Pig's ear: Streptococcus suis Meningitis and its associated inner ear implications

Abstract

Streptococcus suis (S. suis) is a zoonotic pathogen commonly found in Asian countries. Infection with this bacterium typically clinically presents as meningitis and individuals whom handle swine are at increased risk of developing infections. We present a case of a patient with a S. suis meningitis who worked as a butcher. The 48-year-old man was admitted to our department with headaches, fevers, nausea and bilateral hearing loss. According to his medical history, the patient had sustained a cut on his finger while preparing pork meat. A microbiological examination of the cerebrospinal fluid and blood revealed S. suis. The patient was empirically treated with ceftriaxone, vancomycin and dexamethasone. The patient made a complete recovery from the meningitic process and inflammatory markers. However, the hearing and vestibular loss persisted with considerable functional impact upon his daily life. He was elected for a right cochlear implant, 7 weeks after the presentation with a poor outcome. It is important to remember that inner-ear dysfunction can occur frequently in S. suis meningitis surviving patients. Physicians should have a high index of suspicion if risk factors are present and initiate urgent treatment to prevent serious long-term consequences.

Keywords: Streptococcus suis; Vestibular areflexia; Zoonosis.

Fig. 1

A) Right (i) and left (ii) audiogram revealing bilateral profound sensorineural hearing loss. B) Videonystagmography recording revealing a bilateral areflexia. C) Brain MRI: axial T2 weighted (i) and gadolinium-enhanced (ii) images showing no abnormalities in the inner ear and brain parenchyma.