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Streptococcus suis type 2: Pathogenesis and clinical disease
Abstract
35 human cases of Streptococcus suis type 2 meningitis were reported in the UK between 1975 and 1990. Of the cases where clinical details were available, deafness occurred in 50% of patients, vertigo and ataxia in 30% and arthritis in 53%; there was a case fatality rate of 13%. The highest incidences of disease were in butchers and abattoir workers. S. suis type 2 is endemic in the UK pig population and is a major cause of meningitis in pigs. Carriage of the organism in crypts of the palatine tonsil in pigs is widespread. Whilst S. suis type 2 is spread between pigs mainly by aerosol, transmission to humans is thought to be mainly via minor skin abrasions. Meningitis occurs after a period of bacteraemia when the organisms invade the cerebrospinal fluid within monocytes, an example of the 'Trojan horse' mechanism of entry. The incidence of hearing loss in cases of S. suis meningitis in humans is much higher than for any other meningitides. The deafness, which also occurs in pigs, is due to cochlear sepsis following invasion of the organism from the subarachnoid space into the perilymph of the inner ear. Septic arthritis is another frequent complication and may also result from a monocyte-mediated transport of bacteria across the synovium.
... Streptococcus suis (S. suis) is an emerging zoonotic pathogen, which has been demonstrated as an etiological agent in human infections in increasing frequency [1,2]. The clinical presentations of these-often serious or life-threatening-infections may be wide-ranging, including syndromes such as purulent meningitis, sepsis, streptococcal toxic shock-like syndrome (STSLS), uveitisendophthalmitis and arthritis; nevertheless, S. suis has also been described as an opportunistic pathogen of lower respiratory tract infections (e.g., pneumonia) [3][4][5]. In recent years, due to the increased availability and utility of novel diagnostic technologies and molecular biological methods both in veterinary and human clinical microbiology, more studies have been published on this zoonotic infectious entity, including the epidemiology of human infections and the virulence factors of this pathogen [6,7]. ...
... cases/100,000 population (with highest prevalence in the Netherlands and the UK) [1,4]. The epidemiological situation in Australasia is similar to the one on the European continent, while the Americas and Japan has reported the lowest prevalence of human S. suis cases (<1% of global cases) [1][2][3][4]. The clinical relevance of these invasive infections must not be underestimated; based on the results of a metaanalysis, the mortality rate associated with these infections is 12.8% (confidence interval: 9.0%-18.0%), ...
... In humans, the intestinal route of infection seems to be an important port of entry, after consumption of fresh/raw contaminated pork meat (e.g., in some Southeast Asian countries) [41]. In fact, the epidemiology of human infections may be significantly affected by the cultural differences and eating habits between the Asian and the European/American regions, while this also raises concerns regarding imported cases due to increasing levels of tourism towards Asia [1][2][3][4][5]. Apart from the handling or ingestion of pork meat, direct contact with the mucous membranes of pets (cats, dogs), livestock (horses, ruminants) and wild animals (deer, wild boar) may also be an important source of infection [37,38]. ...
Streptococcus suis (S. suis) is an emerging zoonotic pathogen, demonstrated as an etiological agent in human infections in increasing frequency, including diseases like purulent meningitis, sepsis, uveitis-endophtalmitis and arthritis. Due to the increased availability and utility of novel diagnostic technologies in clinical microbiology, more studies have been published on the epidemiology of S. suis, both in veterinary and human medicine; however, there are no comprehensive data available regarding human S. suis infections from East-Central European countries. As a part of our study, data were collected from the National Bacteriological Surveillance (NBS) system on patients who had at least one positive microbiological result for S. suis, corresponding to an 18-year study period (2002-2019). n = 74 S. suis strains were isolated from invasive human infections, corresponding to 34 patients. The number of affected patients was 1.89 ± 1.53/year (range: 0-5). Most isolates originated from blood culture (63.5%) and cerebrospinal fluid (18.9%) samples. Additionally, we present detailed documentation of three instructive cases from three regions of the country and with three distinctly different outcomes. Hungary has traditional agriculture, the significant portion of which includes the production and consumption of pork meat, with characteristic preparation and consumption customs and unfavorable epidemiological characteristics (alcohol consumption, prevalence of malignant diseases or diabetes), which have all been described as important predisposing factors for the development of serious infections. Clinicians and microbiologist need to be vigilant even in nonendemic areas, especially if the patients have a history of occupational hazards or having close contact with infected pigs.
... S. suis is an important zoonotic pathogen in mostly swines and wild boars, but occurs in a wide range of animals and humans [1]. Clinical presentations associated with this species in human infections are most frequently manifest as acute purulent bacterial meningitis, but include sepsis, streptococcal toxic shock-like syndrome (STSLS) with multiple organ failure, endocarditis, and uveitis-endophthalmitis [2][3][4]. Generalized septicemia caused by S. suis may transform into arthritis, which affects different types of joints such as hips, elbows, wrists, sacroiliac, spine, and thumbs. Permanent hearing loss and vestibular dysfunction are commonly noted sequelae of these infections [5]. ...
