title: [An outbreak of human Streptococcus suis serotype 2 infections presenting with toxic shock syndrome in Sichuan, China].
abstract: OBJECTIVE
  In mid-July 2005, five patients presented with septic shock to a hospital in Ziyang city in Sichuan, China, to identify the etiology of the unknown reason disease, an epidemiological, clinical, and laboratory study were conducted.
  
  
  METHODS
  An enhanced surveillance program were established in Sichuan, the following activities were introduced: active case finding in Sichuan of (a) laboratory diagnosed Streptococcus suis infection and (b) clinically diagnosed probable cases with exposure history; supplemented by (c) monitoring reports on meningococcal meningitis. Streptococcus suis serotype 2 infection was confirmed by culture and biochemical reactions, followed by sequencing for specific genes for serotype and virulence factors.
  
  
  RESULTS
  From June 10 to August 21, 2005, 68 laboratory confirmed cases of human Streptococcus suis infections were reported. All were villagers who gave a history of direct exposure to deceased or sick pigs in their backyards where slaughtering was performed. Twenty six (38%) presented with toxic shock syndrome of which 15 (58%) died. Other presentations were septicaemia or meningitis. All isolates were tested positive for genes for tuf, species-specific 16S rRNA, cps2J, mrp, ef and sly. There were 136 clinically diagnosed probable cases with similar exposure history but incomplete laboratory investigations.
  
  
  CONCLUSIONS
  An outbreak of human Streptococcus suis serotype 2 infections occurred in villagers after direct exposure to deceased or sick pigs in Sichuan. Prohibition of slaughtering in backyards brought the outbreak to a halt. A virulent strain of the bacteria is speculated to be in circulation, and is responsible for the unusual presentation of toxic shock syndrome with high case fatality.
authors.affiliation: Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention, Beijing 100050, China. ywz126@vip.sina.com
authors.forename: Wei-zhong
authors.initials: WZ
authors.lastname: Yang
authors.forename: Hong-jie
authors.initials: HJ
authors.lastname: Yu
authors.forename: Huai-qi
authors.initials: HQ
authors.lastname: Jing
authors.forename: Jian-guo
authors.initials: JG
authors.lastname: Xu
authors.forename: Zhi-hai
authors.initials: ZH
authors.lastname: Chen
authors.forename: Xiao-ping
authors.initials: XP
authors.lastname: Zhu
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.forename: Xue-cCheng
authors.initials: XC
authors.lastname: Liu
authors.forename: Shi-wen
authors.initials: SW
authors.lastname: Wang
authors.forename: Lun-guang
authors.initials: LG
authors.lastname: Liu
authors.forename: Rong-qiang
authors.initials: RQ
authors.lastname: Zu
authors.forename: Long-ze
authors.initials: LZ
authors.lastname: Luo
authors.forename: Ni-juan
authors.initials: NJ
authors.lastname: Xiang
authors.forename: Hong-lu
authors.initials: HL
authors.lastname: Liu
authors.forename: Wen-jun
authors.initials: WJ
authors.lastname: Zhong
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Ling
authors.initials: L
authors.lastname: Meng
authors.forename: Heng
authors.initials: H
authors.lastname: Yuan
authors.forename: Yong-jun
authors.initials: YJ
authors.lastname: Gao
authors.forename: Hua-mao
authors.initials: HM
authors.lastname: DU
authors.forename: Yang-bin
authors.initials: YB
authors.lastname: Ou
authors.forename: Chang-yun
authors.initials: CY
authors.lastname: Ye
authors.forename: Dong
authors.initials: D
authors.lastname: Jin
authors.forename: Qiang
authors.initials: Q
authors.lastname: Lv
authors.forename: Zhi-gang
authors.initials: ZG
authors.lastname: Cui
authors.forename: Yan
authors.initials: Y
authors.lastname: Huang
authors.forename: Shou-yin
authors.initials: SY
authors.lastname: Zhang
authors.forename: Xiang-dong
authors.initials: XD
authors.lastname: An
authors.forename: Ting
authors.initials: T
authors.lastname: Huang
authors.forename: Xing-yu
authors.initials: XY
authors.lastname: Zhou
authors.forename: Liao
authors.initials: L
authors.lastname: Feng
authors.forename: Qi-di
authors.initials: QD
authors.lastname: Pang
authors.forename: Yue-long
authors.initials: YL
authors.lastname: Shu
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
mesh_terms: D000818:Animals; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D006801:Humans; D016920:Meningitis, Bacterial / Q000453:epidemiology / Q000382:microbiology; D012772:Shock, Septic / Q000453:epidemiology* / Q000382:microbiology*; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000662:veterinary; D017011:Streptococcus suis / Q000302:isolation & purification*; D013552:Swine; D013553:Swine Diseases / Q000382:microbiology