agent in cases of meningitis or bacteremia.
... range of swine diseases, including meningitis, septicemia, and endocarditis, and it is responsible for severe economic losses to the swine industry worldwide (1,2). It is also of significance in public health, as humans in close contact with pigs or pork products can be infected with the bacteria through skin wounds or the consumption of raw pork (3,4). Human infections with S. suis commonly lead to meningitis (5). ...
We report here the second complete genome sequence of Streptococcus suis serotype 3 (strain YB51). The genome is 2,043,655 bp in length, which is 14,840 bp longer than the first reported genome
of the same serotype, and it covers 2,012 coding sequences, 56 tRNAs, and 4 rRNA loci.
... In many cases, biofilms are surface-attached microbial communities that are protected by a self-generated organic polymer matrix, which can act as a diffusion barrier and limit the penetration of antimicrobials to the innermost cells (19). In S. suis, biofilm formation is recently reported to Biofilm in S. suis be prevalent especially in field isolates, suggesting possible role of biofilm in S. suis pathogenesis (11,14). Previous studies have indicated that the nutritional content of the growth medium can regulate biofilm formation (7,16). ...
Streptococcus suis is a swine pathogen and also a zoonotic agent. The formation of biofilms allows S. suis to become persistent colonizers and resist clearance by the host immune system and antibiotics. In this study, biofilm forming potentials of various S. suis strains were characterized by confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM) and tissue culture plates stained with crystal violet. In addition, the effects of five antimicrobial agents on biofilm formation were assayed in this study. S. suis produced biofilms on smooth and rough surface. The nutritional contents including glucose and NaCl in the growth medium modulated biofilm formation. There was a significant difference in their biofilm-forming ability among all 46 S. suis strains. The biofilm-forming potential of S. suis serotype 9 was stronger than type 2 and all other types. However, biofilm formation was inhibited by five commonly used antimicrobial agents, penicillin, erythromycin, azithromycin, ciprofloxacin, and ofloxacin at subinhibitory concentrations, among which inhibition of ciprofloxacin and ofloxacin was stronger than that of other three antimicrobial agents.Our study provides a detailed analysis of biofilm formation potential in S. suis, which is a step towards understanding its role in pathogenesis, and eventually lead to a better understanding of how to eradicate S. suis growing as biofilms with antibiotic therapy.
... It is also an emerging zoonotic agent. Humans can be infected when in close contact with pigs or pork products through skin wounds, or through consumption of raw pork[3][4][5]. S. suis human infections commonly lead to meningitis[6]. Septic shock, endocarditis, cellulitis, peritonitis, rhabdomyolysis, arthritis, spondylodiscitis, pneumonia, uveitis, and endophthalmitis can also occur[7]. ...
Streptococcussuis is an important zoonotic agent causing severe diseases in pigs and humans. To date, 33 serotypes of S. suis have been identified based on antigenic differences in the capsular polysaccharide. The capsular polysaccharide synthesis (cps) locus encodes proteins/enzymes that are responsible for capsular production and variation in the capsule structures are the basis of S. suis serotyping. Multiplex and/or simplex PCR assays have been developed for 15 serotypes based on serotype-specific genes in the cps gene cluster. In this study, we developed a set of multiplex PCR (mPCR) assays to identify the 33 currently known S. suis serotypes. To identify serotype-specific genes for mPCR, the entire genomes of reference strains for the 33 serotypes were sequenced using whole genome high-throughput sequencing, and the cps gene clusters from these strains were identified and compared. We developed a set of 4 mPCR assays based on the polysaccharide polymerase gene wzy, one of the serotype-specific genes. The assays can identify all serotypes except for two pairs of serotypes: 1 and 14, and 2 and 1/2, which have no serotype-specific genes between them. The first assay identifies 12 serotypes (serotypes 1 to 10, 1/2, and 14) that are the most frequently isolated from diseased pigs and patients; the second identifies 10 serotypes (serotypes 11 to 21 except 14); the third identifies the remaining 11 serotypes (serotypes 22 to 31, and 33); and the fourth identifies a new cps cluster of S. suis discovered in this study in 16 isolates that agglutinated with antisera for serotypes 29 and 21. The multiplex PCR assays developed in this study provide a rapid and specific method for molecular serotyping of S. suis.
