ABSTRACT
A cluster of 18 inpatients and 21 outpatients with a major complaint of meningitis and a history of sharing traditional delicacies of raw pork and pig blood in a village festival led to the suspicion of Streptococcus suis (S. suis) meningitis in Sibang Kaja Village, Badung, Bali, Indonesia. We conducted an investigation and case finding to prevent human fatalities. Demography and laboratory examinations of the inpatients were recorded. Bacterial culture, identification, and sensitivity tests were conducted using a VITEK 2 Compact machine (Biomeriuex®) with cerebrospinal fluid (CSF) or blood from the inpatients. The bacterial species were confirmed via PCR. A subsequent investigation was also conducted to identify the source of the meat, the presence of S. suis in slaughtered pigs, and the zoosanitary measures at pig farms and slaughterhouses. The five most common clinical signs were fever (92.3%), myalgia (46.1%), neck stiffness (25.6%), headache (23.1%), and nausea/vomiting (20.5%). S. suis was confirmed in two CSF and one blood specimens. All inpatients recovered following intravenous treatment with ceftriaxone every 12 h for 14 days and dexamethasone every 6 h for 4 days, while the outpatients were treated with 500 mg of amoxicillin three times daily for 7 days. The veterinary and environmental investigation identified the source of the pork for the festival, confirmed the presence of S. suis in the slaughtered pigs, and elucidated the sanitary measures applied at the pig farms and slaughterhouses. We conclude that infections of S. suis in humans can spread in cluster phenomena following the sharing of high-risk food. A prompt and early response, as well as early treatment of patients, is paramount in case finding to enable a favourable outcome of full recovery. Additionally, the implementation of the "One Health" approach provides a comprehensive picture of the management of S. suis infection in humans.
ABSTRACT
BACKGROUND: Streptococcus suis is an emerging zoonotic pathogen. This bacterium commonly causes meningitis in human and is often associated with hearing and vestibular dysfunction. S. suis tends to be misidentified, leading to under-diagnosis. CASE PRESENTATION: A previously healthy 50-year-old man was admitted to one of the district hospitals in Bali Province, Indonesia, due to meningitis. He had a history of consuming homemade raw pork product two days before the onset of illness. Streptococcus mitis was identified from the cerebrospinal fluid culture by using VITEX 2 COMPACT (Biomeriuex) with a 99% probability score. This patient had clinical symptoms and risk factor identical to S. suis infection. Therefore, we performed confirmation tests for the cerebrospinal fluid by PCR (using primer specific for gdh and recN) and sequencing of those PCR products. Both of the confirmation tests showed a positive result for S. suis. CONCLUSION: There are few reports of S. suis infections in Indonesia, but we believe that the cases in Indonesia, especially Bali, are not uncommon. The under-reported cases are perhaps due to the difficulties in differentiating S. suis from other Streptococcus species by culture method, particularly Streptococcus mitis. Therefore, confirmation by PCR is necessary.
ABSTRACT
SUMMARY: The emergence of human and animal rabies in Bali since November 2008 has attracted local, national and international interest. The potential origin and time of introduction of rabies virus to Bali is described. The nucleoprotein (N) gene of rabies virus from dog brain and human clinical specimens was sequenced using an automated DNA sequencer. Phylogenetic inference with Bayesian Markov Chain Monte Carlo (MCMC) analysis using the Bayesian Evolutionary Analysis by Sampling Trees (BEAST) v. 1.7.5 software confirmed that the outbreak of rabies in Bali was caused by an Indonesian lineage virus following a single introduction. The ancestor of Bali viruses was the descendant of a virus from Kalimantan. Contact tracing showed that the event most likely occurred in early 2008. The introduction of rabies into a large unvaccinated dog population in Bali clearly demonstrates the risk of disease transmission for government agencies and should lead to an increased preparedness and efforts for sustained risk reduction to prevent such events from occurring in future.
