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Volume 22, Number 8—August 2016
Letter

Fatal Septic Meningitis in Child Caused by Streptococcus suis Serotype 24

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To the Editor: Streptococcus suis is a zoonotic bacterium that causes invasive infections in humans and pigs (1). Of the 29 described serotypes, serotype 2 is the most prevalent in humans, almost exclusively affecting adults (1). Other serotypes occurring sporadically in humans have been reported (1). Here we report a rare case of S. suis serotype 24 infection in a child.

A 2-year-old girl with Down syndrome was admitted to a hospital in Rayong Province, eastern Thailand, in May 2015. She had a high fever of 3 days’ duration, vomiting, stiff neck, rash, and purpura on her right leg and hip. The initial diagnosis was cellulitis and suspected meningococcal meningitis. Physical examination revealed a temperature of 39.5°C, pulse rate of 160 beats/min, respiratory rate of 80 breaths/min, and blood pressure of 94/55 mm Hg. Oxygen saturation was 80%, which is indicative of severe respiratory failure. An analysis of the complete blood count showed a leukocyte count of 21,460 cells/mL (83% neutrophils, 13% lymphocytes, 1% eosinophils, 3% monocytes) and platelet count of 155,000 cells/μL. A comprehensive metabolic panel test was not performed.

Bacteria were isolated from the patient's cerebrospinal fluid culture; however, hemoculture did not show any growth. Traditional biochemical tests and an API20Strep system assay (BioMérieux, Marcy l’Etoile, France) suggested that the organism was S. suis. The samples tested positive for S. suis serotype 24 by multiplex PCR and coagglutination testing (2,3). On the basis of these results, the condition was diagnosed as septic meningitis. Unfortunately, the patient died the day after admission, even though she had been treated with ceftriaxone on the day of admission.

The isolate from the child was susceptible to penicillin (MIC <0.12 μg/mL), ceftriaxone (MIC <1 μg/mL), erythromycin (MIC <0.25 μg/mL), levofloxacin (MIC <2.0 μg/mL), clindamycin (MIC <0.25 μg/mL), and vancomycin (MIC <1.0 μg/mL). Because breakpoints for S. suis are not defined in the 2015 Clinical and Laboratory Standards Institute guidelines, breakpoints for viridans streptococci were used instead (4). Multilocus sequence typing determined that the isolate was sequence type 221, which belongs to clonal complex (CC) 221/234. The previously described virulence markers (epf, mrp, and sly genes) were absent (1). These markers are mostly present in serotype 2 strains from Europe and Asia (1). We have shown that CC221/234 is a newly emerging, human infectious clone that includes serotypes 24 and 31, but not serotype 2, strains (5,6). Therefore, the presence of this CC should be monitored, and characterization of virulence factors of strains belonging to this CC should be further investigated.

The routes of S. suis infection include occupational exposure, recent contact with pigs or raw pork products, and recent consumption of raw pork products (1). This patient had no history of contact with pigs or pork products nor consumption of raw pig’s blood soup or any other source of undercooked meals before the onset of illness. S. suis may affect various other animal species (7), but the patient did not have any close contact with other animal species. Close family members of the patient did not report having consumed raw pork products, although they did report having close contact with pork meat for cooking. However, so far, no human cases have been confirmed to be the consequence of close contact with or consumption of undercooked meat from animal species other than pigs. In addition, human-to-human transmission of S. suis has not been reported (8). As reported in other similar cases, the route of the infection could not be confirmed in this case. A previous case of S. suis infection in a child was reported in a 1-month-old girl with meningitis in Thailand; however, certain details of that case, including the causative bacterial serotype, were not reported (Table) (9).

Although the isolation rate for S. suis serotype 24 strains remains low, increased awareness among clinicians treating patients with predisposing conditions is required given the emergence of S. suis infections caused by uncommon serotypes. Such awareness will be important for development of enhanced surveillance, epidemiologic control, and prevention strategies for public health.

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Acknowledgment

This work was supported by research grants from the Ministry of Health, Labor, and Welfare of Japan; the Japan Initiative for a Global Research Network on Infectious Diseases, which was launched by the Ministry of Education, Science, and Culture, Japan; and the Natural Sciences and Engineering Research Council of Canada (grant no. 04435).

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Anusak KerdsinComments to Author , Marcelo Gottschalk, Rujirat Hatrongjit, Shigeyuki Hamada, Yukihiro Akeda, and Kazunori OishiComments to Author 

Author affiliations: Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, Thailand (A. Kerdsin, R. Hatrongjit); University of Montreal, Montreal, Quebec, Canada (M. Gottschalk); Osaka University, Osaka, Japan (S. Hamada, Y. Akeda); National Institute of Infectious Diseases, Tokyo, Japan (K. Oishi)

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References

  1. Goyette-Desjardins  G, Auger  JP, Xu  J, Segura  M, Gottschalk  M. Streptococcus suis, an important pig pathogen and emerging zoonotic agent-an update on the worldwide distribution based on serotyping and sequence typing. Emerg Microbes Infect. 2014;3:e45. DOIPubMed
  2. Kerdsin  A, Akeda  Y, Hatrongjit  R, Detchawna  U, Sekizaki  T, Hamada  S, Streptococcus suis serotyping by a new multiplex PCR. J Med Microbiol. 2014;63:82430. DOIPubMed
  3. Gottschalk  M, Higgins  R, Boudreau  M. Use of polyvalent coagglutination reagents for serotyping of Streptococcus suis. J Clin Microbiol. 1993;31:21924.PubMed
  4. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, 25th informational supplement (M100-S25). Wayne (PA): Institute; 2015. p. 94–6.
  5. Hatrongjit  R, Kerdsin  A, Gottschalk  M, Takeuchi  D, Hamada  S, Oishi  K, First human case report of sepsis due to infection with Streptococcus suis serotype 31 in Thailand. BMC Infect Dis. 2015;15:392. DOIPubMed
  6. Kerdsin  A, Dejsirilert  S, Sawanpanyalert  P, Boonnark  A, Noithachang  W, Sriyakum  D, Sepsis and spontaneous bacterial peritonitis in Thailand. Lancet. 2011;378:960. DOIPubMed
  7. Gottschalk  M, Xu  J, Calzas  C, Segura  M. Streptococcus suis: a new emerging or an old neglected zoonotic pathogen? Future Microbiol. 2010;5:37191. DOIPubMed
  8. Yu  H, Jing  H, Chen  Z, Zheng  H, Zhu  X, Wang  H, Streptococcus suis study groups. Human Streptococcus suis outbreak, Sichuan, China. Emerg Infect Dis. 2006;12:91420. DOIPubMed
  9. Vilaichone  RK, Vilaichone  W, Nunthapisud  P, Wilde  H. Streptococcus suis infection in Thailand. J Med Assoc Thai. 2002;85(Suppl 1):S10917.PubMed

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Cite This Article

DOI: 10.3201/eid2208.160452

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Table of Contents – Volume 22, Number 8—August 2016

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Anusak Kerdsin, Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon 47000, Thailand; ; and Kazunori Oishi, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjyuku, Tokyo, Japan

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Page created: July 15, 2016
Page updated: July 15, 2016
Page reviewed: July 15, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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