Abstract
Background Streptococcus suis is the most common cause of meningitis in pork consuming and pig rearing countries in South-East Asia. We performed a systematic review of studies on S. suis meningitis to define the clinical characteristics, predisposing factors and outcome.MethodologyStudies published between January 1, 1980 and August 1, 2015 were identified from main literature databases and reference lists. Studies were included if they were written in West-European languages and described at least 5 adult patients with S. suis meningitis in whom at least one clinical characteristic was described.FindingsWe identified 913 patients with S. suis meningitis included in 24 studies between 1980 and 2015. The mean age was 49 years and 581 of 711 patients were male (82%). Exposure to pigs or pork was present in 395 of 648 patients (61%) while other predisposing factors were less common. 514 of 528 patients presented with fever (97%), 429 of 451 with headache (95%), 462 of 496 with neck stiffness (93%) and 78 of 384 patients (20%) had a skin injury in the presence of pig/pork contact. The case fatality rate was 2.9% and hearing loss was a common sequel occurring in 259 of 489 patients (53%). Treatment included dexamethasone in 157 of 300 (52%) of patients and was associated with reduced hearing loss in S. suis meningitis patients included in a randomized controlled trial.Conclusion S. suis meningitis has a clear association with pig and pork contact. Mortality is low, but hearing loss occurs frequently. Dexamethasone was shown to reduce hearing loss.
Highlights
Bacterial meningitis is a severe infectious disease with a high mortality and morbidity
We identified 913 patients with S. suis meningitis included in 24 studies between 1980 and 2015
S. suis meningitis has a clear association with pig and pork contact
Summary
Bacterial meningitis is a severe infectious disease with a high mortality and morbidity. Transmission of pathogens causing bacterial meningitis can occur directly from animals to humans, a condition referred to as zoonotic bacterial meningitis. One of the most common zoonotic pathogens causing bacterial meningitis is Streptococcus suis. This pathogen has its natural reservoir in pigs and may cause meningitis, endocarditis and sepsis in humans after contact with pig or pork [3, 4]. Due to high pork consumption and frequent small scale pig rearing, S. suis infection is endemic in South-East Asia, where several outbreaks and cohort studies of S. suis meningitis have been reported [5,6,7,8]. We performed a systematic review on studies on S. suis meningitis to define the clinical characteristics, risk factors and outcome of S. suis meningitis
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