... In a former case of a farmer suffering from S. suis endocarditis, the patient was successfully treated with 6 × 4 MIU of penicillin G/day i.v. for 4 weeks and gentamicin (dosage adjusted to the blood levels) for 10 days, in combination with aortic valve replacement. In our most recent case, we started treating the patient with ampicillin (3)(4)(5)(6)(7)(8)(9)(10)(11). However, because the condition of our patient did not improve and CRP levels increased, we suspected that ampicillin did not penetrate into the hip joint. ...
... Since its induction of major outbreaks in China and Vietnam (2, 3), S. suis has elicited considerable public health concern worldwide because it has resulted in substantial economic losses and emerged as a zoonotic pathogen with novel variants that cause streptococcal toxic shock-like syndrome in humans. It has been shown to be the primary cause of adult meningitis in Vietnam, the secondary cause in Thailand, and the third most common cause of community-acquired bacterial meningitis in Hong Kong (3)(4)(5)(6). Adhesion to human and porcine epithelial and endothelial cells is a critical step during S. suis colonization and invasion (7). Uncovering the molecular mechanisms that mediate S. suis adherence to host cells may contribute to the development of effective vaccines and therapeutic strategies. ...
Streptococcus suis, one of the most important and prevalent pathogens in swine, presents a major challenge to global public health. HP0197 is
an S. suis surface antigen that was previously identified by immunoproteomics and can bind to the host cell surface. Here, we investigated
the interaction between HP0197 and the host cell surface glycosaminoglycans (GAGs) using indirect immunofluorescence and cell
adhesion inhibition assays. In addition, we determined that a novel 18-kDa domain in the N-terminal region of HP0197 functions
as the GAG-binding domain. We then solved the three-dimensional structures of the N-terminal 18-kDa and C-terminal G5 domains
using x-ray crystallography. Based on this structural information, the GAG-binding sites in HP0197 were predicted and subsequently
verified using site-directed mutagenesis and indirect immunofluorescence. The results indicate that the positively charged
residues on the exposed surface of the 18-kDa domain, which are primarily lysines, likely play a critical role in the HP0197-heparin
interaction that mediates bacterium-host cell adhesion. Understanding this molecular mechanism may provide a basis for the
development of effective drugs and therapeutic strategies for treating streptococcal infections.
Streptococcus suis is a zoonotic pathogen that can cause severe systemic infections in pigs and humans. Meningitis and septicemia are the critical clinical manifestations of the cases. Hearing loss (HL) reported by up to one-half of the patients is one of the striking features of the S. suis infection at presentation or a few days later (Wertheim et al., Clin Infect Dis 48:617–625, 2009; Huang et al., J Microbiol Immunol Infect 38:306–313, 2005). In addition to HL, vestibular dysfunction is another common complication among patients.
In recent years, the number of cases of S. suis infection has notably increased, with the highest prevalence in Southeast Asia, in which the swine consumption rate is high. Moreover, most patients are seen in Vietnam and Thailand (Rayanakorn et al., Sci Rep 8:13,358, 2018). The mortality among S. suis meningitis cases is lower than the cases caused by other causative agents; however, some authors reported a higher neurological sequelae ratio than other bacterial meningitis (Edmond et al., Lancet Infect Dis 10:317–328, 2010). Although pig or occupational exposure is not documented in all cases of S. suis infection, pigs and pig-related occupations, including farming and works involving meat processing, seem to be the significant risk factor for human S. suis infection. The risk of infection among the general population or other risk factors such as eating habits should not be underestimated for S. suis diseases (Rayanakorn et al., Sci Rep 8:13,358, 2018; Mai et al., Clin Infect Dis 2008;46:659–667).
We analyzed the clinical characteristics and outcomes of patients with Streptococcus suis meningitis in Liuzhou, China, to improve diagnostic accuracy and lower the chances of misdiagnosis. The major clinical manifestations, auxiliary examination results, treatment strategies, treatment efficacy, and follow-up results of 17 consecutively admitted patients with S. suis meningitis were evaluated. The most common clinical manifestations were fever (15/17), sensorineural hearing loss (13/17), headache (11/17), and altered mental status (8/17). In addition, 64.71% of the patients had residual symptoms of sensorineural hearing loss at discharge, and moderate disabilities occurred in 68.75% of the patients in the form of sensorineural deafness (11/17) and hemiparesis (1/17). The cerebrospinal fluid (CSF) of nine patients was used for metagenomic analysis with next-generation sequencing. The metagenomic analysis of CSF of four patients was positive, whereas blood and CSF cultures were negative. The average modified Rankin Scale (mRS) and Activities of Daily Living (ADL) scores improved significantly at the 6-month follow-up compared with those at admission ( P < 0.05). There was no correlation between altered mRS and ADL scores and the CSF findings ( P > 0.05). Early administration of antibiotics can prevent sensorineural hearing loss. Early CSF metagenomic analysis may be superior to blood and CSF culture.
