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Volume 19, Number 9—September 2013

Letter

Streptococcus suis Meningitis and Bacteremia in Man, French Guiana

Suggested citation for this article

To the Editor: Streptococcus suis is a major swine pathogen and is increasingly recognized as the cause of an emerging zoonosis in humans. It is responsible for severe systemic infections, most commonly meningitis and sepsis, which lead to high rates of illness and death. Serotype 2 is considered to be the strain most pathogenic for humans and pigs (1,2).

The first reported infection in a human was in Denmark (3), but human infections have been now described worldwide, with a predominance in countries in Southeast Asia (1,2,4). However, only 2 cases of human infection have been described in South America, in Argentina in 2005 (5) and 2008 (6). One infection was related to a serotype 2 strain (5). We report a human case of S. suis infection with meningitis and bacteremia in an immunocompetent patient living in French Guiana.

In August 2011, a 42-year-old Haitian man was admitted to Cayenne Hospital (Cayenne, French Guiana) because of a 3-day history of fever, headache, vertigo, and vomiting. He was an unemployed illegal immigrant who had lived in French Guiana for 4 years. He had no particular medical history and no risk factors for immunodeficiency. At admission, he was lethargic, weak, and frail. He had a stiff neck, vestibular dysfunction, ataxia, and nystagmus. He did not have hearing loss or skin abnormalities. Cranial computed tomography with contrast and gadolinium-enhanced cranial magnetic resonance imaging did not show any abnormal findings.

Blood tests indicated thrombocytopenia (106 × 109 platelets/L), lymphopenia (0.57 ×109 lymphocytes/L), a high level of C-reactive protein (170 mg/L) and mild cytolysis (3.8-fold increase in aspartate aminotransferase and 2.5-fold increase in alanine aminotransferase levels). There was no hyperleukocytosis (leukocyte count 7.7 × 109 cells/L). Cerebrospinal fluid (CSF) was slightly opalescent and had a protein level of 1.16 g/L, a glucose level of 2.2 mmol/L, and 270 leukocytes/μL (79% neutrophils and 21% lymphocytes). Gram staining of CSF showed numerous gram-positive cocci in pairs and short chains.

CSF and blood cultures after 12 and 48 hours, respectively, of incubation showed numerous alpha-hemolytic colonies on blood and chocolate agar. The bacteria were gram positive, optochin resistant, and catalase negative, and were reliably identified by using API 20 Strep (bioMérieux, Marcy l’Etoile, France) as S. suis (probability 99.7%).

Antimicrobial drug susceptibility tests were conducted by using Mueller-Hinton agar and the disk diffusion method. An E-test was performed for ampicillin (MIC<0.016 μg/mL). The isolate was resistant to gentamicin (500 μg/L), tetracycline, and norfloxacin, and sensitive to penicillin, ampicillin, amoxicillin, oxacillin, cefotaxim, pristinamycin, vancomycin, teicoplanin, trimethoprim/sulfamethoxazole, erythromycin, and lincomycin in comparison with published data (7). Slide agglutination with type-specific hyperimmune serum and specific multiplex PCR (8,9) identified the isolate as serotype 2. Multilocus sequence typing identified the isolate as a member of the sequence type 1 complex, which has spread throughout most countries in Europe. This complex has been strongly associated with isolates from patients with septicemia, meningitis, and arthritis (10).

After S. suis was identified, the patient reported contact with swine and that he had slaughtered 4 pigs 24 hours before onset of symptoms. During this activity, he injured his left thumb. The patient was empirically given a 2-day course of intravenous, high-dose ceftriaxone (3 g, 2×/d), which was replaced by intravenous high-dose amoxicillin (3g, 4×/d) for 14 days.

While the patient was receiving treatment for 2 days, moderate bilateral hypoacousia developed, which required adjunctive corticoid therapy. The hypoacousia developed into severe hearing loss in the left ear. Audiograms showed moderate sensorial hearing loss (50 dB) in the right ear on day 7 of treatment, which resolved 1.5 years later, and complete hearing loss in the left ear on day 7 of treatment, which that gradually decreased. However, the patient still has severe sensorinoral hearing loss (80 dB) in the left ear. The patient did not have signs or symptoms of endocarditis by cardiac ultrasonography.