... S. suis is a Gram-positive, facultative anaerobic coccus, that has been implicated as the cause of a wide range of clinical diseases in swine and can be found in wide range of animal species, including wild boars, horses, dogs, raccoon dogs, cats, and birds [1][2][3][4][5][6]. In pigs, the natural habitat of S. suis is the upper respiratory tract, particularly tonsils (tonsil carriage rate in piglets aged 4-6 months was 32-50%), nasal cavities, genital and alimentary tracts [33,34], they could be healthy carriers or afflicted. ...
... In contrast to the serotypes infecting pigs, S. suis serotype 2 is the most common cause of this disease in humans [33,34]. S. suis infection normally occurs among certain risk population particularly veterianers, hunters, farmers, and abattoir works involving meat processing [1][2][3][4][5][6]. There is a wide clinical variation in the presentation of S. suis infections in humans, but meningitis is the most common clinical manifestation; S. suis can cause a very rare but serious infection: there was a description of a large-scale STSS outbreak among humans in China in 2005 caused by a single clonal S. suis type 2 strain [35]. ...
Streptococcus suis is an emerging zoonotic human pathogen, which is a causative agent of invasive infections in people who are in close contact with infected pigs or contaminated pork products. It is associated with severe systemic infections, most commonly meningitis and sepsis, which may lead to high rates of morbidity and mortality. Serotype 2 is the most prevalent type in S. suis infections in humans. We have reported a case of a very rapidly proceeding fatal human S. suis infection in a splenectomized, but otherwise immunocompetent patient in Hungary. We would like to highlight the attention for this pathogen for the risk group patients, not only pig breeders, veterinarians, abattoir workers, meat processing and transport workers, butchers and cooks, that those persons who are immunocompromised including those with spleen removed, persons with diabetes mellitus, cancer and alcoholism, are also at greater risk of infection.
... 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 . ...
... A lower mean age was noted in 2 studies 16,28 . Mean age was reported in most studies 9,11,[13][14][15][16]18,20,[22][23][24]26,[29][30][31][32][33][34][35]38 whereas 6 studies reported the value in median 10,21,25,27,36,39 . Neither mean nor median age were reported in 3 studies 17,37,41 (see supplementary appendix Table S1. ...
... Study population were mainly S. suis meningitis identified from studies done in bacterial meningitis patie nts 9,10,13,15,19,22,23,28,29,35,41 while the rest were patients diagnosed with S. suis infection 11,14,[16][17][18]20,21,[24][25][26][27][31][32][33][34][38][39][40]42 . Diagnosis was based on either standard bacterial culture or real-time polymerase chain reaction (RT-PCR) in most studies. ...
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.
... In humans, S. suis usually produces a purulent or non-purulent meningitis (Arends and Zanen, 1988). In addition, endocarditis, cellulitis, peritonitis, rhabdomyolysis , arthritis, spondylodiscitis, pneumonia, uveitis and endopthalmitis have been reported (Walsh et al., 1992; Huang et al., 2005 ). Arthritis affects various joints including hips, elbows, wrists, sacroiliac, spine and thumbs (Walsh et al., 1992). ...
... In addition, endocarditis, cellulitis, peritonitis, rhabdomyolysis , arthritis, spondylodiscitis, pneumonia, uveitis and endopthalmitis have been reported (Walsh et al., 1992; Huang et al., 2005 ). Arthritis affects various joints including hips, elbows, wrists, sacroiliac, spine and thumbs (Walsh et al., 1992). In most cases, arthritis reflects generalized septicemia caused by S. suis. ...
... One of the most striking features of the infection is the consequence of deafness and/or vestibular dysfunction following S. suis meningitis (Lutticken et al., 1986; Huang et al., 2005). Indeed, the recorded incidence of deafness following infection caused by this pathogen is consistently higher than that reported for other meningitiscausing bacteria, such as S. pneumoniae, Neisseria meniningitidis and Haemophilus influenzae, and can reach 50 and 65% in Europe and Asia, respectively (Walsh et al., 1992). The reason for these observations is unknown. ...
Infections caused by Streptococcus suis are considered a global problem in the swine industry. In this animal species, S. suis is associated with septicemia, meningitis, endocarditis, arthritis and, occasionally, other infections. Moreover, it is an agent of zoonosis that afflicts people in close contact with infected pigs or pork-derived products. Although sporadic cases of S. suis infection in humans have been reported, a large outbreak due to S. suis serotype 2 emerged in the summer of 2005 in Sichuan, China. A similar outbreak was observed in another Chinese province in 1998. Symptoms reported in these two outbreaks include high fever, malaise, nausea and vomiting, followed by nervous symptoms, subcutaneous hemorrhage, septic shock and coma in severe cases. The increased severity of S. suis infections in humans, such as a shorter incubation time, more rapid disease progression and higher rate of mortality, underscores the critical need to better understand the factors associated with pathogenesis of S. suis infection. From the 35 capsular serotypes currently known, serotype 2 is considered the most virulent and frequently isolated in both swine and humans. Here, we review the epidemiological, clinical and immunopathological features of S. suis infection in humans.
... The association between human S. suis infection and occupational exposures to pigs or pork has been reported in Europe and Asia since 1968 [6,15,16]. In Vietnam, the proportion of patients reported to have occupational exposures was lower than reported in European patients but it remained an important independent risk factor. ...
