Emerging infectious diseases: Streptococcus suis meningitis

Coinfection of Streptococcus suis and Nocardia asiatica in the human central nervous system: A case report

BACKGROUND

Streptococcus suis (S. suis) is an anthropozoonotic pathogen that shows clinical manifestations of meningitis, septicemia, and arthritis in infected humans. Nocardia is another type of anthropozoonotic bacteria, with clinical manifestations of skin, lung, and brain abscesses in infected humans. Few intracranial infections caused by S. suis or Nocardia have been reported. To the best of our knowledge, no study has reported a patient with simultaneous intracranial infection by S. suis and Nocardia.

CASE SUMMARY

A 66-year-old male presented at Liaocheng People’s Hospital (Liaocheng, Shandong Province, China) reporting dizziness with nausea and vomiting. Metagenomic next-generation sequencing (mNGS) was performed on cerebrospinal fluid for examination, and the patient was diagnosed with suppurative meningitis caused by S. suis infection. He received anti-infection treatment with penicillin sodium and ceftriaxone. The patient’s condition initially improved but then deteriorated. Further mNGS of cerebrospinal fluid revealed both S. suis and Nocardia. Imaging examination revealed a brain abscess. Furthermore, a mixed infection of S. suis and Nocardia was detected in the patient’s central nervous system. The patient was treated with antibiotics and sulfamethoxazole. He was discharged after his condition improved.

CONCLUSION

This case shows that the disease can be recurrent in patients with intracranial infection of a rare pathogen. The possibility of mixed infection should also be considered, especially in patients treated with immunosuppressive agents. mNGS of cerebrospinal fluid is a supplement to conventional microbial pathogen identification methods. Patients with unknown pathogen diagnosis, early extensive use of antibiotics and infection with rare pathogens can be diagnosed by the combination of conventional methods and mNGS of cerebrospinal fluid.

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.