Meningitis por Streptococcus suis / Streptococcus suis meningitis

Resumen Streptococcus suis (S. suis) es un patógeno porcino prevalente a nivel mundial, capaz de generar infec ciones en humanos que estuvieron en contacto con el animal o la carne cruda del mismo. Las manifestaciones clínicas comprenden desde casos asintomáticos hasta compromiso sistémico, con una baja mortalidad, pero con la posibilidad de dejar secuelas definitivas como la ataxia e hipoacusia. Son pocos los reportes de casos, debido al descono cimiento de la enfermedad y a su forma atípica de pre sentación. El objetivo de este artículo es relatar el caso de un varón con antecedentes ocupacionales de contacto con porcinos, que ingresó por meningitis y en el cual se obtuvo el aislamiento de S. suis en líquido cefalorra quídeo y hemocultivos pareados; completó tratamiento antibiótico ajustado a la sensibilidad bacteriana, quedó con hipoacusia leve como secuela.

Abstract Streptococcus suis (S. suis) is a globally prevalent swine pathogen, capable of generating infections in humans who were in contact with the animal or its raw meat. Clinical manifestations range from asymptomatic cases to systemic involvement, with low mortality, but with the possibility of leaving definitive sequelae such as ataxia and hearing loss. There are few case reports, due to lack of knowledge of the disease and its atypical presentation. The objec tive of this article is to report the case of a man with an occupational history of contact with pigs, who was admitted for meningitis and in whom the isolation of S. suis was obtained in cerebrospinal fluid and paired blood cultures; He completed antibiotic treatment adjusted to bacterial sensitivity, and was left with mild hearing loss as a consequence.

[Streptococcus suis meningitis]. / Meningitis por Streptococcus suis.

Streptococcus suis (S. suis) is a globally prevalent swine pathogen, capable of generating infections in humans who were in contact with the animal or its raw meat. Clinical manifestations range from asymptomatic cases to systemic involvement, with low mortality, but with the possibility of leaving definitive sequelae such as ataxia and hearing loss. There are few case reports, due to lack of knowledge of the disease and its atypical presentation. The objective of this article is to report the case of a man with an occupational history of contact with pigs, who was admitted for meningitis and in whom the isolation of S. suis was obtained in cerebrospinal fluid and paired blood cultures; He completed antibiotic treatment adjusted to bacterial sensitivity, and was left with mild hearing loss as a consequence.

Streptococcus suis (S. suis) es un patógeno porcino prevalente a nivel mundial, capaz de generar infecciones en humanos que estuvieron en contacto con el animal o la carne cruda del mismo. Las manifestaciones clínicas comprenden desde casos asintomáticos hasta compromiso sistémico, con una baja mortalidad, pero con la posibilidad de dejar secuelas definitivas como la ataxia e hipoacusia. Son pocos los reportes de casos, debido al desconocimiento de la enfermedad y a su forma atípica de presentación. El objetivo de este artículo es relatar el caso de un varón con antecedentes ocupacionales de contacto con porcinos, que ingresó por meningitis y en el cual se obtuvo el aislamiento de S. suis en líquido cefalorraquídeo y hemocultivos pareados; completó tratamiento antibiótico ajustado a la sensibilidad bacteriana, quedó con hipoacusia leve como secuela.

Streptococcus suis meningitis: An emerging zoonotic disease in Brazil

ABSTRACT Streptococcus suis has been widely reported as a pathogen in animals, especially pigs. In terms of human health implications, it has been characterized as a zoonosis associated with the consumption of pork products and occupational exposure, particularly in Southeast Asian countries. Here, we present a rare case of human S. suis infection in Brazil, diagnosed in an older adult swine farmer, a small rural producer residing in the semi-arid region of Bahia, Brazil.

