title: First human case report of sepsis due to infection with Streptococcus suis serotype 31 in Thailand.
abstract: BACKGROUND
  Streptococcus suis is a zoonotic pathogen that causes invasive infections in humans and pigs. It has been reported that S. suis infection in humans is mostly caused by serotype 2. However, human cases caused by other serotypes have rarely been reported. This is the first report of a human case of infection with S. suis serotype 31 in Thailand.
  
  
  METHODS
  A 55-year-old male alcohol misuser with liver cirrhosis was admitted with sepsis to a hospital in the Central Region of Thailand. He had consumed a homemade, raw pork product prior to the onset of illness. He was alive after treatment with ceftriaxone and no complication occurred. An isolate from blood culture at the hospital was suspected as viridans group Streptococcus. It was confirmed at a reference laboratory as S. suis serotype 31 by biochemical tests, 16S rDNA sequencing, and multiplex polymerase chain reaction for serotyping, but it was untypable by the co-agglutination test with antisera against recognized S. suis serotypes, suggesting loss of capsular material. The absence of a capsule was confirmed by transmission electron microscopy. The isolate was confirmed to be sequence type 221, with 13 putative virulence genes that are usually found in serotype 2 strains.
  
  
  CONCLUSIONS
  We should be aware of the emergence of S. suis infections caused by uncommon serotypes in patients with predisposing conditions. Laboratory capacity to identify S. suis in the hospital is needed in developing countries, which can contribute to enhanced surveillance, epidemiological control, and prevention strategies in the prevalent area.
authors.affiliation: Faculty of Science and Engineering, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Muang, Sakon Nakhon Province, 47000, Thailand. h_rujirat@hotmail.com.
authors.forename: Rujirat
authors.initials: R
authors.lastname: Hatrongjit
authors.affiliation: National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Tiwanon Road, Muang, Nonthaburi Province, 11000, Thailand. noksak99@gmail.com.|Present address: Faculty of Public Health, Kasetsart University Chalermphrakiat Sakon Nakhon Province Campus, Sakon Nakhon, Thailand. noksak99@gmail.com.
authors.forename: Anusak
authors.initials: A
authors.lastname: Kerdsin
authors.affiliation: Faculty of Veterinary Medicine, University of Montreal, Québec, Canada. marcelo.gottschalk@umontreal.ca.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Gottschalk
authors.affiliation: Laboratory of Clinical Research on Infectious Diseases, International Research Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan. dantake@biken.osaka-u.ac.jp.
authors.forename: Dan
authors.initials: D
authors.lastname: Takeuchi
authors.affiliation: Thailand-Japan Research Collaboration Center on Emerging and Re-emerging Infections, Nonthaburi Province, Thailand. hamadas@biken.osaka-u.ac.jp.
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Hamada
authors.affiliation: Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Shinjyuku, Tokyo, Japan. oishik@nih.go.jp.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Oishi
authors.affiliation: Laboratory of Clinical Research on Infectious Diseases, International Research Center for Infectious Diseases, Research Institute for Microbial Diseases, Osaka University, 3-1 Yamadaoka, Suita, Osaka, 565-0871, Japan. akeda@biken.osaka-u.ac.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Akeda
mesh_terms: D000372:Agglutination Tests; D000818:Animals; D016667:Bacterial Capsules / Q000648:ultrastructure; D004275:DNA, Ribosomal / Q000235:genetics*; D006801:Humans; D008297:Male; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D060885:Multiplex Polymerase Chain Reaction; D066256:Raw Foods / Q000382:microbiology*; D000069466:Red Meat / Q000382:microbiology*; D018805:Sepsis / Q000382:microbiology*; D065288:Serogroup; D012703:Serotyping; D013290:Streptococcal Infections / Q000382:microbiology*; D017011:Streptococcus suis / Q000235:genetics* / Q000302:isolation & purification / Q000648:ultrastructure; D013552:Swine / Q000382:microbiology; D013785:Thailand; D014774:Virulence / Q000235:genetics
chemical_list: D004275:DNA, Ribosomal