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Published on: July 1, 2018
Streptococcus suis Meningitis: A Systematic Review and Meta-analysis
Anusha van Samkar1, Matthijs C Brouwer1, Constance Schultsz2
1Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Department of Neurology, Amsterdam, the Netherlands.
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.
Methodology:
Studies 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.
Findings:
We 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.
Insights
Streptococcus suis meningitis, common in Southeast Asia, is linked to pig contact. While mortality is low, hearing loss is frequent, but dexamethasone may reduce this risk.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- Streptococcus suis meningitis is a significant cause of illness in pig-rearing regions of Southeast Asia.
- This systematic review focuses on defining the clinical profile, risk factors, and outcomes of S. suis meningitis.
Purpose of the Study:
- To systematically review and synthesize data on Streptococcus suis meningitis.
- To define the clinical characteristics, predisposing factors, and outcomes of S. suis meningitis.
Main Methods:
- Systematic review of studies published between 1980 and 2015.
- Inclusion criteria: West-European languages, minimum of 5 adult patients with described clinical characteristics of S. suis meningitis.
Main Results:
- 913 patients from 24 studies (1980-2015) were analyzed.
- Fever (97%), headache (95%), and neck stiffness (93%) were common symptoms; 61% had pig/pork exposure.
- Case fatality rate was 2.9%, with hearing loss affecting 53% of patients. Dexamethasone use was associated with reduced hearing loss.
Conclusions:
- S. suis meningitis is strongly associated with contact with pigs or pork products.
- The condition has a low mortality rate but frequently results in hearing loss.
- Dexamethasone treatment shows potential in mitigating hearing loss sequelae.