... 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 contrast, pediatric infections with S. suis are extremely rare, presumably related to a lack of exposure associated with increased risk of S. suis infection, in children. The association between human S. suis infection and occupational exposures to pigs or pork has been reported in Europe and Asia since 1968 [6,15,16]. In Vietnam, the proportion of patients reported to have occupational exposures was lower than reported in European patients but it remained an important independent risk factor. ...
... Slaughtering and processing sick or dead pigs were also associated with S. suis infection in a case-control study conducted during the Sichuan outbreak [13]. 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). ...
[This corrects the article on p. e17604 in vol. 6.].
... In contrast, pediatric infections with S. suis are extremely rare, presumably related to a lack of exposure associated with increased risk of S. suis infection, in children. The association between human S. suis infection and occupational exposures to pigs or pork has been reported in Europe and Asia since 1968 [6,15,16]. In Vietnam, the proportion of patients reported to have occupational exposures was lower than reported in European patients but it remained an important independent risk factor. ...
... Slaughtering and processing sick or dead pigs were also associated with S. suis infection in a case-control study conducted during the Sichuan outbreak [13]. 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). ...
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.
A case-control study with appropriate hospital and matched community controls for each patient was conducted between May 2006 and June 2009. Potential risk factors were assessed using a standardized questionnaire and investigation of throat and rectal S. suis carriage in cases, controls and their pigs, using real-time PCR and culture of swab samples. We recruited 101 cases of S. suis meningitis, 303 hospital controls and 300 community controls. By multivariate analysis, risk factors identified for S. suis infection as compared to either control group included eating "high risk" dishes, including such dishes as undercooked pig blood and pig intestine (OR(1) = 2.22; 95%CI = [1.15-4.28] and OR(2) = 4.44; 95%CI = [2.15-9.15]), occupations related to pigs (OR(1) = 3.84; 95%CI = [1.32-11.11] and OR(2) = 5.52; 95%CI = [1.49-20.39]), and exposures to pigs or pork in the presence of skin injuries (OR(1) = 7.48; 95%CI = [1.97-28.44] and OR(2) = 15.96; 95%CI = [2.97-85.72]). S. suis specific DNA was detected in rectal and throat swabs of 6 patients and was cultured from 2 rectal samples, but was not detected in such samples of 1522 healthy individuals or patients without S. suis infection.
This case control study, the largest prospective epidemiological assessment of this disease, has identified the most important risk factors associated with S. suis bacterial meningitis to be eating 'high risk' dishes popular in parts of Asia, occupational exposure to pigs and pig products, and preparation of pork in the presence of skin lesions. These risk factors can be addressed in public health campaigns aimed at preventing S. suis infection.
... The exact route of infection for humans has not been well delineated, but S. suis infection occurs mainly in adults and is often related to accidental inoculation through skin injuries. Occupational exposure to pigs and pork, inhalation of aerosols, and ingestion of contaminated pork have also been suggested [3,5]. More than 400 cases of S. suis infection have been described previously, with a geographic distribution heavily biased toward northern Europe and eastern and southeastern Asia, including China, Hong Kong, Thailand, and Taiwan [6]. ...
... Patients infected with S. suis are usually previously healthy adults, although patients with asplenia, diabetes mellitus, alcoholism, and malignancy are at greater risk of such infection [7,8]. Human infections with S suis are most frequently manifested as purulent meningitis, but reports of septic shock with multiple organ failure, endocarditis, pneumonia, arthritis, and peritonitis have also been published [5]. ...
Streptococcus suis is a common infection of pigs. Human infection is often related to accidental inoculation through skin injuries during occupational exposure to pigs and pork. The disease may present as meningitis, bacteremia, and less commonly endocarditis, arthritis, or bronchopneumonia.
Case report and review of the literature.
We report a case of bacteremia and severe sepsis caused by S. suis serotype 2 complicated by septic arthritis in a 56-year-old male with history of a prior contact with unprocessed pork. The causative agent was isolated from blood cultures and aspirated synovial fluid. The patient's condition improved after treatment with penicillin, but he was found subsequently to have an abdominal aortic aneurysm, confirmed by computed tomography (CT) scan. The mycotic aneurysm was successfully repaired using an in situ graft reconstruction. Tissue samples analyzed using polymerase chain reaction identified S. suis serotype 2 as the causative organism. After completion of two weeks of parenteral antibiotics, an oral form of ciprofloxacin (0.25 g twice a day) was continued for one month. The patient was discharged from our institution after uncomplicated recovery. Clinical review, a CT scan, and inflammatory markers nine months after surgery revealed no evidence of infection.
This is the first report of mycotic aneurysm caused by S. suis, which may be an etiologic agent of mycotic aneurysms, especially when complicated by bacteremia in adults with a recent history of contact with pigs or unprocessed pork.
... In humans, S. suis usually produces a purulent or nonpurulent meningitis. Additionally, endocarditis, cellulitis, peritonitis, rhabdomyolysis, arthritis, spondylodiscitis, pneumonia, uveitis, and endopthalmitis may occur [4,11,12]. Both severe infections with shock and a high mortality also have been described [13,14]. ...
