Meningitis caused by swine streptococcus

Swine Streptococcus can cause many diseases such as hemorrhage, pneumonia, meningitis, arthritis and myocarditis,... In which, swine streptococcus meningitis is a particularly dangerous condition. potentially life-threatening to the patient.

1. What is Swine Streptococcus?

Streptococcus suis (swine streptococcus) is an important pathogen in pigs and can sometimes cause disease in humans. This type of bacteria usually resides in the respiratory tract, digestive tract and genitals of pigs. In addition, it also exists in some other animals such as cows, goats, sheep, even dogs, cats,... Streptococcus suis has the ability to live well in outdoor conditions. Specifically, it can live up to 6 weeks in animal carcasses at 10°C, 2 hours at 50°C. At 0°C, this bacterium can survive up to 1 month in dust, more than 3 months in feces.
However, it can be easily destroyed by bleach. Swine Streptococcus is also sensitive to many antibiotics, so antibiotics have been widely used in the prevention and treatment of this bacteria.
Swine strep bacteria can be transmitted to humans by direct contact (through wounds in the skin and mucous membranes). Specifically, the bacteria is transmitted through lesions on the skin of people who slaughter, process, or eat undercooked diseased pork. People who are prone to disease caused by swine streptococcus are mainly immunocompromised subjects such as the elderly and weak, those who have undergone splenectomy, alcoholism, and chronic diseases in humans. Streptococcus suis can cause many pathologies such as gastrointestinal toxicity, meningitis, pneumonia, hemorrhage, arthritis and myocarditis. In more severe cases, patients may experience septic shock, blood clotting disorders, respiratory failure and multi-organ failure, which can easily lead to death. Among them, meningitis is a fairly common disease.
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2. Overview of swine streptococcal meningitis

Meningitis is an infection of the membranes covering the brain and spinal cord caused by swine streptococcus.
2.1 Clinical symptoms Incubation period: Usually about 1 week after the patient slaughters, processes sick/dead pork or eats undercooked pork (especially pig head and pig intestine). In addition, it is not excluded that the patient is exposed to other livestock species such as cows, goats,...; Stage of onset: The disease has an acute onset in 1-2 days with symptoms of high fever, accompanied by chills, headache, nausea and vomiting, dizziness. In many cases, patients suffer from muscle fatigue, skin pain, and possibly joint pain. There are cases of dull abdominal pain, loose stools without bloody mucus; Full-blown stage: The patient has had obvious meningeal syndrome such as muscle spasms (especially in the nape of the neck), disturbances in consciousness (delirium, lethargy), agitation, even coma. Accompanied by focal neurological symptoms such as hearing loss (even severe deafness in both ears), postural-motor coordination disorders, cranial nerve palsies, tremors in the extremities,...; Other symptoms: Mild acute renal failure, skin rash (e.g. widespread erythema or purpura), extremity embolism, dry necrosis of the fingers and toes; After specific treatment, the fever gradually decreased and then disappeared, but the neurological symptoms decreased quite slowly. Patients may experience sequelae of hearing loss, impaired coordination of posture - movements.

2.2 Laboratory tests Peripheral blood tests: There is an increase in the number of white blood cells and neutrophils. If testing is early in the onset or in severe disease, white blood cells may not be elevated. Severe cases often have thrombocytopenia or other coagulation disorders. Slight increase in liver enzymes ALT and AST, slight increase in urea and creatinine. There may be proteinuria in the urine; Cerebrospinal fluid examination can detect Gram-positive cocci in pairs or chains; Cerebrospinal fluid: Cloudy, increased pressure of cerebrospinal fluid. When biochemical tests of cerebrospinal fluid show an increase in protein, a decrease in glucose. On cytological examination showed an increase in the number of cells in the CSF, increased neutrophils; Culture machine and cerebrospinal fluid: Streptococcus suis is found, usually type 2. 2.3 Complications of the disease Osteomyelitis, spondylitis, discitis; Epidural abscess; Accompanying purulent meningitis is endophthalmitis, arthritis; Dizziness and hearing loss can become sequelae of the disease.
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2.4 Treatments Meningococcal meningitis caused by swine streptococcus has a very rapid progression, requiring prompt antibiotic treatment to improve the patient's chances of recovery. Delaying treatment can increase the risk of permanent brain damage and even death. Treatment methods for patients include:
Specific treatment
Use of antibiotics: Ampicillin, Penicillin G, third generation Cephalosporins,... Initial dose can be: Ampicillin 2g intravenously/time, every 4 hours (for children, the dose is 200mg/kg/24 hours); can be combined with or used alone, ceftriaxone injection or intravenous infusion 2g/time, every 12 hours (for children, the dose is 100mg/kg/24 hours); After 2-3 days, it is necessary to have a lumbar puncture to assess the response to treatment, then adjust the antibiotic according to the results of the antibiogram and the patient's clinical response; Use antibiotics until the CSF test returns to normal (or 3 weeks). Supportive treatment
Respiratory support: In case of coma, it is necessary to put an endotracheal tube early to protect the airway, mechanical ventilation can be given when necessary; Anticonvulsants: Use Diazepam 0.1 mg/kg/time intravenously, with rectal enema for children. After 15 minutes, if convulsions still occur, continue to use again; Against cerebral edema: Use Mannitol 20% 0.5 -1 g/kg IV infusion for 20-30 minutes, repeat after 6 hours, and closely monitor the patient's clinical symptoms; Anti-inflammatory: Use Methylprednisolone 0.5 - 1 mg/kg/24 hours before antibiotics. 2.5 Health monitoring and patient care Health monitoring
Severe cases of meningitis requiring monitoring and treatment in the emergency room; Monitor the patient's consciousness; Monitor vital signs including breathing rate, SpO2, pulse, temperature, blood pressure, urine; Monitor bleeding of internal organs and mucous membranes; Monitor for signs of increased intracranial pressure such as headache, vomiting, slow pulse, increased blood pressure, abnormally dilated pupils,... Health Care
Patient's position: Keep head elevated 30°; Respiratory: If indicated, give the patient oxygen, and at the same time aspirate sputum to ensure the patient's airway; Nutrition: For patients who cannot eat, it is necessary to actively feed through a nasogastric tube to ensure sufficient energy and balance of necessary micronutrients; Careful hygiene, change lying positions to prevent ulcers, reasonable exercise and therapy. The patient is discharged from the hospital if there are no signs of shock, infection and meningitis; Fever was gone for 3 days and peripheral blood tests returned to normal.

2.6 Disease prevention and control measures Streptococcus suis in pigs, disease prevention in pigs; Control the raising and slaughter of pigs so that the disease does not spread to humans; Do not have direct contact with sick or dead pigs. If you have to handle sick or dead pigs, you need to use protective equipment such as gloves, boots, medical masks,...; Do not slaughter or eat sick, dead or pigs of unknown origin; Should buy pork that has been tested, avoid buying pork with unusual red color, edema or bleeding; Store pork processing equipment in a clean place, wash hands and utensils after handling pork, use separate raw and cooked meat processing equipment; Only eat pork that has been fully cooked. Do not eat undercooked pork such as rare meat, pork intestines, blanched viscera, blood pudding, spring rolls,... Meningitis caused by streptococci is a dangerous disease that can leave many serious sequels. severe, even life-threatening. Therefore, patients need to pay attention to cooked food, drink boiling water, apply effective preventive measures to avoid the risk of contracting this dangerous disease.
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