Meningoencefalitis aguda por Streptococcus suis. Reporte de caso / Streptococcus suis acute meningoencephalitis. Case report / Meningoencefalite aguda por Streptococcus suis. Relato de caso

La infección por Streptococcus suis es una zoonosis proveniente de los cerdos con manifestaciones clínicas variadas dentro de las cuales la meningitis purulenta es la más frecuente. Es una infección con baja mortalidad, pero con graves secuelas en un importante número de casos. Hasta el momento han sido reportados 5 casos Uruguay. Presentamos los casos de dos pacientes trabajadores rurales con exposición a cerdos, que ambos se presentaron como meningitis aguda supurada con buena evolución clínica con tratamiento antibiótico y cortocoideo. Realizamos una revisión de la literatura sobre este tema enfatizando aspectos clínicos, epidemiológicos, microbiológicos y del tratamiento.

The infection by Streptococcus suis is a zoonosis transmitted from pigs to humans with a wide clinical manifestation among which purulent meningitis is the most frequent. It's an infection with low mortality but with severe sequalae. Up to date, only 5 cases, including ours, have been reported in our country. We present the cases of two rural worker patients with exposure to pigs, who both presented as acute purulent meningitis with good clinical outcome due to antibiotic and corticosteroid treatment. We present a review of the literature empathizing on clinical, epidemiological, microbiological and treatment aspects.

A infecção por Streptococcus suis é uma zoonose proveniente de suínos com manifestações clínicas variadas, sendo a meningite purulenta a mais comum. É uma infecção com baixa mortalidade, mas com graves sequelas em um número significativo de casos. Até o momento, foram relatados 5 casos no Uruguai. Apresentamos os casos de dois pacientes trabalhadores rurais com exposição a suínos, ambos apresentando-se como meningite aguda purulenta com boa evolução clínica com tratamento antibiótico e corticosteroide. Realizamos uma revisão da literatura sobre o tema, enfatizando aspectos clínicos, epidemiológicos, microbiológicos e de tratamento.

Histopathologic patterns and etiologic diagnosis of porcine respiratory disease complex in Brazil / Padrões histopatológicos e diagnóstico etiológico do complexo de doenças respiratórias dos suínos no Brasil

Porcine respiratory disease complex is a major health concern for the porcine industry, causing significant economic loss. In this study, a total of 156 samples from pigs referred to a diagnostic laboratory in Brazil for 15 months were analyzed by histopathology, bacterial isolation, PCR, and immunohistochemistry. Multiple infections were common, so 42.3% of the pigs had more than one pathogen detected in the lungs. Swine influenza virus was detected in 25.0% of the cases. Porcine circovirus type 2 was detected in 7.1% of the pigs, which was often associated with Pasteurella multocida. In addition, one case of porcine circovirus type 3 infection associated with granulomatous pneumonia was diagnosed. Bacteria were isolated in 125 cases, namely Pasteurella multocida (34.0%), Glaesserella (Haemophilus) parasuis (35.2%), Streptococcus suis (13.5%), and Actinobacillus pleuropneumoniae (7.7%). Mycoplasma hyopneumoniae was identified in 7.0% of the cases, and 18.6% of pigs carried Salmonella sp. The most common patterns of pulmonary inflammation were broncopneumonia, bronchointerstitial pneumonia, and pleuritis, in that order. This study demonstrated that histopathology is an efficient tool along with other laboratorial diagnostic tests for establishing an etiologic diagnosis in cases of porcine respiratory disease complex.

O complexo de doenças respiratórias de suínos é um dos principais problemas sanitários na suinocultura, causando perdas econômicas significativas. O presente estudo incluiu amostras de 156 suínos, que foram encaminhados a um laboratório de diagnóstico no Brasil, durante um período de 15 meses, sendo realizados histopatologia, isolamento bacteriano, PCR e imuno-histoquímica. Coinfecções por múltiplos patógenos foram comuns, correspondendo a 42,3% dos animais, que tiveram mais de um agente identificado nos pulmões. O vírus da influenza suína foi detectado em 25,0%. O circovírus suíno tipo 2 foi detectado em 7,1% dos animais, frequentemente associado à Pasteurella multocida. Além disso, foi diagnosticado um caso de circovírus suíno tipo 3 associado à pneumonia granulomatosa. Foram isoladas bactérias em 125 casos, a saber: Pasteurella multocida (34,0%), Glaesserella (Haemophilus) parasuis (35,2%), Streptococcus suis (13,5%) e Actinobacillus pleuropneumoniae (7,7%). Mycoplasma hyopneumoniae foi identificado em 7,0%, e 18,6% dos animais tiveram isolamento de Salmonella sp. Os padrões mais frequentes de inflamação pulmonar foram: broncopneumonia, pneumonia broncointersticial e pleurite, nesta ordem. Este estudo demonstrou que a histopatologia é uma ferramenta eficiente, juntamente a outras técnicas laboratoriais de diagnóstico, para o estabelecimento de diagnóstico etiológico em casos do complexo de doenças respiratórias de suínos.