Streptococcus suis is a Gram-positive cocci bacterium that are found mainly in pigs and can be transmitted to human through pigs or pork exposure. The disease is mainly found among occupations involving swine contact in western countries whereas in Asia the disease is usually contracted through raw pork consumption. In this case report, we present a case of a middle-aged Thai man who acquired the infection from raw pork consumption. He presented with endogenous endophthalmitis with infective spondylodiscitis, sepsis and meningitis and later developed blindness of the right eye and permanent bilateral hearing loss disseminated from S. suis infection. Our report suggests that S. suis infection be considered as a causative factor in patient presenting with established clinical symptoms and predisposing factors. Cultural habit of eating raw pork should be taken into account especially in Asian countries.
PROBLEM: Streptococcus suis is a common cause of adult bacterial meningitis in Viet Nam, and possibly other parts of Asia, yet this disabling infection has been largely neglected. Prevention, diagnosis and treatment are relatively straightforward and affordable but, in early 2007, no national diagnostic, case management or prevention guidelines existed in Viet Nam. APPROACH: Enhanced detection of S. suis infections was established in 2007 as part of a collaborative research programme between the National Hospital for Tropical Diseases, a key national hospital with very close links to the Ministry of Health, and a research group affiliated with Oxford University based in Viet Nam. The results were reported directly to policy-makers at the Ministry of Health. LOCAL SETTING: Viet Nam is a low-income country with a health-care system that has seen considerable improvements and increased autonomy. However, parts of the system remain fairly centralized the Ministry of Health. RELEVANT CHANGES: Following the improved detection and reporting of S. suis cases, the Ministry of Health issued guidance to all hospitals in Viet Nam on the clinical and laboratory diagnosis, treatment and prevention of S. suis. A public health laboratory diagnostic service was established at the National Institute of Hygiene and Epidemiology and training courses were conducted for clinicians and microbiologists. Ministry of Health guidance on surveillance and control of communicable diseases was updated to include a section on S. suis. LESSONS LEARNT: Research collaborations can efficiently inform and influence national responses if they are well positioned to reach policy-makers.
Streptococcus suis (SS) infection has aroused tremendous attention recently. We report a restaurant worker who suffered acute confusion due to SS meningitis. Sporadic cases have been reported in Hong Kong since 1981. Little was known in the past about its characteristic fulminant clinical deterioration. We explored the literature and discuss the epidemiology, pathogenesis, clinical manifestations and management of this disease.
Fhb is a surface virulence protein from Streptococcus suis, which could aid bacterial evasion of host innate immune defense by recruiting complement regulator factor H to inactivate C3b deposited on bacterial surface in blood. Here we successfully expressed and purified the N terminal domain of Fhb (N-Fhb) and obtained crystals of the N-Fhb by sitting-drop vapor diffusion method with a resolution of 1.50 Å. The crystals belong to space group C2 with unit cell parameters a = 127.1 Å, b = 77.3 Å, c = 131.6 Å, α = 90°, β = 115.9°, (.)γ = 90°. The structure of N-Fhb was determined by SAD method and the core structure of N-Fhb is a β sandwich. We speculated that binding of Fhb to human factor H may be mainly mediated by surface amino acids with negative charges.
Streptococcus suis is a worldwide pathogen of a variety of porcine infection and has also been described as a pathogen for humans. We studied biochemical characteristics, antimicrobial susceptibility, and identification of polymerase chain reaction (PCR) of S. suis isolated from diseased pigs in Gyeongbuk province from 2004 to 2009. Sixty-one isolates were identified as S. suis by biochemical characteristics and PCR from 40 farms. The biochemical characteristics of S. suis isolates were production of VP-negative, hippurate, esculin, and arginine decarboxylase-positive, and fermentation of carbohydrate was variable lactose, trehalose, inulin, and raffinose, which was typeable 11 phenotype. In an antimicrobial susceptibility test, the majority of isolates were highly susceptible to amoxicillin/clavulanic acid, ampicillin, cephalothin, cefoperazone and florfenicol, while being highly resistant to streptomycin, kanamycin, amikacin, neomycin, erythromycin, clindamycin, and tetracycline. The isolates were divided into 11 phenotypes of biochemistry. By using PCR, the 16S-rRNA gene DNA fragment was detected at 304 bp from all of isolates. These results may provide the basic information needed to establish strategies for the prevention of S. suis infection in pigs.