... Both severe infections with shock and a high mortality also have been described [13,14]. One striking feature of S. suis-related meningitis is the complication of deafness and/or vestibular dysfunction, which occurs at a rate consistently higher than that reported for other meningitis-causing bacteria and which reaches 50% and 65% in Europe and Asia, respectively [11,12]. Most cases of S. suis infection have been attributed to serotype 2 strains; however, cases due to serotypes 4, 14, and 16 also have been reported [4]. ...
... Other streptococcal species have been shown to be capable of causing zoonotic infections. [25][26][27][28][29][30][31][32][33][34] Outbreaks of S. suis septicemia and meningitis have been documented in pigs, especially under adverse environmental conditions. 29,33 Similar disease has been described in humans after contact with live or slaughtered pigs. ...
... 29,33 Similar disease has been described in humans after contact with live or slaughtered pigs. [30][31][32][33][34] The portal of entry is unknown, but it often appears to be the skin. As we found with S. iniae, only certain clones of S. suis are commonly associated with disease in humans. ...
Streptococcus iniae is a pathogen in fish, capable of causing invasive disease and outbreaks in aquaculture farms. During the winter of 1995-1996 in the greater Toronto area there was a cluster of four cases of invasive S. iniae infection in people who had recently handled fresh, whole fish from such farms.
We conducted a prospective and retrospective community-based surveillance for cases of S. iniae infection in humans. To obtain a large sample of isolates, we studied cultures obtained from the surface of fish from aquaculture farms. Additional isolates were obtained from the brains of infected tilapia (oreochromis species). All the isolates were characterized by pulsed-field gel electrophoresis (PFGE).
During one year, our surveillance identified a total of nine patients with invasive S. iniae infection (cellulitis of the hand in eight and endocarditis in one). All the patients had handled live or freshly killed fish, and eight had percutaneous injuries. Six of the nine fish were tilapia, which are commonly used in Asian cooking. Thirteen additional S. iniae isolates (2 from humans and 11 from infected tilapia) were obtained from normally sterile sites. The isolates from the nine patients were indistinguishable by PFGE and were highly related to the other clinical isolates. There was substantial genetic diversity among the 42 surveillance isolates from the surface of fish, but in 10 isolates the PFGE patterns were identical to those from the patients with S. iniae infection.
S. iniae can produce invasive infection after skin injuries during the handling of fresh fish grown by aquaculture. We identified a clone of S. iniae that causes invasive disease in both humans and fish.
... Streptococcus suis is responsible for a wide variety of porcine disease syndromes, such as meningitis, septicaemia, arthritis and endocarditis (Higgins & Gottschalk, 1998). It is also recognized as a human pathogen, causing mainly meningitis (with deafness as a common sequela) and endocarditis (Walsh et al., 1992;Arends & Zanen, 1988;Trottier et al., 1991). T o date, 35 serotypes of S. suis have been described, with serotype 2 being the most frequently isolated from diseased animals (Higgins & Gottschalk, 1996). ...
... Presence of N-acetylneuraminic acid (NANA) was shown by coarse aggregates. Absence of NANA was confirmed by the thiobarbituric acid assay (Warren, 1963). ...
Streptococcus suis serotype 2 is responsible for a wide variety of porcine infections. In addition, it is considered a zoonotic agent. Knowledge about the virulence factors for this bacterium is limited but its polysaccharide capsule is thought to be one of the most important. Transposon mutagenesis with the self-conjugative transposon Tn916 was used to obtain acapsular mutants from the virulent S. suis type 2 reference strain S735. Clones were screened by colony-dot ELISA with a monoclonal antibody specific for a type 2 capsular epitope and clones that failed to react with the antibody were characterized. Two mutants, 2A and 79, having one and two Tn916 insertions respectively, were chosen for further characterization. Absence of capsule was confirmed by coagglutination, capillary precipitation and capsular reaction tests and by transmission electron microscopy. Absence of capsular polysaccharides correlated with increased hydrophobicity and phagocytosis by both murine macrophages and porcine monocytes compared to the wild-type strain. Furthermore, both mutants were shown to be avirulent in murine and pig models of infection. Finally, mutant 2A was readily eliminated from circulation in mice compared to the wild-type strain, which persisted more than 48 h in blood. Thus, isogenic mutants defective in capsule production demonstrate the importance of capsular polysaccharides as a virulence factor for S. suis type 2.
... The first human case of S. suis meningitis was reported in 1968 in Denmark [4]. Over 150 cases have been reported worldwide including the United Kingdom [5], France [6], Germany [7][8][9][10], The Netherlands [11], Sweden [12], New Zealand [13], Thailand [14], Singapore [15], Taiwan [16] and Hong Kong [17][18][19]. In July 2005, a large outbreak affecting over 200 people in Sichuan, China attracted international attention [20]. ...
... Ours series shows a case-fatality rate of 5% which is almost the same as the previous local series [19] but lower than another study (23 %) [18]. Case-fatality rates reported elsewhere ranged from 7 % to 13 % [5,11,14]. Low case-fatality rate may be partly attributable to early hospital admission and administration of appropriate antibiotics. The only death in our series was associated with intravascular coagulation, which was also reported in two of the other local series [18,19]. ...
