title: [Streptococcus suis infection--clinical manifestations].
abstract: BACKGROUND
  Streptococcus suis is a bacterium causing a disease in pigs and rarely in humans. This zoonosis is mostly found as a sporadic disease in individuals that were in contact with the affected or infected pigs: farmers, veterinarians and workers engaged in fresh pork processing. It is assumed that the bacterium enters the body through a cut abrasion in the skin. Initially, the condition resembles a flu, followed by signs of bacteriemia and sepsis. The most frequent clinical manifestation of Streptococcus suis infection is meningitis, leading to hearing loss in over 75% of patients, and subsequent arthritis, endophtalmitis, endocarditis and pneumonia. Toxic shock syndrome with hemorhagic manifestations rarely develops.
  
  
  METHODS
  This study included five male patients aged 22 to 63 years treated in the Intensive Care Unit of the Institute of Infectious and Tropical Diseases in Belgrade, due to Streptococcus suis infection. The aim of this study was to point to the existence of this bacteria in our environment, to describe clinical manifestations of the disease and to point out the importance of its prevention.
  
  
  RESULTS
  All patients had epidemiological evidence of being in contact with pork meat. There were no data about diseased pigs. The estimated incubation period was 4 to 8 days. All patients had meningeal signs. Clinical symptoms included shivering, fever, vomiting, headache, malaise, vertigo and tinitus. Three patients presented with alerterd level of awarrness. Four patients developed very severe bilateral hearing impairment, whereas one endophtalmtis and one developed endocarditis. The cerebrospinal fluid (CSF) was opalescent in four patients, and only one patient presented with clear CSF. CSF examination showed typical changes characteristic for bacterial meningitis. Streptoccocus suis was isolated in CSF in all patients, and in one patient the bacteria was isolated in blood as well. All patients underwent treatement with II and III generation cephalosporins and one with one aminoglycosides. All patients were cured, but 4 of them developed sequelae like permanent sensorineural deafness and mild ataxia.
  
  
  CONCLUSIONS
  Streptococcus suis infection is present as a zoonosis in pigs, while humans are contracted occasionaly, most frequently related to occupational risk. In cases with bacterial meningitis with sepsis and hearing loss, Streptococcus suis infections must be suspected. Effective prevention requires collaboration between epidemiologists, veterinarians and human medicine physicians.
authors.affiliation: Klinicki centar Srbije Institut za infektivne i tropske bolesti Centar za infekcije nervnog sistema sa odeljenjem za intenzivno lecenje i reanimaciju.
authors.forename: Julijana
authors.initials: J
authors.lastname: Dragojlović
authors.forename: Branko
authors.initials: B
authors.lastname: Milosević
authors.forename: Neda
authors.initials: N
authors.lastname: Sasić
authors.forename: Mijomir
authors.initials: M
authors.lastname: Pelemis
authors.forename: Milan
authors.initials: M
authors.lastname: Sasić
mesh_terms: D000328:Adult; D000818:Animals; D006801:Humans; D008297:Male; D008875:Middle Aged; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000635:transmission; D017011:Streptococcus suis; D013552:Swine / Q000382:microbiology; D015047:Zoonoses