Meningitis e hipoacusia por manipulación de carne porcina / Meningitis and hypoacusia due to swine meat handling

Resumen En Chile se han descrito ocasionalmente casos de meningitis zoonótica por Streptococcus suis ligados a criaderos de cerdos en el sur del país. Presentamos el caso de una mujer que desarrolló un cuadro de meningitis aguda bacteriana por este agente dos días después de manipular un cerdo faenado. No tenía crianza de cerdos ni visitaba granjas de animales. El diagnóstico fue establecido por el cultivo del LCR. Desarrolló una hipoacusia profunda que no mejoró a pesar del uso de corticoesteroides ni tratamiento antimicrobiano, sin otras complicaciones. La meningitis por S. suis es una condición emergente y ligada a porcinos en diferentes formas. La hipoacusia es una complicación frecuente con este agente.

Zoonotic meningitis by Streptococcus suis has been described occasionally in Chile and linked to pig farmers in the south of the country. We report a female case that developed acute bacterial meningitis by this agent, two days after handling a piece of raw swine meat. She did not participate on swine breeding nor visited farms. Diagnosis was obtained by CSF culture. A severe hearing loss and not recovered despite corticosteroids use and antimicrobial treatment, without others complications. Meningitis by S. suis is emerging as a new pathogen and linked to swine in different forms. Hypoacusis happens frequently with this agent.

Pericardite em suínos ao abate no Rio Grande Sul: avaliação de agentes bacterianos e lesões associadas / Bacterial agents and lesions associated with pericarditis in slaughter pigs in Rio Grande do Sul, Brazil

O objetivo do presente estudo foi identificar a frequência de lesões macroscópicas e microscópicas e dos agentes bacterianos envolvidos em pericardites em suínos no abate no Estado do Rio Grande do Sul. As amostras foram coletadas em frigoríficos de suínos com Serviço de Inspeção Federal (SIF) entre fevereiro a outubro de 2010 e a condenação por pericardite dos animais acompanhados foi de 3,9 por cento(299/7.571). No total foram investigados 91 casos de pericardites, 89% deles foram classificados como crônicos por histopatologia e pleurite crônica foi observada em 47 porcento dos pulmões correspondentes, todavia não houve associação significativa entre as duas lesões. Os agentes bacterianos isolados a partir dos corações foram Streptococcus spp., Pasteurella multocida, Haemophilus parasuis e Streptococcus suis. DNA bacterianos mais detectados pela PCR foram de Mycoplasma hyopneumoniae e Actinobacillus pleuropneumoniae. Houve associação significativa entre isolamento de P. multocida e Streptococcus sp. nos corações e pulmões correspondentes. Esses resultados sugerem que a infecção no pulmão possa ter servido de porta de entrada para a colonização do pericárdio adjacente. Apesar de M. hyopneumoniae ter sido o agente detectado com maior frequência pela PCR em corações e pulmões correspondentes, não houve associação significativa da detecção dos agentes nos órgãos. Isto sugere que as infecções foram eventos independentes. Os demais agentes investigados não apresentaram associação significativa entre isolamento ou detecção de DNA em coração e pulmão correspondente. Outro achado importante foi a presença de coinfecções bacterianas em 2 por cento dos corações e por PCR foi detectado DNA bacteriano de dois ou mais agentes em 16,5 por cento dos corações. Esses resultados sugerem que as coinfecções em pericardites precisam ser melhor estudadas.

The objective of the study was to identify the frequency of macroscopic and microscopic lesions and bacterial agents involved with pericarditis in slaughter pigs in the State of Rio Grande do Sul, Brazil. The samples were collected in slaughterhouses with Federal Inspection Service (SIF) between February and October, 2010. Condemnation due to pericarditis in the examined animals was 3.9 percent (299/7,571). Ninety one cases of pericarditis were examined and by histopathology 89% were chronic and 47 percent of the corresponding lungs showed chronic pleuritis, but there was no significant association between both lesions. The bacterial agents isolated from the hearts were Streptococcus spp., Pasteurella multocida, Haemophilus parasuis and Streptococcus suis. Bacterial DNA from Mycoplasma hyopneumoniae and Actinobacillus pleuropneumoniae were the most frequently detected by PCR. There was significant association between isolation of P. multocida and Streptococcus spp. in the hearts and corresponding lungs. The results suggest that lung infection could act as a port of entry to the colonization of the adjacent pericardium. In spite of the fact that M. hyopneumoniae was the agent more frequently identified by PCR in the heart and corresponding lung, there was no significant association of the agent in the organs. This suggests that the infections were independent events. The other agents investigated did not show significant association between isolation or DNA detection in heart and corresponding lungs. Another important finding was the presence of coinfection between bacterial agents in 2 percent of the hearts and by PCR were identified bacterial DNA of two or more agents in 16.5 percent of the hearts. These results suggest that coinfections in cases of pericarditis need further investigation.

