Journal Article

Streptococcus suis Meningitis in Adults in Vietnam

Thi Hoang Mai, Nguyen, Dieu Linh, Le, Xuan Sinh, Dinh, Campbell, James, Dang Trung Nghia, Ho, de Jong, Menno D., Ngoc Minh, Tran, Hoan Phu, Nguyen, Farrar, Jeremy, Thi Hong Chau, Tran, Van Vinh Chau, Nguyen, Tinh Hien, Tran, Thi Hoa, Ngo, Vu Thieu Nga, Tran, Van Chuong, Ly, Tran Chinh, Nguyen, Song Diep, To, Schultsz, Constance

2008

Overview

Background. Streptococcus suis infection is an emerging zoonosis in Asia. We determined the detailed epidemiological, clinical, and microbiological characteristics of S. suis meningitis in adults. Methods. We prospectively studied 450 patients with suspected bacterial meningitis. Four hundred thirty-five (96.7%) of the patients participated in a trial to determine the effect of adjunctive dexamethasone treatment. For patients with S. suis infection, bacterial DNA load at hospital admission and during treatment was analyzed in cerebrospinal fluid specimens using quantitative real-time polymerase chain reaction. S. suis strains were characterized using pulsed-field gel electrophoresis and multilocus sequence typing. Putative virulence factors, including extracellular protein factor, suilysin, and muramidase released protein, were detected using polymerase chain reaction and Western blot assay. Predictors of outcome were identified using logistic regression analysis. Results. S. suis was the most common pathogen and was detected in 151 (33.6%) of the patients. Fifty (33.1%) of these 151 patients reported exposure to pigs or pork. Mortality was low (2.6%; 4 of 151 patients died), but mild to severe hearing loss occurred in 93 (66.4%) of 140 patients. Severe deafness at hospital discharge was associated with age >50 years (odds ratio, 3.65; 95% confidence interval, 1.15–11.6), a strain carrying the epf gene (odds ratio, 3.42; 95% confidence interval, 1.02–11.4), and dexamethasone therapy (odds ratio, 0.23; 95% confidence interval, 0.06–0.78) but was not associated with cerebrospinal fluid bacterial DNA load. Bacterial DNA was still detectable in 58 (63%) of 92 cerebrospinal fluid samples after 6–10 days of antimicrobial treatment. Ninety-one of 92 S. suis strains had serotype 2. Thirty-three (36%) of these epidemiologically unrelated strains belonged to 1 pulsed-field gel electrophoresis cluster of multilocus sequence type 1, indicating clonal spread. Conclusion. S. suis serotype 2 is the most frequent cause of bacterial meningitis in adults in southern Vietnam and is associated with substantial morbidity attributable to hearing loss.

• Publisher: The University of Chicago Press,University of Chicago Press,Oxford University Press
• Subject: Adult / Adults / Aged / Aged, 80 and over / Analysis of Variance / Animals / Articles and Commentaries / Bacteria / Bacterial diseases / Bacterial diseases of the nervous system. Bacterial myositis / Bacterial DNA / Bacterial meningitis / Biological and medical sciences / Clinical outcomes / Deafness / Deoxyribonucleic acid / Dexamethasone - therapeutic use / DNA / DNA, Bacterial - genetics / DNA, Bacterial - isolation & purification / Electrophoresis / Female / Glasgow Coma Scale / Hearing loss / Hospital admissions / Human bacterial diseases / Humans / Infections / Infectious diseases / Male / Medical sciences / Meningitis / Meningitis, Bacterial - epidemiology / Middle Aged / Morbidity / Neisseria meningitidis - genetics / Neisseria meningitidis - isolation & purification / Pneumococcal meningitis / Polymerase chain reaction / Regression analysis / Staphylococcal infections, streptococcal infections, pneumococcal infections / Streptococcal Infections - epidemiology / Streptococcus infections / Streptococcus pneumoniae - genetics / Streptococcus pneumoniae - isolation & purification / Streptococcus suis / Streptococcus suis - genetics / Streptococcus suis - isolation & purification / Studies / Symptoms / Treatment Outcome / Vietnam - epidemiology / Young Adult / Zoonoses - epidemiology