The value of next-generation sequencing for the diagnosis of Streptococcus suis meningitis

SUMMARY OBJECTIVE: The aim of this study was to investigate the value of next-generation sequencing for the diagnosis of Streptococcus suis meningitis. METHODS: Patients with meningitis in the Department of Neurology of the Hainan General Hospital were recruited and divided into a next-generation sequencing group and a control group. In the next-generation sequencing group, we used the next-generation sequencing method to detect the specific pathogenic bacteria in the patients. In the control group, we used the cerebrospinal fluid bacterial culture method to detect the specific pathogenic bacteria in the patients. RESULTS: A total of 28 participants were recruited for this study, with 14 participants in each group. The results showed similarities in both the average age and average course of the disease between the two groups (p>0.05). The white blood cell count, percentage of neutrophils, and level of C-reactive protein in the next-generation sequencing group were significantly higher than those in the control group (p<0.05). There were similarities in both the temperature and intracranial pressure between the two groups (p>0.05). In the next-generation sequencing group, all patients (100%) were detected as having had the S. suis meningitis infection by next-generation sequencing, while only 6 (43%) patients in the control group had been detected as having the S. suis meningitis infection by cerebrospinal fluid bacterial culture. CONCLUSIONS: The positive detection rate of S. suis by the next-generation sequencing method was significantly higher compared with using a cerebrospinal fluid bacterial culture. Therefore, the next-generation sequencing method is valuable for the diagnosis of S. suis meningitis and is worthy of clinical application.

Clinical and pathological aspects of an outbreak of Streptococcus suis serotype 9 infection in pigs / Aspectos clínicos e patológicos de um surto de infecção por Streptococcus suis sorotipo 9 em suínos

Streptococcus suis is a Gram-positive pathogen that inhabits the upper respiratory tract and can cause severe systemic inflammatory disease in pigs, mainly during the nursery phase. Streptococcus suis is a reemergent pathogen, and outbreaks of its inducing disease represent significant economic losses for the pig industry worldwide. In this study, we described the clinical, pathological, and molecular aspects of an outbreak of S. suis infection with atypically high mortality. The outbreak occurred in nursery farms integrated into a cooperative in the state of Paraná, Brazil. Of the 30 nurseries, 10 were severely affected by the pathogen and had high economic losses. Clinical signs usually started approximately 10 days after weaning and were mainly characterized by acute nervous and locomotor disorders. The mortality of the affected batches usually ranged between 8% and 10%, but in some cases, it reached 18%. Nine piglets were submitted to post mortem examination. Macroscopically, the synovial joints were enlarged and contained fibrinous exudates. In the central nervous system, there was hyperemia of the leptomeningeal vessels associated with deposition of fibrin and purulent exudate in the leptomeninges. In three piglets, there was thickening of the choroid plexus associated with dilation of the lateral ventricles. Microscopic lesions were characterized mainly by fibrinosuppurative inflammation, which involved the synovial membranes, leptomeninges of the brain, and spinal cord. Furthermore, it also affects the choroid plexus, ependyma, nerve roots, and central canal of the spinal cord. S. suis was isolated from the cerebrospinal fluid, meningeal swabs, and/or synovial fluid of 8/9 piglets, and typified as serotype 9 by multiplex PCR.