Primer caso de meningitis por Streptococcus suis en el noroeste de Argentina / First case of meningitis by Streptococcus suis in the norwest area of Argentina

Streptococcus suis causes meningitis, bacteremia, endocarditis, endophthalmitis, artrithis and toxic shock in both pigs and human beings. The incidence of this pathogen is increasing worldwide. A case of 54 years old men from a rural zone of Tucumán, Argentina with two days of headache, vomit and photophobia was admitted septic, with purulent meningitis. Streptococcus suis was growth from the blood and cerebrospinal fluid culture. The patient was treated with ceftriaxona and had a good evolution without sequels. This is the first case of S. suis described in the northwest of Argentina and the third of Latin America, and it is emphasized that the occupational contact with pigs is an important background for the initial suspect of this pathogen.

La infección por Streptococcus suis puede causar meningitis, bacteriemia, endocarditis, endoftalmitis, artritis y shock tóxico, tanto en el ser humano como en cerdos. La incidencia de esta zoonosis está aumentando en el mundo. Se presenta el caso de un varón de 54 años de edad, trabajador rural proveniente de la provincia de Tucumán, Argentina, que consultó por cefalea, vómitos y fotofobia de dos días de evolución, constatándose una sepsis de foco meníngeo. Tanto en el cultivo de líquido cefalorraquídeo como en el hemocultivo se aisló S. suis. Se trató con ceftriaxona con buena evolución y sin secuelas. Es el primer caso de S. suis en el noroeste argentino y el tercero en Latinoamérica. Se resalta la importancia del antecedente de exposición laboral a cerdos para la sospecha inicial de este microorganismo.

Meningitis bacteriana aguda por Streptococcus suis en criadores de cerdos: comunicación de los primeros dos casos en Chile / Streptococcus suis meningitis in pig farmers: report of first two cases in Chile

Human infection by Streptococcus suis is a zoonosis with a known occupational risk. Meningitis is its most frequent clinical manifestation. We present the first two cases in Chile. First case: 54-year-old female patient, pig-farmer. She presented headache, vomiting, confusion and meningismus. She presented septic shock. Second case: 48-year-old male patient, also pig farmer, presented headache, vomiting and meningismus. A Gram's staining of cerebrospinal fluid (CSF) showed gram-positive cocci in both cases. Ceftriaxone and dexamethasone treatment was administered. The CSF cultures were positive for Streptococcus suis serotype 2. The patients experienced a good outcome, without neurological sequelae at the time of discharge. It is considerable to evaluate epidemiologic factors in order to suspect this etiological agent in cases of meningitis. These cases enhance the need of heighten awareness of potential for occupational exposure and infection by this emerging human pathogen. Educating population at risk about simple preventive measures must be considered.

La infección humana por Streptococcus suis es una zoonosis con riesgo ocupacional conocido, siendo la meningitis aguda su manifestación clínica más frecuente. Se presentan los dos primeros casos en Chile. Primer caso: Mujer de 54 años con un cuadro de cefalea y vómitos, confusión y signos meníngeos. Evolucionó con un shock séptico. Segundo caso: Varón de 48 años, refirió cefalea y vómitos. Presentó signos meníngeos al examen físico. En ambos casos en la tinción de Gram de líquido cefalorraquídeo (LCR) se observaron cocáceas grampositivas. Fueron tratados con ceftriaxona y dexametasona. El cultivo de LCR fue positivo en ambos casos para S. suis serotipo 2. En los dos pacientes la evolución clínica fue favorable, sin alteraciones neurológicas al alta. En ambos casos se obtuvo en forma retrospectiva el antecedente de realizar labores de crianza de ganado porcino. Se destaca la importancia de investigar los antecedentes epidemiológicos para sospechar este agente etiológico en meningitis aguda. Se debe considerar el riesgo ocupacional en una posible infección por este patógeno humano emergente y educar a la población en riesgo sobre medidas preventivas simples.