Background:
Streptococcus suis meningoencephalitis is a rare but increasingly important condition. Good history taking will give clues to the diagnosis. This is the fourth case report in the United States.
Case:
A 52-year-old Filipino man who recently returned from a trip to the Philippines was admitted with classic symptoms of bacterial meningitis. His cerebrospinal fluid culture grew Streptococcus suis. His clinical course was complicated by seizures, hearing loss, and permanent tinnitus.
Conclusion:
Clinicians should be aware of this emerging disease especially in patients with recent travel history to endemic areas. Early recognition and appropriate management could potentially prevent complications.
Human infection by Streptococcus suis (S. suis) is a zoonosis, with a known occupational risk and clinical presentation mainly as a purulent meningitis with low mortality and frequent hearing loss and ataxia sequela. Less than 150 human cases have been reported since original one thirty years ago. There is a geographical distribution most patients living in northen Europe and south Asia. S. suis disease in human has been reported in two patients in Spain the last years. We present two patients with S. suis meningitis, both were men with occupation related by pork meet, and good outcome. They come at our hospital in a lapse of one month. Both had neurosensorial hearing loss and walking ataxia. One patient had peripheral facial paralysis and diplopia because of paresia of contralateral sixth nerve, with complete resolution at three months.The rare presentation of S. suis meningitis in our country must not forget us to record the working risk at anamnesis.
Infections caused by Streptococcus suis are an important economic problem in the swine industry. Moreover, S. suis (especially serotype 2) is an agent of zoonosis that has the potential to afflict those who are in close contact with infected pigs or pork-derived products. Although sporadic cases of S. suis infections in humans have been reported during the last 40 years, a large outbreak in China emerged in 2005. The severity of the infection in humans during the outbreak, such as clinical signs of streptococcal toxic shock syndrome, attracted much attention from the scientific community and the public press. This two-part review will focus on this organism and the infections it causes, highlighting the differences between Asian and Western countries, particularly with respect to its epidemiology. In part I, the general characteristics of the organism are reviewed, as well as the clinical characteristics associated with S. suis infection in humans, the pathogenesis of infection and associated virulence factors, and, finally, the interactions between S. suis and the host's immune system.
Bacterial meningitis is a serious health risk to the newborn. No effective vaccines against the important causative agents E. coli K1 and N. meningitidis group B exist, apparently due to tolerance induced by host tissue glycans structurally similar to the bacterial capsular polysaccharides. Insufficient data on these cross-reactivities and poor understanding of the antibody interaction with the immunologically evasive capsular polysialic acid have hindered the development of polysaccharide vaccines against meningitis. Recent advance in analytical techniques and novel immonotherapeutic approaches have however, improved the situation significantly. The nature of polysialic acid-antibody interaction is now established and new promising therapeutical strategies have emerged. In this article, studies of immunological properties of polysialic acid and vaccine development spanning more than quarter of century are reviewed.
The article proposes to present a review of the Brazilian literature on manifestations of racism in schoolbooks. Based on previous reviews of the state-of-the-art as well as on original works (such as Baptista, 2002), the text analyzes the Brazilian production under two perspectives: publications that spell out the racism in schoolbooks, and publications that refer to the combat to racism in schoolbooks. Following the history of the subject, the authors try to indicate aspects in common to the analyses previously produced, the gaps that have remained, and the diversity of theoretical- methodological approaches employed. The authors conclude the article analyzing the main actions that have been developed by the Black movement and by the official bodies to fight against racism in schoolbooks, such as the National Schoolbook Program and the recent Act No 10.639 of 9th January 2003, which establishes the mandatory teaching of Afro-Brazilian history and culture in primary schools.
Report on the second human case of a Streptococcus suis type 2 (group R streptococci) infection in the GDR. The patient, a 33-year-old butcher, fell ill with an acute meningitis and an initial myocarditis. Group R streptococci were isolated from cerebrospinal fluid and blood. The patient was treated with penicillin G, ampicillin and gentamicin, followed by trimethoprim-sulfamerazine. Both, meningitis and myocarditis disappeared and the patient recovered completely. The disease was recognized as an occupational disease. Review of the literature. Since 1968 108 cases of human S.suis type 2 infections were described, mostly as meningitis. In most of the cases a close contact to pigs could be confirmed.