Journal of Global Infectious Diseases

LETTER TO EDITOR
Year
: 2015  |  Volume : 7  |  Issue : 2  |  Page : 92--93

Chronic osteomyelitis due to streptococcus Suis: First case report from India


Dharitri Mohapatra1, Gitanjali Sarangi1, Priyadarshini Patro1, Bimoch P Paty1, Nirupma Chayani1, Dibya P Mohanty2,  
1 Department of Microbiology, S.C.B. Medical College and Hospital, Cuttack, Odisha, India
2 V.S.S. Medical College and Hospital, Sambalpur, Odisha, India

Correspondence Address:
Dharitri Mohapatra
Department of Microbiology, S.C.B. Medical College and Hospital, Cuttack, Odisha
India




How to cite this article:
Mohapatra D, Sarangi G, Patro P, Paty BP, Chayani N, Mohanty DP. Chronic osteomyelitis due to streptococcus Suis: First case report from India.J Global Infect Dis 2015;7:92-93


How to cite this URL:
Mohapatra D, Sarangi G, Patro P, Paty BP, Chayani N, Mohanty DP. Chronic osteomyelitis due to streptococcus Suis: First case report from India. J Global Infect Dis [serial online] 2015 [cited 2021 Dec 2 ];7:92-93
Available from: https://www.jgid.org/text.asp?2015/7/2/92/154449


Full Text

Sir,

Streptococcus suis is a major porcine pathogen and is also emerging as a zoonotic agent capable of causing severe invasive diseases in humans. [1] It causes meningitis, septicemia, endocarditis, arthritis, and pneumonia in human beings. [2] We report a rare case of chronic osteomyelitis caused by S. suis.

A seven-year-old female child presented with swelling over the base of her amputed right index finger, with discharging sinus and intermittent fever since seven months [Figure 1]. The lesion started as a nodule over the base of her right index finger one year back, which was initially nontender, but gradually increased in size and became painful, with discharging sinus. A diagnosis of chronic osteomyelitis was done based on the typical x-ray findings and excision biopsy. Amputation of the right index finger was done and Ampicillin-sulbactam therapy was advised. However, the patient discontinued the treatment. After two months she again developed discharging sinus from the amputed area. {Figure 1}

On examination, the child was febrile. The local area was swollen, tender with petechiae, and discharging sinuses. She had right axillary lymphadenopathy. Other systemic examinations were normal. The hemogram showed an Hb of 6.25 gm/dl, leukocytosis with neutrophilia, and a total platelet count of 2.5 of lakhs/mm. The erythrocyte sedimentation rate (ESR) was increased (20 mm/first hour) and the C-reactive protein (CRP) was elevated. The Mantoux test was negative. The routine biochemical tests were normal. An x-ray AP view of the right hand showed areas of sclerosis in the amputed stump of the index finger.

A Gram stain of the aspirated pus showed numerous polymorphonuclear cells and many gram-positive cocci arranged singly and in pairs. Acid fast staining was negative. Culture on 5% sheep blood agar yielded small, grayish, α-hemolytic colonies, after 24 hours of aerobic incubation at 37°C, which changed to a large, beta-hemolytic type after prolonged incubation for 48 hours. A gram stain of the colonies showed gram-positive cocci arranged in pairs and short chains. It was catalase negative, optochin-resistant, bacitracin-resistant, and Christie, Atkins and Munch-Peterson(CAMP) test-negative. It grew in the presence of 40% bile and hydrolyzed esculin, but was unable to grow in 6.5% Sodium Chloride (NaCl) broth. It was negative for the Voges-Proskauer test. It fermented glucose, sucrose, lactose, maltose, trehalose, and salicin with production of acid, but did not ferment arabinose, sorbitol, raffinose, mannitol, and inositol. Blood and urine culture was negative.

The isolate was presumptively identified as S. suis and confirmed by the automated Vitek 2 system (bioMérieux; 99.0% probability) and the API 20 Strep system (bioMérieux; 99.7% probability). The isolate was identified as serotype 2 by the slide agglutination test, using specific antisera (SSI Diagnostica, Denmark). It was susceptible to ceftriaxone, gentamicin, vancomycin, and linezolid, but resistant to clindamycin and amoxyclav. The child was treated with ceftriaxone 1 gm IV q 24 hours for six weeks, with regular antiseptic irrigation of the sinus. The patient showed subsequent improvement. Further enquiry into the potential pig exposure revealed that the father's occupation was in pig rearing.

Streptococcus suis is a gram-positive cocci and belongs to the lancefield group R, S, RS or T. [3] On the basis of capsular antigens, 35 serotypes have been described. The most prevalent serotype that causes invasive human infections worldwide is serotype 2. [4],[5] S. suis is usually susceptible to penicillin, ceftriaxone, and vancomycin, and the least active agents are tetracycline, erythromycin, and chloramphenicol. [5] Patients with chronic osteomyelitis usually require a prolonged antibiotic course between four and six weeks. Previous non-adherence to the treatment may be the cause for the relapse in our case.

Our case belongs to a non-endemic area and a small amount of data is available for circulation on the epidemiology of S. suis in India. However, S. suis was diagnosed in a private piggery in Kerala. This is perhaps the first case report of S. suis infection in India, presenting as chronic osteomyelitis, which is a rare presentation worldwide. Increased awareness of both clinicians and microbiologists is needed to fully appreciate the importance of S. suis as a human pathogen.

References

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2Lun ZR, Wang QP, Chen XG, Li AX, Zhu XQ. Streptococcus suis: An emerging zoonotic pathogen. Lancet Infect Dis 2007;7:201-9.
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4World Health Organization Regional Office For The Western Pacific. Fact Sheets - Streptococcus suis August 1 2005. http://www.wpro.who.int. [Online].; 2005 [cited 2013 August 26]. Available from: http://www.wpro.who.int/mediacentre/factsheets/fs_20050802/en/
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