Abstract
Streptococcus suis (S. suis) is an emerging zoonotic pathogen, demonstrated as an etiological agent in human infections in increasing frequency, including diseases like purulent meningitis, sepsis, uveitis-endophtalmitis and arthritis. Due to the increased availability and utility of novel diagnostic technologies in clinical microbiology, more studies have been published on the epidemiology of S. suis, both in veterinary and human medicine; however, there are no comprehensive data available regarding human S. suis infections from East-Central European countries. As a part of our study, data were collected from the National Bacteriological Surveillance (NBS) system on patients who had at least one positive microbiological result for S. suis, corresponding to an 18-year study period (2002–2019). n = 74 S. suis strains were isolated from invasive human infections, corresponding to 34 patients. The number of affected patients was 1.89 ± 1.53/year (range: 0–5). Most isolates originated from blood culture (63.5%) and cerebrospinal fluid (18.9%) samples. Additionally, we present detailed documentation of three instructive cases from three regions of the country and with three distinctly different outcomes. Hungary has traditional agriculture, the significant portion of which includes the production and consumption of pork meat, with characteristic preparation and consumption customs and unfavorable epidemiological characteristics (alcohol consumption, prevalence of malignant diseases or diabetes), which have all been described as important predisposing factors for the development of serious infections. Clinicians and microbiologist need to be vigilant even in nonendemic areas, especially if the patients have a history of occupational hazards or having close contact with infected pigs.
Highlights
Streptococcus suis (S. suis) is an emerging zoonotic pathogen, which has been demonstrated as an etiological agent in human infections in increasing frequency [1,2]
During the 18-year study period (2002–2019) n = 74 S. suis strains were isolated from invasive human infections in Hungarian hospitals, corresponding to 34 patients
Among the indications listed for sample submissions, the most common was meningitis (n = 36, 48.6%), followed by fever (n = 18, 24.4%), sepsis (n = 10, 13.5%), and other infectious processes (n = 10, 13.5%)
Summary
Streptococcus suis (S. suis) is an emerging zoonotic pathogen, which has been demonstrated as an etiological agent in human infections in increasing frequency [1,2]. The clinical presentations of these—often serious or life-threatening—infections may be wide-ranging, including syndromes such as purulent meningitis, sepsis, streptococcal toxic shock-like syndrome (STSLS), uveitis-endophthalmitis and arthritis; S. suis has been described as an opportunistic pathogen of lower respiratory tract infections (e.g., pneumonia) [3,4,5]. The number of human S. suis cases reported has increased over the past few years, with the highest prevalence rate in Southeast Asia, where there is a high rate of pig meat consumption: the majority of these infections originated from Thailand (~36%), Vietnam (~30%) and China (~22%); Thailand and Vietnam have the highest disease prevalence stratum globally, with estimated 0.82 and 0.54 cases/100,000 population, respectively [13,14]. The clinical relevance of these invasive infections must not be underestimated; based on the results of a meta-analysis, the mortality rate associated with these infections is 12.8% (confidence interval: 9.0%–18.0%), with notable geographical differences observed among geographical regions (Asia: up to 26%, Western countries: 2–4%); in addition, almost half of the patients experience some kind of neurological sequelae after recovery [4]
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