In vitro biofilm forming potential of Streptococcus suis isolated from human and swine in China

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.

Postantibiotic effects and postantibiotic sub-MIC effects of tilmicosin, erythromycin and tiamulin on erythromycin-resistant Streptococcus suis

The postantibiotic effects (PAEs) and postantibiotic sub-MIC effects (PA SMEs) of tilmicosin, erythromycin and tiamulin on erythromycin-susceptible and erythromycin-resistant strains of Streptococcus suis (M phenotype) were investigated in vitro. Tilmicosin and tiamulin induced significantly longer PAE and PA SME against both erythromycin-susceptible and erythromycin-resistant strains than did erythromycin. The durations of PAE and PA SMEs were proportional to the concentrations of drugs used for exposure. The PA SMEs were substantially longer than PAEs on S. suis (P<0.05) regardless of the antimicrobial used for exposure. The results indicated that the PAE and PA SME could help in the design of efficient control strategies for infection especially caused by erythromycin-resistant S. suis and that they may provide additional valuable information for the rational drug use in clinical practice.

Infecção por Streptococcus suis: Uma revisão / Infección por Streptococcus suis: Una revisión / Infections caused by Streptococcus suis: A review

O Streptococcus suis é um importante microrganismo na suinocultura, que desencadeia meningites, septicemias, polisorites, artrites, endocardites, pneumonia, e morte súbita. Até o momento, já foram identificados 35 sorotipos, sendo o sorotipo II considerado o mais violento, geralmente associado aos fenótipos MRP + EF + e MRP + EF Foram estudadas, na região de Botucatu, 331 amostras pertencentes a nove propriedades quando foram isolados 34 cepas de S. suis tipo II. Este mesmo sorotipo foi detectado em granjas de SP, MG e PR. A virulência está correlacionada aos genes codificadores de EF, MRP e suilisina, sendo estes confirmados através da PCR. Com auxílio de estudos epidemiológicos em sete estados brasileiros (MG, PR, SP, RS, MS, SC e PE), foi constatado que a idade de maior ocorrência é no período de creche. Estudos na região de Minas Gerais, avaliaram a eficácia de uma bacterina autógena contra o S. suis tipo II, por via intravenosa, a qual mostrou-se efetiva. Porém, o mesmo não aconteceu quando testada por via intraperitoneal. Esta enfermidade em suínos é de extrema importância, pois os prejuízos causados em granjas são grandes, afetando principalmente o estado de SP e MG.No entanto, em muitas regiões não há dados relacionados ao isolamento ou diagnóstico da enfermidade, os quais poderiam auxiliar na detecção de áreas endêmicas.

Streptococcus suis is an important microorganism in pig production which unleashes meningitis, septicemias,arthritis, endocarditis, pneumonia, and sudden cardiac death. Swine diseases are extremely important as the losses caused in swine farms are considerable, mainly striking the states of São Paulo and Minas Gerais. However, in several regions there are no data related to the isolation and diagnosis of the disease which could aid detecting endemic areas. So far, 35 serum types were identified and serum type II was considered the most virulent, usually associated to the phenotypes MRP+ EF+ and MRP+ EF. The zoonotic character of the disease makes this agent extremely import since a number of infection in humans caused by S. suis type II, mainly in Europe, have been reported. As the majority of people affected were related to pig production, such as swine growers, rural workers, butchers, and veterinaries, this disease is considered to be occupational-related. Thus, this paper has the purpose of characterizing the agent, elucidating the clinical signs and the risks of contamination.

