Human Streptococcus suis Meningitis in the United States

Abstract

A 59-year-old male farmer in [New York] USA, presented with sudden onset of fever and confusion. On physical examination, he was minimally responsive with meningismus, and had a temperature of 39.2°C, blood pressure of 115/63 mmHg, pulse rate of 135 beats/min and respiratory rate of 22 breaths/min. White cell count was 12 800/mm3 with 73% neutrophils. A lumbar puncture yielded the following: cloudy fluid with 3520 white cells/mm3, glucose less than 1 mg/dl, total protein of 368 mg/dl, and a Gram staining showed Gram-positive diplococci. Ceftriaxone (2 g), vancomycin (1 g every 12 h) and dexamethasone (0.15 mg/kg body weight every 6 h) were given intravenously. His condition deteriorated and he required intubation. Cultures of blood and cerebrospinal fluid obtained at presentation grew Streptococcus suis. His antibiotic therapy was changed to intravenous ampicillin (2 g every 4 h). On hospital day 4, he was extubated; he was verbally responsive and able to follow commands. The next day, he reported low back pain. Magnetic resonance imaging revealed discitis and osteomyelitis of L3 and L4. He was discharged to his home without symptoms and neurologically intact after a 13-day hospital stay, with instructions to complete 6 weeks total of intravenous ampicillin, followed by 6 weeks of oral clindamycin (450 mg, thrice daily) for presumed osteomyelitis. At the completion of antibiotic therapy, he appeared well and had no back pain. The infection was thought to be transmitted to the patient through handling of infected pigs.