We conducted a 31-month retrospective review of all laboratory-confirmed Streptococcus suis infections admitted to public hospitals in Hong Kong. Strain identification, serotyping and antibiotic susceptibility tests were conducted on S. suis isolates. Twenty-one sporadic cases were identified, comprising 18 (86%) males and 3 (14%) females. About half were patients aged 65 years. More cases occurred during summer. Occupational exposure was documented in five (24%) cases. The estimated annual incidence was 0.09/100 000 in the general population and 32/100 000 in people with occupational exposure to pigs and raw pork. The primary clinical manifestations were meningitis (48%), septicaemia (38%) and endocarditis (14%). The case-fatality rate was 5%. All available isolates from 15 patients were serotype 2, sensitive to penicillin, ampicillin, ceftriaxone, but resistant to tetracycline. Injury prevention and proper handling of pigs or raw pork should be advocated to both at-risk occupational groups and the general population.
... For instance, Streptococcus suis infection causes septicemia, lymph node enlargement, arthritis, and other symptoms in pigs. In addition, Streptococcus suis is a common zoonotic bacterium that, in humans, can cause pneumonia, encephalitis, septicemia, endocarditis, fibrositis, and impaired prognosis of hearing [37,38]. In the present study, we found that the number of Streptococcus spp. ...
In this study, we investigated the effects of the dietary inclusion of different proportions of whole-plant corn silage on growth performance, serum biochemical indexes, and intestinal microorganisms in Hezuo pigs. Thirty-two two-month-old Hezuo pigs (body weight: 7.88 ± 0.81 kg) were randomly divided into four groups of eight pigs (half male, half female) each. The control (CON) group received a basal diet, while the three experimental groups were fed the basal diet, part of which had been replaced with 5%, 10%, and 15% whole-plant corn silage, respectively. The experiment lasted for 127 days, including 7 days of pre-testing and 120 days of formal testing. At the end of the experiment, blood and fecal samples were collected. Compared with the CON group, the feed-to-gain ratio was significantly lower in the 10% test group (p < 0.05), whereas the total protein, albumin, triglyceride, and glucose contents were significantly higher (p < 0.05). No significant differences in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, creatinine, urea, aspartate aminotransferase, and alanine aminotransferase were observed among the groups (p > 0.05). The addition of whole-plant corn silage to the diet significantly increased alpha diversity in the pig gut based on 16S rRNA gene sequencing. The principal coordinate analysis results showed significant clustering of the different groups (p < 0.05). At the phylum level, the addition of whole-plant corn silage to the diet significantly decreased (p < 0.05) the relative abundance of Firmicutes and significantly increased (p < 0.05) that of Bacteroidetes. At the genus level, the relative abundance of Streptococcus significantly decreased (p < 0.05) with increasing silage supplementation levels, whereas species diversity significantly increased (p < 0.05). In conclusion, 10% is the recommended inclusion ratio for whole-plant corn silage in the diets of pigs.
... The risk of contracting the disease also increases with age and some studies have shown an association with alcoholism and diabetes mellitus [13,14]. ...
This is a case study on epidemiological factor clinical spectrum and drug susceptibility of a rare zoonotic infection caused by Streptococcus sui in a 60 year female patient. Presented with fever and altered sensorium. Blood culture analysis revealed the causative agent to be Streptococcus sui. Antibiotic sensitivity screening of the culture was also performed. So while recording the case history it was noted that the patient was in close contact with pigs on regular basis. The patient was treated with ceftriaxone antibiotic and responded favorably to the therapy. We represent the first human case of Streptococcus sui from Goa.
... Bolesne`ivotinje izlu~uju u okolinu veliki broj bakterija koje se aerosolom ili direktnim kontaktom prenose na osetljive doma}ine. Uzro~nik u le{evima uginulih svinja mo`e da pre`ivi 6 nedelja na temperaturi od 4 o C i 12 dana na temperaturi [22][23][24][25] (Yu i sar., 2006). Zahvaljuju}i faktorima virulencije (sposobnosti da formira kapsulu, da lu~i suilizin, fosflipazu C, ekstracelularni faktor i inhibitorne supstance sli~ne bakteriocinu, kao i sposobnosti da formira biofilm u razli~itim sredinama), koji su istovremeno i njegovi odbrambeni mehanizmi, S. suis se veoma dobro pri-lago|ava organizmu doma}ina i tako uspeva da opstane u organizmu i izazove infekciju. ...