El Streptococcus suis es un importante microorganismo en la porcicultura, que desencadena meningitis, septicemias, polisorites, artritis, endocarditis, pulmonía y muerte súbita. Hasta el momento, ya fueron identificados 35 serotipos, siendo el serotipo II considerado el más violento, generalmente asociado a los fenotipos MRP + EF + eMRP + EF. Fueron estudiadas en la región de Botucatú, 331 muestras pertenecientes a nueve propiedades cuando fueron aisladas 34 cepas de S. suis tipo II. Este mismo serotipo fue detectado en granjas de SP, MG y PR. La virulencia está correlacionada a genes codificadores de EF, MRP y suilisina, siendo estos confirmados a través de la PCR. Con auxilio de estudios epidemiológicos en siete estados brasileños (MG, PR, SP, RS, MS, SC y PE), fue constatado que la edad de mayor ocurrencia es en el período de guardería. Estudios en la región de Minas Gerais, con el objetivo de evaluar la eficacia de una bacteria autógena contra el S. suis tipo II, por vía intravenosa, la cual se mostró efectiva. Sin embargo, el mismo no sucedió cuando testada por vía intraperitoneal. Esta enfermedad en porcinos es de extrema importancia, pues los perjuicios causados en granjas son grandes, afectando principalmente el estado de SP y MG. Sin embargo, en muchas regiones no hay datos relacionados al aislamiento o diagnóstico de la enfermedad, los cuales podrían ayudar en la detección de áreas endémicas.

Swine infection by Streptococcus suis: a retrospective study / Infecção em suínos por Streptococcus suis: estudo retrospectivo

The epidemic aspects of swine infections caused by Streptococcus suis were studied, focusing mainly on the occurrence of several serotypes. A total of 323 samples of S. suis were isolated from clinically ill animals, serotyped according to the co-agglutination procedure, and analyzed. The serotyping revealed that S. suis was present in several Brazilian states. The largest number was isolated from the states of Minas Gerais (62.5 percent), São Paulo (10.8 percent), and Paraná (9.3 percent). Serotype 2 was the most frequent (61.0 percent), followed by the serotypes 1, 3, 4, 7, and 8. The largest number of isolations was obtained from the brain (60.1 percent), followed by the lungs (10.4 percent). About 9.4 percent of the cases were due to septicemia.

Estudaram-se os aspectos epidêmicos das infecções de suínos causadas por Streptococcus suis, enfocando, principalmente, a ocorrência de diferentes sorotipos. Foram analisadas 323 amostras isoladas de animais clinicamente doentes, as quais foram sorotipadas de acordo com o procedimento de co-aglutinação. Foi verificado que S. suis está presente em vários estados brasileiros e o maior número de isolados originou-se dos estados de Minas Gerais (62,5 por cento), São Paulo (10,8 por cento) e Paraná (9,3 por cento). O sorotipo 2 foi o mais freqüente (61.0 por cento), seguido pelos sorotipos 1, 3, 4, 7 e 8. Os isolamentos foram obtidos principalmente de cérebro (60,1 por cento) e pulmões (10,4 por cento). Os casos de septicemia representaram 9,4 por cento.

Streptococcus suis meningitis: the newest serious infectious disease.

The authors report 41 patients with meningitis caused by Streptococcus suis. The clinical feature of the meningitis is characteristic with severe sensorineural hearing loss, developing early during the course of meningitis. These patients were cured with high doses of penicillin or third generation cephalosporins but the deafness remained permanent. The mechanism of the cochlear and vestibular damage is uncertain; presumably, it is caused by some oto-toxins from bacteria. The disease may become an occupational risk of pork handlers and a public health problem in Thailand.

Concentração inibitória mínima (CIM) de oito antimicrobianos frente isolados de Streptococcus suis / Mininum inhibitory concentration of eigth antibiotics toward isolates of Streptococcus suis

