MENINGITIS CAUSED BY STREPTOCOCCUS-SUIS T YPE-2 IN AN ADULT

History and admission findings: A 54-year-old huntsman who 3 days prev iously had shot a wild pig, developed severe headache, nausea and vomi ting over the last 10 hours. Physical examination was unremarkable exc ept for an 8 X 4 cm large reddenign of the skin over the right tibia a nd fever (38.2 degrees C). Investigations: Cranial computed tomography was normal. Cerebrospinal fluid showed pleocytosis (5.200 cells/mm(3) ). Gram-stained (CSF) smear showed gram-positive cocci and an increase d white cell count (14,000/mu l) was found in blood. Diagnosis, treatm ent and course: After the diagnosis of bacterial meningitis had been m ade antibiotics were given intravenously (penicillin G 10 mill. IU, th ree times daily on days 1 to 16; at first with cefotaxim, three times daily 2 g on days 1 to 3, then with gentamicin twice 80 mg on days 3 t o 13). The acute neurological signs quickly regressed, the pretibial r eddening (presumably at the port of entry) disappeared, as did the fev er on the 4th day of the illness. The streptococci isolated from CSF a nd blood were identified as S. suis type 2 (Lancefield group R). But d espite the early and effective antibiotic treatment cochleovestibular symptoms (hearing impairment, vertigo and unsteady gait) set in after initial improvement, a frequent complication of S. suis meningitis. Co nclusion: S. suis should be considered as the causative organism of ge neralized septicaemia and meningitis in adults, if the history reveals contact with domestic or wild pigs and there are early cochleovestibu lar signs.