The aim of this investigation was to establish the presence and prevalence of streptococci, enterococci and streptococci-like bacteria in various materials originating from healthy, slaughtered and dead pigs belonging to different categories from several farms and slaughterhouses in the Republic of Serbia. The total number of investigated samples comprised 226 swabs of tonsils and noses from clinically healthy breeders, swabs of tonsils from piglets 5-20 days old, parts of nasopharyngeal tonsils from breeders slaughtered in a slaughterhouse, parts of nasopharyngeal tonsils from piglets slaughtered in a slaughterhouse, swabs of slaughtered pig carcasses from a slaughterhouse, swabs from knives for evisceration in a slaughterhouse, as well as swabs of lungs, abdominal cavity and organs from piglets which died suddenly. The standard microbiological methods were used for investigations of the presence of the listed microorganisms. Commercial biochemical tests were used for the identification of the isolated bacteria and specific sera for capsular antigenes were used for serological determination of the isolated S. suis strains. It was established that the great majority of the isolated strains belonged to the genus Streptococcus (36) (75%), and the minority of the strains belonged to the following genera: Enterococcus (6) (10.4%), Aerococcus (3) (6.2%), Lactococcus (2) (4.2%) and Globicatella (2) (4.2%). The great majority of Streptococcus species belonged to S. suis. The presence of other á haemolytic streptococci was established in the swabs of nasopharyngeal tonsils: Streptococcus sanguinis (13.8%), Streptococcus salivarius (5.6%), Streptococcus mitis (5.6%), Streptococcus parasanguinis (2.7%) and Streptococcus oralis (2.7%). Also, S. bovis was isolated in a smaller percentage (5.6%). The greatest number of isolated bacteria from the genus Enterococcus belonged to Enterococcus faecalis (80%), while the minority of isolated strains belonged to Enterococcus faecium (20%). The following from the streptococci-like bacteria were isolated: Aerococcus viridans, Globicatella sanguinis and Lactococcus lactis ssp.cremoris.
... In the United Kingdom, the risk for butchers is even higher. 239 The annual incidence for the occupational group (direct contact with pigs) in Hong Kong was 32/100 000, 350 times higher than that of the general population (0.09/100 000) and 30 times higher than the homologous group in the Netherlands. 82 In addition, a less dramatic difference between the occupational group and the general population was observed in Hong Kong (350 times higher in Hong Kong versus 1500 times in the Netherlands). ...
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.
... Meningitis was the most common intracranial complication (43.7%), followed by lateral sinus thrombosis (31.2%), cerebellar abscess (18.7%), epidural abscess (21.8%), perisinus abscess (15.6%), cerebral abscess and interhemispheric abscess (6.2%), and subdural abscess, otitic hydrocephalus, and otogenic cavernous sinus thrombosis patients (3.1%) [21]. Recently, the most common microbiological cause for otogenic cerebellar abscess was found to be Streptococcus spp, including the Enterococci as reported in the literature [22][23][24][25][26]. A recent study from India has reported that among the 57 cases of brain abscess, Streptococcus spp (36.8%) was the most common causative, followed by Staphylococcus aureus (22.8%) and Pseudomonas spp (5.2%) [27]. ...
Intracranial complications secondary to ear infections is an established clinical condition. The proximity of the brain compartments to the ear increases the chances of infections getting percolated to central nervous system. Early clinical and laboratory diagnosis of such infections and better patient management strategies are required to minimize the intracranial and extracranial complications. Acute and chronic suppurative otitis media (CSOM) have been considered as risk factors for otogenic brain complications. Among the microbiological causes, recently, there has been an increase in the cases of otogenic brain abscess due to Streptococcus spp. This review discusses the microbiological causes, implications, laboratory, diagnosis, and management of otogenic complications of central nervous system.
... S. suis is not only a major problem in the swine industry (Holtkamp et al., 2007): but it has also been recognized as an emerging zoonotic pathogen (Lun et al., 2007;Smith et al., 2008;Feng et al., 2009). After the first reports of zoonosis in the Netherlands and England in the early 1950s (Jensen and Dorseen van, 1957), the disease has been documented worldwide (Walsh et al., 1992; The Government of the Hong Kong Special Administrative Region, 2005;Lun et al., 2007;Gottschalk et al., 2007Gottschalk et al., , 2010. S. suis has been recognized as a sporadic cause of human meningitis and septicemia, with significant hearing loss a common sequel (Wertheim et al., 2009a;Feng et al., 2010). ...
This paper reviews information on antimicrobial resistance patterns and prudent use of antimicrobials to reduce the impact and spread of resistant Streptococcus suis strains. S. suis is an important pathogen in swine, which can cause significant economic loss. Prudent use of antimicrobials for S. suis is essential to preserve the therapeutic efficacy of broad-spectrum antimicrobials and to minimize selection of resistant S. suis strains. Resistance of S. suis to antimicrobials commonly used in swine, including lincosamides, macrolides, sulphonamides, and tetracycline, has been documented worldwide, with resistance in up to 85% of strains. Among antimicrobials examined, resistance of S. suis has been demonstrated to be relatively low for penicillin (0-27%), ampicillin (0.6-23%), and ceftiofur (0-23%). For penicillin, this result may be due in part to the unique mechanism by which resistance is acquired through modifications in the structure of penicillin-binding proteins. Recommendations to control S. suis infection include focused and careful choice and appropriate use of antimicrobials, together with preventive measures intended to improve swine management.
... This serotype is also recognized as a zoonotic agent since it has been identified as a cause of meningitis (2,27), septicemia (15), and endocarditis (31,49) in humans, particularly those occupationally exposed to pigs or pig products (2,6,31). Human survivors of S. suis infection often suffer sequelae such as arthritis or deafness (53). ...