Little data are available for circulation and epidemiology of S. suis in South America (3). We report a human case of S. suis infection with meningitis and bacteremia. Clinical and laboratory data, microbiological findings, and outcome for this case-patient were similar to those of the 2 case-patients reported in Asia (1,2).

Our study shows that in nonendemic areas, infection with this pathogen, although not frequently reported, should be considered when diagnoses are made for patients who work in piggeries. Persons with occupational exposure to swine or pork products should be educated and made aware of this risk for infection.

Magalie DemarComments to Author , Carine Belzunce, Christine Simonnet, Alain Renaux, Philippe Abboud, Antoine Okandze, Corrine Marois-Créhan, and Felix Djossou
Author affiliations: Centre Hospitalier de Cayenne, Cayenne, French Guiana (M. Demar, C. Belzunce, C. Simonnet, A. Renaux, P. Abboud, A. Okandze, F. Djossou); Agence Nationale de Sécurité Sanitaire, Ploufragan, France (C. Marois-Créhan)

References

  1. Wertheim HF, Nghia HD, Taylor W, Schultsz C. Streptococcus suis: an emerging human pathogen. Clin Infect Dis. 2009;48:61725. DOIPubMed
  2. Lun ZR, Wang QP, Chen XG, Li AX, Zhu XQ. Streptococcus suis: an emerging zoonotic pathogen. Lancet Infect Dis. 2007;7:2019. DOIPubMed
  3. Perch B, Kristjansen P, Skadhauge K. Group R streptococci pathogenic for man: two cases of meningitis and one fatal case of sepsis. Acta Pathol Microbiol Scand. 1968;74:6976. DOIPubMed
  4. Mai NT, Hoa NT, Nga TV. Linh le D, Chau TT, Sinh DX, et al. Streptococcus suis meningitis in adults in Vietnam. Clin Infect Dis. 2008;46:659–67.
  5. Lopreto C, Lopardo HA, Bardi MC, Gottschalk M. Primary Streptococcus suis meningitis: first case in humans described in Latin America [in Spanish]. Enferm Infecc Microbiol Clin. 2005;23:110. DOIPubMed
  6. Nagel A, Manias V, Busquets N, Sniadowsky S, Anzardi J, Méndez Ede L. Streptococcus suis meningitis in an immunocompetent patient [in Spanish]. Rev Argent Microbiol. 2008;40:15860 .PubMed
  7. Manzin A, Palmieri C, Serra C, Saddi B, Princivalli MS, Loi G, Streptococcus suis meningitis without history of animal contact, Italy. Emerg Infect Dis. 2008;14:19468. DOIPubMed
  8. Gottschalk M, Higgins R, Jacques M, Mittal KR, Henrichsen J. Description of 14 new capsular types of Streptococcus suis. J Clin Microbiol. 1989;27:26336 .PubMed
  9. Marois C, Bougeard S, Gottschalk M, Kobisch M. Multiplex PCR assay for detection of Streptococcus suis species and serotypes 2 and 1/2 in tonsils of live and dead pigs. J Clin Microbiol. 2004;42:316975. DOIPubMed
  10. King SJ, Leigh JA, Heath PJ, Luque I, Tarradas C, Dowson CG, Development of a multilocus sequence typing scheme for the pig pathogen Streptococcus suis: identification of virulent clones and potential capsular serotype exchange. J Clin Microbiol. 2002;40:367180. DOIPubMed

Suggested citation for this article: Demar M, Belzunce C, Simonnet C, Renaux A, Abboud P, Okandze A, et al. Streptococcus suis meningitis and bacteremia in man, French Guiana [letter]. Emerg Infect Dis [Internet]. 2013 Sep [date cited]. http://dx.doi.org/10.3201/eid1909.121872

DOI: 10.3201/eid1909.121872

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Table of Contents – Volume 19, Number 9—September 2013

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Magalie Demar, Unit of Infectious and Tropical Diseases, Cayenne Hospital, Avenue des Flamboyants, Cayenne BP 6006.97300, French Guiana


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