Avaliou-se a concentração inibitória mínima (CIM) de 75 isolados de Streptococcus suis frente a oito antimicrobianos freqüentemente utilizados no controle da infecção por esse microrganismo. A CIM foi realizada em placas previamente preparadas com ágar sangue, contendo concentrações variando de 0,25 a 256 μg/ml dos seguintes antimicrobianos: amoxicilina, ampicilina, penicilina, ceftiofur sódico, florfenicol, lincomicina, penicilina, sulfametoxazol-trimetoprim e tetraciclina. A amoxicilina nas concentrações de 1 e 2 μg/ml, o florfenicol a 1 μg/ml e o sulfametoxazol-trimetoprim nas concentrações de 2 e 8 μg/ml, foram os antimicrobianos frente aos quais os microrganismos apresentaram menor resistência. Em contraste, a ampicilina, tetraciclina, ceftiofur sódico e lincomicina, foram menos efetivos, apresentando CIM de (64 e 128 μg/ml), (64 e 128 μg/ml), (128 e 256 μg/ml) e (>256 μg/ml), respectivamente. Os resultados deste estudo demonstram que a amoxicilina e o florfenicol são os antibióticos de escolha para o tratamento de infecções pelo S. suis em suínos.

The minimun inhibitory concentration (MIC) was determined toward amoxicilin, ampicilin, penicillin, ceftiofur, florfenicol, lincomycin, trimethoprim-sulfadiazine and tetracycline for 75 strains of Streptococcus suis. The MIC was performed on sheep blood agar plates containing concentrations varying from 0,25 to 256 μg/ml of the antibiotic described above. The amoxicilin in the concentrations of 1 and 2 μg/ml, florfenicol in the concentration of 1 μg/ml and trimethoprim-sulfadiazine in the concentrations of 2 e 8 μg/ml, were the antibiotics that presented minor resistance. In contrast, the ampicilin, tetracycline, ceftiofur and lincomycin, presented MIC of 64 and 128 μg/ml, 64 and 128 μg/ml, 128 and 256 μg/ml and >256 μg/ml, respectively. The results of this study show that the amoxicilin and florfenicol are the antibiotics of choice for the treatment of diseases by S. suis in swine.

Serotyping and evaluation of the virulence in mice of Streptococcus suis strains isolated from diseased pigs

Um total of 110 amostras de Streptococcus suis isoladas de suínos doentes, no Brasil foram sorotipificadas e analisadas para a virulência. Sorotipificação das amostras resultou na seguinte classificação: 42 amostras do sorotipo 2 (38,2%), 10 amostras do sorotipo 14 (9,1%), sete amostras do sorotipo 9 (6,4%), três amostras de cada sorotipo, 7 e 11 (2,7%), duas amostras de cada sorotipo, 1 e 8 (1,8%) e uma amostra de cada um dos sorotipos, ½, 3, 5, 6 e 10 (0,9%). Reações cruzadas entre os sorotipos 1, 14 e 7 foram observadas em 21 amostras (19,1%). Somente 41,9% das amostras foram patogênicas para camundongos.

Streptococcus suis infection: overview of case reports in Thailand.

This paper presents an overview of reports of Streptococcus suis infection in Thailand from 1987-2000. Nine reports (N=27 samples) have been collected and analyzed descriptively. The demographic data and clinical data showed 15 samples (55.6%) of all samples had a history of contact with pig, raw pork product or a history of raw pork, or uncooked pig's blood, consumption. The ages of the patients ranged from 23 to 72 years (mean 47 +/- 8.91). Most presented with fever (N=27, 100%), headache (N=11, 40.74%) and neck stiffness (N=13, 48.15%). Twelve (44.44%) cases developed septic shock, and only one survived with loss of hearing ability. Two cases were the first report of human S. suis endocarditis from Thailand. One case was probably the first case report of S. suis peritonitis. Laboratory results and treatment have been also reviewed and may highlight the importance of microbiological laboratories that have limited facilities for identification of the organism.

Streptococcus suis peritonitis: case report.

A 45-year-old Thai man who presented with peritonitis was seen in a tertiary care centre in Thailand. An exploratory laparotomy was done because of peritonitis from abdominal trauma. Postoperatively the patient received intravenous ceftriaxone and metronidazole, but he developed rhabdomyolysis and acute renal failure. Hemodialysis was performed. After 8 days, the peritonitis had relapsed with hypotension. The patient was given vasopressives but clinicaly deteriorated and expired on day 11. The peritoniteal fluid culture grew Streptococcus suis serotype 2 and the organism was resistant to multiple antimicrobial agents including penicillin (MIC > 32 mcg/ml) but was susceptible to vancomycin.