A case report of atypical human infection with Streptococcus suis purulent meningitis
Ailing Han1,2, Jialing Guo1,2, Yidan Wang1,2
1The Hospital of Chifeng, Chifeng, China.
Rationale:
We report a case of purulent meningitis caused by Streptococcus suis infection in a 65-year-old male patient. The patient had no typical epidemiological history and was admitted with fever, headache, and psycho-behavioral abnormalities. Compared with previous reports, this case has particularities in terms of diagnostic methods, epidemiology and clinical manifestations. Combined with the literature analysis, it aims to provide reference for clinical development of targeted diagnosis and treatment plan, clear research direction and guide public health institutions to carry out traceability prevention and control.
Patient Concerns:
Fever, headache, psychiatric behavioral abnormalities (delirium, confusion), neck stiffness, and a positive Kernig's sign, indicating meningeal irritation; there were no symptoms such as nausea, vomiting, or convulsions.
Diagnoses:
Purulent meningitis caused by S suis infection.
Interventions:
During the initial stage, broad-spectrum antibiotics such as meropenem and vancomycin were administered empirically. After confirmation of S suis infection, the treatment was adjusted to a high-dose penicillin combined with vancomycin. Supportive therapies, including neurotrophic agents, hepatoprotective drugs, and electrolyte imbalance correction, have also been provided.
Outcomes:
Following treatment, the frequency of fever decreased, consciousness was restored, and inflammatory marker levels improved. Hearing loss remained a sequela. The patient was discharged approximately 2 months after hospitalization and continued penicillin therapy, with instructions to return for follow-up if any discomfort occurred.
Lessons:
This case suggests that vigilance is required even in the absence of a typical epidemiological history; attention should be paid to including next generation sequencing technology in the diagnostic process of unexplained meningitis in order to shorten the time of diagnosis, guide precise anti-infective treatment, avoid antibiotic abuse and reduce drug resistance. When the clinical manifestations are atypical, the influence of pathogenic variants or early treatment needs to be considered and should not be restricted to classical manifestations. In addition, reporting such cases is of great public health importance to regional healthcare facilities and helps raise awareness of zoonoses diagnosis, even in non-endemic areas.
Insights
This case highlights Streptococcus suis meningitis in a patient without typical history. Early diagnosis using advanced techniques like next-generation sequencing is crucial for effective treatment and preventing zoonotic disease spread.
Area of Science:
- Infectious Diseases
- Neurology
- Public Health
Background:
- A case of purulent meningitis caused by Streptococcus suis infection in a 65-year-old male is presented.
- The patient lacked a typical epidemiological history and presented with fever, headache, and behavioral changes.
Purpose of the Study:
- To analyze unique diagnostic, epidemiological, and clinical aspects of this Streptococcus suis meningitis case.
- To provide insights for targeted diagnosis, treatment, research, and public health control strategies.
Main Methods:
- Initial empirical treatment with broad-spectrum antibiotics (meropenem, vancomycin).
- Treatment adjustment to high-dose penicillin and vancomycin upon confirmation of S. suis.
- Supportive therapies including neurotrophic agents and electrolyte correction.
Main Results:
- Successful treatment led to reduced fever, restored consciousness, and improved inflammatory markers.
- Hearing loss was noted as a sequela.
- The patient was discharged after two months with ongoing penicillin therapy.
Conclusions:
- Vigilance for S. suis meningitis is necessary, even without typical exposure history.
- Next-generation sequencing can expedite diagnosis of unexplained meningitis, guiding precise treatment and reducing antibiotic resistance.
- Awareness of zoonotic diseases like S. suis meningitis is vital for public health, even in non-endemic regions.
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