Streptococcus suis é um patógeno Gram positivo que habita o trato respiratório superior e pode causar doença inflamatória sistêmica grave em suínos, principalmente durante a fase de creche. Streptococcus suis é um patógeno reemergente e surtos representam perdas econômicas significativas a suinocultura mundial. Neste estudo descrevemos os aspectos clínicos, patológicos e moleculares de um surto de infecção por S. suis com mortalidade atipicamente alta. O surto ocorreu em creches integradas a uma cooperativa do estado do Paraná, Brasil. Das 30 creches, 10 foram severamente afetadas pelo patógeno e apresentavam elevadas perdas econômicas. Os sinais clínicos iniciavam em torno de 10 dias após o desmame e eram caracterizados principalmente por sinais clínicos nervosos e locomotores agudos. A mortalidade dos lotes afetados variava entre 8% e 10%, mas em alguns casos ultrapassava 18%. Nove leitões foram submetidos ao exame post mortem. Macroscopicamente, as articulações sinoviais estavam aumentadas e continham exsudato fibrinoso. No sistema nervoso central havia hiperemia dos vasos leptomeníngeos associada a deposição de fibrina e exsudato purulento nas leptomeninges. Em três leitões havia espessamento do plexo coroide associado a dilatação dos ventrículos laterais. As lesões microscópicas eram caracterizadas principalmente por inflamação fibrinossupurativa que envolvia as membranas sinoviais, as leptomeninges do cérebro e medula espinhal. Além disso, também afetava o plexo coroide, epêndima, raízes nervosas e canal central da medula espinhal. S. suis foi isolado do líquido cefalorraquidiano, suabe de meninge e/ou líquido sinovial de 8/9 leitões e tipificado como sorotipo 9 por PCR multiplex.

A rare case of meningitis and septicemia caused by Streptococcus suis in a woman without a history of live pig contact or eating raw pork.

Streptococcus suis (S. suis) is a zoonotic pathogen that primarily inhabits the upper respiratory tract of pigs. Therefore, pigs that carry these pathogens are the major source of infection. Most patients are infected through contact with live pigs or unprocessed pork products and eating uncooked pork. S. Suis mainly causes sepsis and meningitis. The disease has an insidious onset and rapid progress. The patient becomes critically ill and the mortality is high. In this case report, we described a rare case of S. suis isolated from a middle-aged woman in Jinhua City, Zhejiang Province, China, who did not have any contact with live pigs and had not eaten uncooked pork. S. Suis was isolated from both the patient's blood and cerebrospinal fluid samples.

Antimicrobial resistance in bacteria isolated from pigs with respiratory clinical signs in Brazil / Resistência a antimicrobianos em bactérias isoladas de suínos com sinais clínicos respiratórios no Brasil

Antimicrobial resistance is a current and important issue to public health, and it is usually associated with the indiscriminate use of antimicrobials in animal production. This study aimed to evaluate the antimicrobial susceptibility profile in bacterial isolates from pigs with clinical respiratory signs in Brazil. One hundred sixty bacterial strains isolated from pigs from 51 pig farms in Brazil were studied. In vitro disk-diffusion method was employed using 14 antimicrobial agents: amoxicillin, penicillin, ceftiofur, ciprofloxacin, enrofloxacin, chlortetracycline, doxycycline, oxytetracycline, tetracycline, erythromycin, tilmicosin, florfenicol, lincomycin, and sulfadiazine/trimethoprim. The majority of isolates were resistant to at least one antimicrobial agent (98.75%; 158/160), while 31.25% (50/160) of the strains were multidrug resistant. Streptococcus suis and Bordetella bronchiseptica were the pathogens that showed higher resistance levels. Haemophilus parasuis showed high resistance levels to sulfadiazine/trimethoprim (9/18=50%). We observed that isolates from the midwestern and southern regions exhibited four times greater chance of being multidrug resistant than the isolates from the southeastern region studied. Overall, the results of the present study showed a great level of resistance to lincomycin, erythromycin, sulfadiazine/trimethoprim, and tetracycline among bacterial respiratory pathogens isolated from pigs in Brazil. The high levels of antimicrobial resistance in swine respiratory bacterial pathogens highlight the need for the proper use of antimicrobials in Brazilian pig farms.(AU)

