[Meningitis caused by Streptococcus suis type 2 in an adult]

A 54-year-old huntsman who 3 days previously had shot a wild pig, developed severe headache, nausea and vomiting over the last 10 hours. Physical examination was unremarkable except for an 8 x 4 cm large reddening of the skin over the right tibia and fever (38.2 degrees C).

Cranial computed tomography was normal. Cerebrospinal fluid showed pleocytosis (5.200 cells/mm3). Gram-stained (CSF) smear showed gram-positive cocci and an increased white cell count (14,000/microliters) was found in blood.

After the diagnosis of bacterial meningitis had been made antibiotics were given intravenously (penicillin G 10 mill. IU, three times daily on days 1 to 16: at first with cefotaxim, three times daily 2 g on days 1 to 3, then with gentamicin twice 80 mg on days 3 to 13). The acute neurological signs quickly regressed, the pretibial reddening (presumably at the port of entry) disappeared, as did the fever on the 4th day of the illness. The streptococci isolated from CSF and blood were identified as 5. suis type 2 (Lancefield group R). But despite the early and effective antibiotic treatment cochleovestibular symptoms (hearing impairment, vertigo and unsteady gait) set in after initial improvement, a frequent complication of S. suis meningitis.

S. suis should be considered as the causative organism of generalized septicaemia and meningitis in adults, if the history reveals contact with domestic or wild pigs and there are early cochleovestibular signs.