Meningitis caused by Streptococcus suis: a case report

Introduction. Streptococcus suis, a diplococcus Gram +, alfa haemolytic, commensal in pigs. Infection in humans is due to a different location and is one of the most common cause of meningitis in adults. Risks: consumption of undercooked pork, rearing and slaughter of pigs. Clinical case.Woman, 46aa., caregiver, Romanian, presents to the emergency of our hospital with fever (39.5C), drowsiness, no neurological deficits. Neutrophilia 93%, ESR 140 mm/h, CRP 26.40 mg/dl; LCR turbid, cell count 950/mm3, glicorrachia undetectable and, proteinorrachia 5.3g/l, PMN prevailing, presence diplococci Gram +, pneumococcal antigen negative. Tac cerebral negative for focal parenchymal lesions, alterations densitometric signs of bleeding. Improving after empiric therapy (ceftriaxone, ampicillin and levofloxacin iv) but emergence of the sense of “muffled ear dx”. Tac fortresses petros and paranasal sinuses: ”breasts not procidenti side of dura mater. Presence of tissue density of the soft parts at the right external ear canal.” Methods. Blood cultures (Bactec 9240 BD) negative. LCR culture (12 h in CO2): development of alfa haemolytic colonies, Gram + diplococci, catalase -, bile esculin -, PYR -, lysis of bile salts -, optochin R. Identified with API 20 strep (bioMérieux) as Streptococcus suis and confirmed by molecular studies. Susceptible to penicillin, ceftriaxone, vancomycin, resistant to tetracycline and clindamycin. Improvement after this therapy, administered for 14 days with disappearance of “the sense of muffled“ and normalization of blood chemical parameters. Conclusions. According to literature, S. suis meningitis is often not recognized.Awareness of the clinicians of this possible etiology and an accurate history of the patient intended to reveal dietary habits (consumption of undercooked pork) and profession (butchers, etc...) are important factors for a prompt diagnosis, since there are negligible sequelae as hearing loss (50% of cases) and complications (TSS, arthritis, pneumonia).