Download Streptococcus suis

Streptococcus suis meningitis in swine worker in Larissa, Greece E.Sogka¹ F.Koumoutsou¹ O.Triantafyllou¹ N. Aggelis¹ V.Lalos¹ S.Karamaggiolis¹ K. Karamitsos¹ 1 Department of Internal Medicine, General Hospital of Larissa. Larissa , Greece

•Streptococcus suis is a zoonotic pathogen. •It is found in the upper airway, reproductive system, and digestive tracts of pigs -without causing disease -and in pork derived products. •Human S. suis infections are most often reported from countries where pig-rearing is common (figure 1). The relative high mean patient age (47-55 years) and almost complete absence of children in case series, as well as the high male-to-female patient ratio (3.5:1.0 to 6.5:1.0) support the notion that infection with S. suis is generally an occupational disease •Meningitis is the most common clinical syndrome. Sepsis, endocarditis, arthritis are other common manifestations. Figure 1

CASE REPORT A previously healthy 34 –year old Indian man, presented with fever, chills and severe headache unresponsive to paracetamol. The symptoms had been present for the past 3 days. No past medical history The patient is employed as a pig breeder for the past 2 years, hasn’t traveled abroad recently and doesn’t smoke or drink alcohol.

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EXAMINATION General appearance: patient looks weak and tired Skin: jaundice (icteric conjunctiva of the eyes), no rash, no open wounds Airway and breathing: Patent airway, spontaneously breathing, clear to percussion and auscultation bilaterally, RR 18, Saturation 99% on air Cardiovascular: regular rate and rhythm with no murmurs or friction rub. HR 80min, AP 110/60 mmHg, ECG SR Abdomen: non-distended , soft, no significant tenderness, liver and spleen are non palpable ,bowel sounds present,. Neurological examination: GCS 15/15, neck stiffness, partial unilateral hearing loss

BLOOD ANALYSIS • • •

Anemia normocytic Raised inflammation Markers: Neutrophilic leycocytosis, High fibrinogen ( 890.00 mg/dl) and high CRP (30.7) Abnormal liver function: SGOT 54IU/L, SGPT 62IU/L, TOTAL BILLIRUBIN 1.62mg/dl, DIRECT BILLIRUBIN 0.72mg/dl, normal INR IMAGING

Meningitis

DIFFERENTIAL DIAGNOSIS Encephalitis Tetanus Dengue fever Subarachnoid hemorrhage

Malaria

INITIAL APPROACH Steps to diagnosis: – Fundoscopy: no signs of raised ICP ( Figure2 ) – CT scan : no abnormal findings – Blood Culture – Lumber puncture : analysis and culture ( Table 1)

Figure 2

CSF findings

Normal Values

Appearance

Slight turbid

Clear

Cell rount

476/mm^3