Ahead of Print -Epidemiology, Clinical Manifestations, and Outcomes of Streptococcus suis Infection in Humans - Volume 20, Number 7—July 2014 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Epidemiology, Clinical Manifestations, and Outcomes of Streptococcus suis Infection in Humans - Volume 20, Number 7—July 2014 - Emerging Infectious Disease journal - CDC

Figure 2

Figure 2. Global cumulative prevalence ofStreptococcus suis infection.

Volume 20, Number 7—July 2014

Synopsis

Epidemiology, Clinical Manifestations, and Outcomes ofStreptococcus suis Infection in Humans

Article Contents

• Methods
• Results
• Discussion
• Acknowledgment
• References
• Figure 1
• Figure 2
• Figure 3
• Figure 4
• Figure 5
• Table 1
• Table 2
• Table 3
• Table 4
• Technical Appendix - 1.22 MB 
• Suggested Citation

Vu Thi Lan Huong1, Ngo Ha1, Nguyen Tien Huy1, Peter Horby, Ho Dang Trung Nghia, Vu Dinh Thiem, Xiaotong Zhu, Ngo Thi Hoa, Tran Tinh Hien, Javier Zamora, Constance Schultsz, Heiman Frank Louis Wertheim, and Kenji Hirayama 

Author affiliations: Oxford University Clinical Research Unit, Hanoi, Vietnam (V.T.L. Huong, P. Horby, H.F.L. Wertheim); University of Oxford, Oxford, UK (V.T.L. Huong, P. Horby, H.F.L. Wertheim, N.T. Hoa); Nagasaki University, Nagasaki, Japan (N. Ha, N.T. Huy, X. Zhu, K. Hirayama); Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam (H.D.T. Nghia, N.T. Hoa, T.T. Hien, C. Schultsz); National Institute of Hygiene and Epidemiology, Hanoi (V.D. Thiem); Ramón y Cajal Hospital, Madrid, Spain (J. Zamora);CIBER Epidemiologia y Salud Publica, Madrid (J. Zamora); Pham Ngoc Thach University of Medicine, Ho Chi Minh City (H.D.T. Nghia); University of Amsterdam, Amsterdam, the Netherlands (C. Schultsz)

Suggested citation for this article

Abstract

Streptococcus suis, a bacterium that affects pigs, is a neglected pathogen that causes systemic disease in humans. We conducted a systematic review and meta-analysis to summarize global estimates of the epidemiology, clinical characteristics, and outcomes of this zoonosis. We searched main literature databases for all studies through December 2012 using the search term “streptococcus suis.” The prevalence of S. suis infection is highest in Asia; the primary risk factors are occupational exposure and eating of contaminated food. The pooled proportions of case-patients with pig-related occupations and history of eating high-risk food were 38.1% and 37.3%, respectively. The main clinical syndrome was meningitis (pooled rate 68.0%), followed by sepsis, arthritis, endocarditis, and endophthalmitis. The pooled case-fatality rate was 12.8%. Sequelae included hearing loss (39.1%) and vestibular dysfunction (22.7%). Our analysis identified gaps in the literature, particularly in assessing risk factors and sequelae of this infection.

Streptococcus suis is a neglected zoonotic pathogen that has caused large outbreaks of sepsis in China (1,2) and has been identified as the most common and the third leading cause of bacterial meningitis in adults in Vietnam and Hong Kong, respectively (3–5). S. suis infection is acquired from pigs, either during slaughtering or by handling and eating undercooked pork products. It is potentially preventable (3,6). Epidemiology of the infection differs between Western and Asian regions (7), and the role of high-risk eating habits (i.e., ingesting raw or undercooked pig parts, including pig blood, organs, and meat) in some Asian communities recently has been recognized (6,8,9). Rates of S. suis infection are low in the general populations of Europe and North America, and cases are concentrated among occupationally exposed groups, including abattoir workers, butchers, and pig breeders (10,11).

In a 2009 review, ≈700 S. suis infections were reported worldwide by 2009, mostly from China and Vietnam (12). Clinical characteristics of this infection have been reviewed (12,13) and include meningitis, sepsis, endocarditis, arthritis, hearing loss, and skin lesions. Treatment of S. suis infection requires ≈2 weeks of intravenous antimicrobial drugs (12). The death rate varies, and deafness is a common sequela in survivors.

Although substantial new data on the incidence, clinical and microbiological characteristics, and risk factors for S. suis infection have accumulated during recent years, the prevalence of this infection has not measurably decreased. We conducted a systematic review and meta-analysis to update the evidence and summarize the estimates of epidemiologic and clinical parameters to support practitioners’ and policy makers’ efforts to prevent and control this infection.

Ms Huong is a DPhil student at the Nuffield Department of Medicine, University of Oxford, and is based at Oxford University Clinical Research Unit, Hanoi. Her primary research interests include epidemiologic and behavioral research on emerging infectious diseases in Asia; the interface between animals and humans and their contribution to the occurrence and spread of diseases in the context of rapidly changing agricultural, husbandry and food supply practices; and how interventions can be culturally tailored to prevent infections.

Acknowledgment

This study was supported in part by Global COE Program (2008–2012) and the Japan Initiative for Global Research Network on Infectious Diseases to K.H; by a “Grant-in-Aid for Scientific Research” from Nagasaki University to N.T. Huy (2007–2009); and by the Wellcome Trust Major Overseas Program and the Vietnam Initiative on Zoonotic Infections (2012–2016). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Figures

• Figure 1. Flow diagram of the search and review process for this review of Streptococcus suisinfection.
• Figure 2. Global cumulative prevalence of Streptococcus suis infection.
• Figure 3. Funnel plot showing evidence of publication bias among 26 studies in a meta-analysis of meningitis rates in Streptococcus suis infectionEach blue circle represents each study in the meta-analysis, forming...
• Figure 4. Forest plot of subgroup meta-analysis (random effects) for the case-fatality rates by country reported in the 25 studies included in a review of Streptococcus suis infectionFor each study, the...
• Figure 5. Meta-regression scatter plot showing the correlation between case-fatality rate and meningitis rate in a review of Streptococcus suis infectionThe logit event rate was calculated for case-fatality rate as follows:...

Tables

• Table 1. Characteristics of 177 articles in a systematic review of Streptococcus suis infection
• Table 2. Epidemiologic factors of patients with Streptococcus suis infection included in a systematic review
• Table 3. Main clinical and laboratory parameters at admission of the patients withStreptococcussuis infection in a systematic review
• Table 4. Summary rates of the main clinical outcomes among patients with Streptococcus suisinfection included in a systematic review

Technical Appendix

• Technical Appendix. Details of publications in a review of the epidemiology, clinical manifestations, and outcome of Streptococcus suis infection in humans.  1.22 MB 

Suggested citation for this article:Huong VTL, Ha N, Huy NT, Horby P, Nghia HDT, Thiem VD, et al. Epidemiology, clinical manifestations, and outcomes of Streptococcus suis infection in humans. Emerg Infect Dis [Internet]. 2014 Jul [date cited]. http://dx.doi.org/10.3201/eid2007.131594

DOI: 10.3201/eid2007.131594

1These authors contributed equally to this article.