Streptococcus suis serotype 2 is a worldwide causative agent of many forms of swine infection and is also recognized as a zoonotic agent causing
human disease, including meningitis. The pathogenesis of S. suis infections is poorly understood. Bacteria circulate in the bloodstream in the nonimmune host until they come in contact with
brain microvascular endothelial cells (BMEC) forming the blood-brain barrier. The bacterial polysaccharide capsule confers
antiphagocytic properties. It is known that group B streptococci (GBS) invade and damage BMEC, which may be a primary step
in the pathogenesis of neonatal meningitis. Interactions betweenS. suis and human endothelial cells were studied to determine if they differ from those between GBS and endothelial cells. Invasion
assays performed with BMEC and human umbilical vein endothelial cells demonstrated that unlike GBS, S. suisserotype 2 could not invade either type of cell. Adherence assays showed that S. suis adhered only to BMEC, whereas GBS adhered to both types of cell. These interactions were not affected by the presence of
a capsule, since acapsular mutants from both bacterial species adhered similarly compared to the wild-type strains. Lactate
dehydrogenase release measurements indicated that some S. suis strains were highly cytotoxic for BMEC, even more than GBS, whereas others were not toxic at all. Cell damage was related
to suilysin (S. suis hemolysin) production, since only suilysin-producing strains were cytotoxic and cytotoxicity could be inhibited by cholesterol
and antisuilysin antibodies. It is possible that hemolysin-positive S. suis strains use adherence and suilysin-induced BMEC injury, as opposed to direct cellular invasion, to proceed from the circulation
to the central nervous system.
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.
Introduction: Hemorrhagic diatheses in pigs may be due to non-infectious and infectious agents, such as Streptococcus suis type II. This bacterium causes meningitides and arthritides in weaned pigs and has zoonotic potential. Porcine circovirus type 2 (PCV-2) is known to be the aetiologic agent of several syndromes, such as postweaning multisystemic wasting syndrome (PMWS) and porcine dermatitis and nephropathy syndrome (PDNS). Co-infections of PCV-2 and bacteria are known to be diagnosed quite often, but the clinical picture of a hemorrhagic diathesis based upon a dual-infection with these two pathogens is not a common one. Case description: A 12-weeks old female pig displayed depressed behaviour, acute petechial bleedings of the skin, and lost blood out of vulva and rectum. The other pigs, which were held together with the sick one, were clinically normal. Gross-pathology showed multiple petechial bleedings of the skin, the parenchymal organs, the serous membranes, and in the musculature. Hematological examination exhibited a mild anemia and a moderate leukocytosis. Serological and molecular-biological analyses excluded classical swine fever, but revealed PCV-2-specific sequences in blood serum and a septicemia caused by Streptococcus suis type II, a bacterium, which has zoonotic potential. Conclusion: In a single pig clinical signs typical of classical swine fever were shown to be due to a co-infection with Streptococcus suis type II and PCV-2.
Streptococcus suis is of importance as causative agent of zoonosis, particulary in humans handling pigs or pig products. The typical clinical manifestation appears as a septic meningitis, often with deafness or hearing loss. Rarely, bacteremia without participation of the meninges or cases of endocarditis are described. S. suis can be identified by cultural, biochemical and serological criteria.
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.
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.
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.
Very few
Streptococcus suis
infections in humans have been reported in Canada, although the condition is frequent in pigs. Meningitis, often accompanied by severe hearing loss, is the most common clinical manifestation. The disease is an occupational illness affecting persons in contact with pigs and may be underdiagnosed because of misidentification of the responsible bacterium. Since Quebec is the leading province for swine production in Canada, physicians and microbiologists should be aware of this infection, especially when a streptococcal meningitis is diagnosed in swine workers. The first case of
S suis
type 2 meningitis reported in Quebec is described.
Streptococcus suis is a major porcine pathogen, causing economical health worldwide problems in the global swine industry. It is also emerging as a zoonotic agent capable of causing severe invasive disease in humans exposed to pigs or pork products. The most important clinical sign in swine and human is meningitis, but other pathological conditions have also been described. Serotype 2 is the most commonly associated with diseases in pigs and humans, and also the most frequently reported serotype isolated from diseased animals worldwide. The majority of human infection occurs in pork handlers, particularly in slaughterhouse workers and by minor wounds or skin abrasions contaminated by raw pork or viscera of pigs. Veterinarians should also be aware that a low but real risk may be present when manipulating S. suis-diseased animals that are probably shedding high numbers of this pathogen. Up today, in Greece there is no published epidemiological data for S. suis serotypes in swine herds and the zoonotic risk of S. suis infection in human with daily contact with pigs and pork meat. However, in our experience clinical forms of S. suis infection are common in most greek swine farms. The aim of this review study is to perform recent information about S. suis infection in swine and human, focus on zoonotic risk of this emerging pathogen and prevention strategies.
