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Pyogenic Spondylitis with Epidural Abscess Caused by Streptococcus suis Serotype 2 ST7: Tissue mNGS Confirmation and
Peiyan He1, Henghui Wang1, Ping Li1
1Jiaxing Key Laboratory of Pathogenic Microbiology, Jiaxing Center for Disease Control and Prevention, Jiaxing 314050, China.
Abstract:
Streptococcus suis is an emerging zoonotic pathogen that typically causes bacteremia or meningitis in humans, whereas vertebral osteomyelitis with epidural abscess is exceedingly rare and may be missed. We describe a 65-year-old farmer with fever and severe low back pain after long-term bare-handed handling of raw pig lungs. Pre-treatment blood cultures yielded S. suis identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). After transient improvement on empirical therapy, fever recurred with worsening lumbar pain. Contrast-enhanced magnetic resonance imaging (MRI) demonstrated multilevel thoracolumbar pyogenic spondylitis with an epidural abscess and a sub-ligamentous abscess beneath the posterior longitudinal ligament (PLL) extending from L2 to L5. Computed tomography-guided lumbar biopsy followed by tissue metagenomic next-generation sequencing (mNGS) detected S. suis, providing concordant evidence supporting pathogen involvement at the vertebral focus. The bloodstream isolate (SS-JX2025-01) was serotype 2, sequence type 7 (ST7). It remained susceptible to β-lactams and glycopeptides but was resistant to macrolide-lincosamide and tetracycline classes, consistent with erm(B), tet(O), tet(40), and ant(6)-Ia detected by whole-genome sequencing (WGS). Virulence profiling revealed an epf+/sly+/mrp- pattern with multiple adhesins and immune-evasion factors, whereas canonical 89K pathogenicity island markers were absent. Core-genome phylogeny placed SS-JX2025-01 within the Chinese ST7 lineage associated with previous outbreaks. This biopsy-supported case expands the clinical spectrum of invasive S. suis infection, highlights the value of tissue mNGS as an adjunct for supporting deep-seated foci in zoonotic infections, and underscores the importance of occupational prevention in small-scale farming households.
Insights
A rare case of vertebral osteomyelitis caused by Streptococcus suis in a farmer highlights the importance of occupational safety. This zoonotic infection, typically causing meningitis, presented as a severe spinal epidural abscess, emphasizing the need for advanced diagnostics.
Area of Science:
- Infectious Diseases
- Microbiology
- Zoonotic Infections
Background:
- Streptococcus suis is an emerging zoonotic pathogen causing bacteremia and meningitis in humans.
- Vertebral osteomyelitis with epidural abscess due to S. suis is exceptionally rare and challenging to diagnose.
- Occupational exposure, such as handling raw pig products, is a risk factor for S. suis infection.
Purpose of the Study:
- To describe a rare case of vertebral osteomyelitis and epidural abscess caused by Streptococcus suis.
- To highlight the diagnostic utility of tissue metagenomic next-generation sequencing (mNGS) in deep-seated zoonotic infections.
- To characterize the virulence factors and antimicrobial resistance profile of the infecting S. suis strain.
Main Methods:
- Case report of a 65-year-old farmer with symptoms of fever and low back pain.
- Identification of S. suis from blood cultures using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS).
- Advanced imaging (MRI) to delineate the extent of vertebral and epidural abscess.
- Computed tomography-guided lumbar biopsy and tissue metagenomic next-generation sequencing (mNGS) for pathogen detection.
- Whole-genome sequencing (WGS) for antimicrobial resistance gene detection and phylogenetic analysis.
Main Results:
- S. suis was identified in blood cultures and confirmed in vertebral/epidural abscess tissue via mNGS.
- The isolate (SS-JX2025-01) was serotype 2, sequence type 7 (ST7), susceptible to beta-lactams and glycopeptides, but resistant to macrolides and tetracyclines.
- Virulence profiling indicated the presence of epf and sly, with absence of 89K pathogenicity island markers.
- Phylogenetic analysis placed the isolate within the Chinese ST7 lineage associated with outbreaks.
Conclusions:
- This case expands the known clinical spectrum of invasive S. suis infections to include vertebral osteomyelitis with epidural abscess.
- Tissue mNGS is a valuable adjunct for diagnosing deep-seated zoonotic infections, providing concordant evidence.
- Occupational prevention strategies are crucial, especially in small-scale farming households, to mitigate the risk of S. suis transmission.
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