A resistência antimicrobiana é uma questão atual e muito importante para a saúde pública, geralmente associada ao uso indiscriminado de antimicrobianos na produção animal. Diante disso, foi investigado o perfil de sensibilidade-antimicrobiana em isolados bacterianos de suínos com sinais clínicos respiratórios no Brasil. Foram estudadas 96 isolados provenientes de 51 granjas de suínos do Brasil. O método de disco-difusão foi empregado usando 14 antimicrobianos: amoxicilina, penicilina, ceftiofur, ciprofloxacina, enrofloxacina, clortetraciclina, doxiciclina, oxitetraciclina, tetraciclina, eritromicina, tilmicosina, florfenicol, lincomicina e sulfadiazina/trimetoprim. Streptococcus suis e Bordetella bronchiseptica foram os patógenos que apresentaram maiores níveis de resistência. Haemophilus parasuis apresentou altos níveis de resistência à sulfadiazina/trimetoprim (9/18=50%). Observou-se que isolados das regiões Centro-Oeste e Sul apresentaram quatro vezes mais chance de serem multirresistentes do que os isolados da região Sudeste. A maioria foi resistente a pelo menos um agente antimicrobiano (98,75%; 158/160) e 31,25% (50/160) das estirpes isoladas eram multirresistentes. No geral, os resultados do presente estudo mostraram grande nível de resistência à lincomicina, eritromicina, sulfadiazina/trimetoprim e tetraciclina entre patógenos respiratórios bacterianos isolados de suínos no Brasil. Os altos níveis de resistência antimicrobiana em patógenos bacterianos respiratórios em suínos reforçam a necessidade do uso criterioso de antimicrobianos na suinocultura brasileira.(AU)

Antimicrobial resistance in bacteria isolated from pigs with respiratory clinical signs in Brazil / Resistência a antimicrobianos em bactérias isoladas de suínos com sinais clínicos respiratórios no Brasil

Antimicrobial resistance is a current and important issue to public health, and it is usually associated with the indiscriminate use of antimicrobials in animal production. This study aimed to evaluate the antimicrobial susceptibility profile in bacterial isolates from pigs with clinical respiratory signs in Brazil. One hundred sixty bacterial strains isolated from pigs from 51 pig farms in Brazil were studied. In vitro disk-diffusion method was employed using 14 antimicrobial agents: amoxicillin, penicillin, ceftiofur, ciprofloxacin, enrofloxacin, chlortetracycline, doxycycline, oxytetracycline, tetracycline, erythromycin, tilmicosin, florfenicol, lincomycin, and sulfadiazine/trimethoprim. The majority of isolates were resistant to at least one antimicrobial agent (98.75%; 158/160), while 31.25% (50/160) of the strains were multidrug resistant. Streptococcus suis and Bordetella bronchiseptica were the pathogens that showed higher resistance levels. Haemophilus parasuis showed high resistance levels to sulfadiazine/trimethoprim (9/18=50%). We observed that isolates from the midwestern and southern regions exhibited four times greater chance of being multidrug resistant than the isolates from the southeastern region studied. Overall, the results of the present study showed a great level of resistance to lincomycin, erythromycin, sulfadiazine/trimethoprim, and tetracycline among bacterial respiratory pathogens isolated from pigs in Brazil. The high levels of antimicrobial resistance in swine respiratory bacterial pathogens highlight the need for the proper use of antimicrobials in Brazilian pig farms.(AU)

