[A Japanese case of Streptococcus suis meningitis associated with lumbar epidural abscess]

A 47-year-old man working at a meat processing factory was admitted to our hospital after suffering high fever and severe headache for a 2-day period. He was alert and showed no neurological symptoms apart from neck stiffness. The CSF was turbid, with 701/microliter of polymorphnuclear leukocytes, a protein concentration of 218 mg/ml, and a sugar concentration of 33 mg/dl. He was diagnosed as suffering from Streptococcus suis (S. suis) serotype 2 meningitis based on CSF culture. Severe headache and high fever subsided after the treatment with intravenous antibiotics and immunoglobin. He developed, however, severe lumbargo on the third day, which was proven to be caused by the lumbar epidural abscess. Also, on the 8th day he developed hearing loss. These symptoms were treated and ameliorated with the administration of dexamethasone. On the 73rd day, the patient was discharged in good clinical condition, although he still suffered from a decrease in hearing perception. S. suis, found as a commensal in the nasopharynx of swine, is responsible for meningitis in the people who are in close contact with swine or unprocessed pork. S. suis meningitis seems to be the result of a preventable occupational infection. Although most of the patients come from other countries in Asia, our patient is the first documented case occurring in Japan. Those who have an occupational exposure to swine and pork are strongly recommended to use protective gloves. Prevention through public health surveillance is important.