Infections caused by Streptococcus suis are considered a global and an economical problem in the swine industry. Moreover, S. suis is an agent of zoonosis that afflicts people in close contact with infected pigs or pork-derived products. Although sporadic cases of S. suis infections in humans (mainly meningitis) have been reported during the last 40 years, a large outbreak due to this pathogen emerged in the summer of 2005 in China. The severity of the infection in humans during the outbreak, such as a shorter incubation time, more rapid disease progression and higher rate of mortality, attracted a lot of attention from the scientific community and the general press. In fact, the number of publications on S. suis (including the number of reported human cases) has significantly increased during recent years. In this article we critically review the present knowledge on S. suis infection in humans, we discuss the hypotheses that may explain the 2005 outbreak and the repercussion of such an episode on the scientific community.
Streptococcus suis infection is acquired through exposure to contaminated pigs or pig meat. Over the past few years, the number of reported
S. suis infections in humans has increased significantly, with most cases originating in Southeast Asia, where there is a high density
of pigs. Increased awareness, improved diagnostics, and the occurrence of outbreaks have contributed to this increase. Meningitis
and sepsis are the most common clinical manifestations of S. suis infection; hearing loss is a frequent complication. In this article, we provide an overview of the emergence and clinical
manifestations of S. suis infection.
A 54-year-old huntsman who 3 days previously had shot a wild pig, developed severe headache, nausea and vomiting over the last 10 hours. Physical examination was unremarkable except for an 8 x 4 cm large reddening of the skin over the right tibia and fever (38.2 degrees C).
Cranial computed tomography was normal. Cerebrospinal fluid showed pleocytosis (5.200 cells/mm3). Gram-stained (CSF) smear showed gram-positive cocci and an increased white cell count (14,000/microliters) was found in blood.
After the diagnosis of bacterial meningitis had been made antibiotics were given intravenously (penicillin G 10 mill. IU, three times daily on days 1 to 16: at first with cefotaxim, three times daily 2 g on days 1 to 3, then with gentamicin twice 80 mg on days 3 to 13). The acute neurological signs quickly regressed, the pretibial reddening (presumably at the port of entry) disappeared, as did the fever on the 4th day of the illness. The streptococci isolated from CSF and blood were identified as 5. suis type 2 (Lancefield group R). But despite the early and effective antibiotic treatment cochleovestibular symptoms (hearing impairment, vertigo and unsteady gait) set in after initial improvement, a frequent complication of S. suis meningitis.
S. suis should be considered as the causative organism of generalized septicaemia and meningitis in adults, if the history reveals contact with domestic or wild pigs and there are early cochleovestibular signs.
A simple flow cytometric method was used to study simultaneously the phagocytosis of Streptococcus suis serotype 2 by polymorphonuclear and mononuclear blood leukocytes from swine and humans. Using this method with a bacteria-to-leukocytes ratio of 10:1 and after 60 min of incubation, 80.2 +/- 2.8% of swine granulocytes and 77.0 +/- 2.8% of swine monocytes were shown to contain FITC-labelled S. suis serotype 2 strain 735. Using the same strain, FITC-labelled bacteria were found in 95.5 +/- 3.2% of human granulocytes and in 92.8 +/- 3.6% of human monocytes. The phagocytosis rates of avirulent and virulent strains of S. suis were not significantly different.
A secreted nuclease, SsnA, was identified in the virulent Streptococcus suis isolate SX332 and subsequently in each of the type strains of capsular serotypes 1 through 9. Screening of 258 porcine clinical
isolates from surface (nasal mucosa or palatine tonsil) or internal (joint, brain or other internal organ) locations revealed
a significant relationship (P < 0.001) between expression of nuclease and isolation from an internal site. A 3,126-bp gene, ssnA, was identified from a phenotypically nuclease-negative pGh9:ISS1 insertion mutant, and analysis of the predicted SsnA sequence revealed a 35-amino-acid (aa) secretion signal sequence, a
22-aa DNA-binding domain, and a typical gram-positive cell wall sorting motif. A requirement of Ca2+ and Mg2+ for SsnA activity was determined, and the substrate specificity was found to be for single- and double-stranded linear DNA.
Reverse transcription-PCR experiments revealed that ssnA is expressed throughout all stages of S. suis growth, and Western blots with porcine anti-S. suis immune sera against a recombinant, truncated SsnA derivative (rSsnAΔ) confirmed that SsnA is expressed in vivo. Furthermore, anti-rSsnAΔ antibodies were sufficient to neutralize SsnA activity. Analyses of subcellular fractions of SX332 and derived mutants, on
DNA-containing polyacrylamide gels and by Western blotting, suggest that SsnA is cell wall located.
Seven cases of Streptococcus suis infection in Japan during 1994 and 2006 were summarized. All cases had porcine exposure and five of them had hand skin injury during the exposure. Five cases presented symptoms of meningitis, three presented symptoms of sepsis, and one resulted in sudden death. All of the isolated S. suis belonged to Lancefield's group D and to serotype 2. They were susceptible to penicillin G, ampicillin, cefotaxime, and ciprofloxacin. However, six of them were resistant to both erythromycin and clindamycin, and four were also resistant to minocycline. Multilocus sequence typing of six isolates showed that they belonged to sequence type (ST) 1, and their pulsed-field gel electrophoresis (PFGE) patterns were similar. The remaining isolate was ST28 and its PFGE pattern was distinct from those of the others.
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