A resistência antimicrobiana é uma questão atual e muito importante para a saúde pública, geralmente associada ao uso indiscriminado de antimicrobianos na produção animal. Diante disso, foi investigado o perfil de sensibilidade-antimicrobiana em isolados bacterianos de suínos com sinais clínicos respiratórios no Brasil. Foram estudadas 96 isolados provenientes de 51 granjas de suínos do Brasil. O método de disco-difusão foi empregado usando 14 antimicrobianos: amoxicilina, penicilina, ceftiofur, ciprofloxacina, enrofloxacina, clortetraciclina, doxiciclina, oxitetraciclina, tetraciclina, eritromicina, tilmicosina, florfenicol, lincomicina e sulfadiazina/trimetoprim. Streptococcus suis e Bordetella bronchiseptica foram os patógenos que apresentaram maiores níveis de resistência. Haemophilus parasuis apresentou altos níveis de resistência à sulfadiazina/trimetoprim (9/18=50%). Observou-se que isolados das regiões Centro-Oeste e Sul apresentaram quatro vezes mais chance de serem multirresistentes do que os isolados da região Sudeste. A maioria foi resistente a pelo menos um agente antimicrobiano (98,75%; 158/160) e 31,25% (50/160) das estirpes isoladas eram multirresistentes. No geral, os resultados do presente estudo mostraram grande nível de resistência à lincomicina, eritromicina, sulfadiazina/trimetoprim e tetraciclina entre patógenos respiratórios bacterianos isolados de suínos no Brasil. Os altos níveis de resistência antimicrobiana em patógenos bacterianos respiratórios em suínos reforçam a necessidade do uso criterioso de antimicrobianos na suinocultura brasileira.(AU)

Streptococcus suis in Brazil: Genotypic, Virulence, and Resistance Profiling of Strains Isolated from Pigs between 2001 and 2016.

Streptococcus suis remains an important challenge for the worldwide swine industry. Considering that Brazil is a major pork producer and exporter, proper monitoring of the pathogen and resistance rates are required. We present here the characterization of Brazilian S. suis strains isolated over a 15 year period by pulsed-field gel electrophoresis (PFGE) typing, capsular, virulence, and antimicrobial resistance profiling. Serotype prevalence revealed a predominance of serotype 2/½ followed by 3, 7, 1/14, 6, 8, 18, 28, and 27; the latter had not yet been reported in Brazil. Resistance profiling enabled the differentiation of nine profiles presenting resistance to three and up to eight antimicrobial classes. Even though an association between the most resistant strains and isolation year starting from 2009 was observed, a high frequency of multidrug-resistant strains isolated from 2001 to 2003 was also detected. This suggests that despite the isolation period, S. suis strains already presented high resistance selection pressure. A slight association of serotype 2/½ with some virulence profiles and PFGE pulsotypes was also identified. Nevertheless, no clonal dispersion or persistency of clones over the analyzed years and herds was detected.

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.

Characterization of Streptococcus suis through serotyping, SE-AFLP and virulence profile / Caracterização de Streptococcus suis por sorotipagem, SE-AFLP e perfil de virulência

Streptococcus suis is one of most important pathogens in the swine industry worldwide. Despite its importance, studies of S. suis characterization in South America are still rare. This study evaluates S. suis isolates from distinct Brazilian states, from 1999 to 2004, and its molecular and serological characterization. A total of 174 isolates were studied. S. suis identification was confirmed by PCR and isolates were further serotyped and genotyped by SE-AFLP and amplification of virulence markers. Serotype 1, 2, 3, 4, 7, 18, 22 and 32 were identified among the studied isolates, and only 4% were characterized as non-typeable. The mrp+/epf+/sly+ genotype was the most frequent. The SE-AFLP analysis resulted in 29 patterns distributed in three main clusters with over 65% of genetic similarity. Isolates presented a slight tendency to cluster according to serotype and origin; however, no further correlation with virulence genotypes was observed.(AU)

