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Introduction
Streptococcus suis is an important pathogen in swine, causing a wide range of diseases including arthritis, meningitis, pneumonia, septicaemia, endocarditis and abscesses. In humans, particularly those in close contact with pigs or pig products, it has been reported that meningitis and/or septicaemia followed by deafness can occur.1
Although its human pathogenicity has been recognised for more than 40 years,2 human infection from S suis was thought to occur only sporadically, until a large outbreak in China in July 2005 attracted renewed public and scientific interest.3 A 2007 review by Lun et al. identified a total number of 409 reported cases worldwide, mostly occurring in China, Thailand and the Netherlands.4 The Thai cases in this review included 47 patients from four articles published between 2001 and 2004.5-8
In 2006, the largest case series was reported by Chiang Mai University Hospital, involving 41 patients with S suis infection in Thailand. The overall mortality rate was 19.5 per cent. Post-meningitis hearing loss was identified in 30.7 per cent.9 Interestingly, only three of the 41 cases appeared retrospectively to have had a history of exposure to swine or pork products. Two studies by Fongcome and colleagues,5,10 however, reported 10 and 19 cases of S suis infection, variously, from Lamphun province (next to Chiang Mai province) in northern Thailand. All cases in these two studies had a history of raw pork or uncooked pig's blood consumption prior to their illness. Additionally, most had a history of chronic alcohol consumption.
The current paper presents the results of an additional 40 cases of S suis infection identified at our institution since January 2003. We assessed the mode of acquisition of S suis infection, the probable predisposing factors aggravating this infection, and details concerning survivors' long term hearing loss and vestibular function. We also present strategies which may prevent S suis infection, in the absence of an effective vaccine.
Materials and methods
The study was conducted at Chiang Mai University Hospital from January 2003 to January 2007. Clinical data for all patients identified as having S suis infection, obtained from clinical specimens forwarded to our central microbiological laboratory, were retrospectively collected and entered onto...