Bakterielle Meningitis durch Streptococcus suis

HISTORY AND ADMISSION FINDINGS: A 42-year-old man was admitted to hospital because of headache and fever for two days and showing signs of meningism. As a butcher he had had frequent cuts on his hands and forearms. INVESTIGATIONS AND DIAGNOSIS: Analysis of the cerebrospinal fluid revealed an elevated leukocyte count (81% segmented neutrophils). Large numbers of Gram-positive bacteria were found in both cerebrospinal fluid and blood culture, which were subsequently identified as Streptococcus suis (S. suis) by biochemical methods. The hypothesis of bacterial meningitis was thus confirmed. TREATMENT AND CLINICAL COURSE: The patient was treated with ampicillin, initially combined with ceftriaxone. Hearing impairment and vestibular dysfunction - a frequent complication after infection with S. suis - were observed as sequelae, indicating involvement of the vestibulocochlear nerve. CONCLUSION: Infections caused by S. suis are rare in Europe but must be taken into account if an occupational exposition to pigs is established.