Streptococcus suis é um dos patógenos de maior importância para indústria suinícola mundial. Apesar de sua importância, a caracterização de isolados de S. suis na América do Sul ainda é pouco descrita. O presente estudo descreve a avaliação de isolados de S. suis provenientes de diferentes Estados brasileiros, e sua caracterização sorológica e molecular. Foram avaliados 174 isolados de S. suis e os mesmos foram submetidos a SE-AFLP e pesquisa de marcadores de virulência. Os sorotipos 1, 2, 3, 4, 7, 18, 22 e 32 foram identificados dentre os isolados estudados e apenas 4% foram caracterizados como não tipáveis. O perfil de virulência mrp+/epf+/sly+ foi o mais frequente. A análise do SE-AFLP resultou em 29 perfis distribuídos em três grupos principais com mais de 65% de similaridade genética. Os isolados apresentaram tendência de se agrupar segundo origem e sorotipo; no entanto, não foi observada correlação entre os grupamentos e os perfis de virulência.(AU)

Characterization of Streptococcus suis through serotyping, SE-AFLP and virulence profile / Caracterização de Streptococcus suis por sorotipagem, SE-AFLP e perfil de virulência

Streptococcus suis is one of most important pathogens in the swine industry worldwide. Despite its importance, studies of S. suis characterization in South America are still rare. This study evaluates S. suis isolates from distinct Brazilian states, from 1999 to 2004, and its molecular and serological characterization. A total of 174 isolates were studied. S. suis identification was confirmed by PCR and isolates were further serotyped and genotyped by SE-AFLP and amplification of virulence markers. Serotype 1, 2, 3, 4, 7, 18, 22 and 32 were identified among the studied isolates, and only 4% were characterized as non-typeable. The mrp+/epf+/sly+ genotype was the most frequent. The SE-AFLP analysis resulted in 29 patterns distributed in three main clusters with over 65% of genetic similarity. Isolates presented a slight tendency to cluster according to serotype and origin; however, no further correlation with virulence genotypes was observed.(AU)

Streptococcus suis é um dos patógenos de maior importância para indústria suinícola mundial. Apesar de sua importância, a caracterização de isolados de S. suis na América do Sul ainda é pouco descrita. O presente estudo descreve a avaliação de isolados de S. suis provenientes de diferentes Estados brasileiros, e sua caracterização sorológica e molecular. Foram avaliados 174 isolados de S. suis e os mesmos foram submetidos a SE-AFLP e pesquisa de marcadores de virulência. Os sorotipos 1, 2, 3, 4, 7, 18, 22 e 32 foram identificados dentre os isolados estudados e apenas 4% foram caracterizados como não tipáveis. O perfil de virulência mrp+/epf+/sly+ foi o mais frequente. A análise do SE-AFLP resultou em 29 perfis distribuídos em três grupos principais com mais de 65% de similaridade genética. Os isolados apresentaram tendência de se agrupar segundo origem e sorotipo; no entanto, não foi observada correlação entre os grupamentos e os perfis de virulência.(AU)

Streptococcus suis serotype 2 strains isolated in Argentina (South America) are different from those recovered in North America and present a higher risk for humans.

INTRODUCTION: Streptococcus suis serotype 2 is an important swine pathogen and emerging zoonotic agent causing meningitis and septicemia/septic shock. Strains are usually virulent (Eurasia) or of intermediate/low virulence (North America). Very few data regarding human and swine isolates from South America are available. CASE PRESENTATION: Seventeen new human S. suis cases in Argentina (16 serotype 2 strains and a serotype 5 strain) are reported. Alongside, 14 isolates from pigs are analyzed: 12 from systemic disease, one from lungs and one from tonsils of a healthy animal. All human serotype 2 strains and most swine isolates are sequence type (ST) 1, as determined by multilocus sequence typing and present a mrp+/epf+/sly+ genotype typical of virulent Eurasian ST1 strains. The remaining two strains (recovered from swine lungs and tonsils) are ST28 and possess a mrp+/epf - /sly- genotype typical of low virulence North American strains. Representative human ST1 strains as well as one swine ST28 strain were analyzed by whole-genome sequencing and compared with genomes from GenBank. ST1 strains clustered together with three strains from Vietnam and this cluster is close to another one composed of 11 strains from the United Kingdom. CONCLUSION: Close contact with pigs/pork products, a good surveillance system, and the presence of potentially virulent Eurasian-like serotype 2 strains in Argentina may be an important factor contributing to the higher number of human cases observed. In fact, Argentina is now fifth among Western countries regarding the number of reported human cases after the Netherlands, France, the UK and Poland.

