Discussion
We reported a rare case of pyogenic ventriculitis associated withS. suis infection. People who handle pork or its derivative
products are at a high risk of S. suis infection [1] since
the route of entry of the organism into humans is via small skin wounds
[12]. However, recent studies have shown that only 20% of patients
reported having skin wounds when handling pork [13]. Kushiyaki is a
traditional Japanese dish in which bite-sized pieces of chicken or pork
are skewered and grilled over an open fire. In this case, the patient
was a kushiyaki chef who handled pork with his bare hands. Since there
were small scars on his hands, probably linked to cooking kushiyaki, we
considered that to be the route of his infection. Kushiyaki chefs may be
at a higher risk of infection than people engaging in other activities
involving pigs. As there is no S. suis vaccine for humans
[14], hand washing and wearing personal protection equipment are the
most practical preventive measures.
Several patients with S. suis meningitis successfully recovered
following a treatment scheme similar to that used for pneumococcal
meningitis [15]. However, other patients with S. suismeningitis showed relapse 2 weeks post-treatment completion and required
prolonged therapy (4–6 weeks) [16]. Dejace et al. suggested that
treatment should be tailored to clinical and laboratory findings
[17]. A recent review found that the antimicrobial treatment
duration ranged from 7 to 42 days in cases of meningitis, spondylitis,
and endocarditis [1]. In this case, S. suis infection only
led to meningitis and pyogenic ventriculitis. Ventriculitis is a rare
condition secondary to meningitis [18] that can cause persistent
infection and treatment failure [19, 20]. Additionally, if
meningitis is associated with ventriculitis, prolonged antibiotic
treatment might be required. Only
one case of S. suismeningitis associated with ventriculitis has been reported so far; the
patient required longer antibiotic treatment than the usual 24-day
course for bacterial meningitis [21].
However, few studies have reported
ventriculitis in cases involving long-term antimicrobial treatment forS. suis meningitis, suggesting that ventriculitis might be an
underlying cause for disease recurrence. Furthermore, although our
patient was treated for a longer period because of the presence of
ventriculitis, the recommended treatment duration for S.
suis -associated ventriculitis has not been determined [22]; thus,
further studies are needed. As ventriculitis is most frequently detected
based on diffusion-weighted MRI findings [23], MRI should be
performed in cases of suspected ventriculitis, especially in cases ofS. suis meningitis involving a poor response to treatment.