Meningoencefalitis por Streptococcus suis.: Primeros dos casos en Uruguay. / Streptococcus suis meningoencephalitis: First two cases reported in Uruguay

La infección por Streptococcus suis (S. suis) es una zoonosis emergente, poco frecuente, secundaria a la exposición alimentaria o laboral a cerdos. La infección en los humanos se considera una enfermedad emergente con aparición de casos esporádicos, y más raramente brotes. Son un importante problema en la industria porcina a nivel mundial, ya que coloniza los tractos respiratorios, digestivo y genital del ganado porcino, siendo éstos portadores asintomáticos en 80% de los casos. En el humano S. suis causa una infección sistémica que puede afectar varios órganos. La meningitis es la manifestación más frecuente (68%); con menor frecuencia puede causar sepsis (25%), artritis (12,9%), endocarditis (12,4%) y endoftalmitis (4,6%). El tratamiento de elección para la meningitis a S. suis es la penicilina. En esta comunicación se presentan los primeros dos casos de meningoencefalitis causada por S. suis en Uruguay en 2008 y 2009. Un tercer caso se reportó en Paysandú en 2009.

Infection with Streptococcus suis (S. suis) is an uncommon emerging zoonosis, secondary to food or occupational exposure to pigs. Infection in humans is considered an emerging disease with onset of sporadic cases and outbreaks rarely. They are a major problem in the swine industry worldwide since colonizes the respiratory, digestive and genital tracts of pigs, they remain asymptomatic carriers in 80% of cases. In the human S. suis causes a systemic infection that can affect various organs. Meningitis is the most common presentation (68%), less often can cause sepsis (25%), arthritis (12.9%), endocarditis (12.4%) and endophthalmitis (4.6%). The treatment of choice for S suis meningitis is penicillin. In this communication the first two cases of meningoencephalitis caused by S. suis in Uruguay in 2008 and 2009. A third case was reported in Paysandú in 2009.

Streptococcus suis in a swine farm worker: first isolation in Brazil / Streptococcus suis em funcionário de granja suinícola: primeiro isolamento no Brasil / Streptococcus suis en un empleado de granja de cerdos: primer aislamiento en Brasil

Streptococcus suis represents a potential zoonosis risk in personnel working in close contact with swines. The purpose of this study was to evidence the human carrier status of S. suis in farm workers belonging to three different pig farms located in three different cities of the state of São Paulo, Brazil. Cotton swab samples were taken from tonsils of 28 workers. The S. suis-like strains were identified by polymerase chain reaction, confirmed by sequencing and serotyped by coagglutination technique. For the first time in Brazil, one farm worker was identified as a human carrier of S. suis.

Streptococcus suis representa um potencial risco zoonótico para indivíduos que trabalham em contato intimo com suínos. O objetivo deste estudo foi evidenciar o estado de portador de S. suis em funcionários de granjas provenientes de três diferentes granjas suinícolas localizadas em três diferentes cidades do estado de São Paulo, Brasil. Foram coletadas amostras de tonsilas de 28 funcionários. As linhagens suspeitas de S. suis foram identificadas por PCR, confirmadas por sequenciamento e sorotipificadas pela técnica de coaglutinação. Pela primeira vez no Brasil, um funcionário de granja foi identificado como portador de S. suis.

Streptococcus suis es un potencial riesgo de zoonosis para las personas que trabajan en contacto directo con cerdos. El propósito de este estudio fue detectar el estado de portador de S.suis en trabajadores de tres diferentes granjas porcinas ubicadas en tres ciudades diferentes en el estado de São Paulo, Brasil. Se recogieron muestras de amigdalas de 28 empleados. Las cepas sospechosas de S. suis fueron identificadas por PCR, confirmadas por secuenciación y serotipificadas mediante la técnica de coaglutinación. Esta es la primera vez en Brasil en que un empleado fue identificado como un portador de S. suis.

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.