MENINGITIS STREPTOCOCICA PORCINA; ANTIBIOTIC

RESISTANCE FROM PIGS

PUBLIC HEALTH INVOLVEMENTS

Additional material:

Manual on DISEASE OUTBREAK INVESTIGATION

Manual on PRUDENT USE OF ANTIBIOTICS

The case: a little region of a developing country where stock breeding is trying to develop to improve the economy of the

regionFirst case of disease in humans appeared on

15th June of 2005

In the next week, 12 cases were described:- Slight cutaneous symptoms on hands and arms- Inflammation and red skin in these zones. - Little grazes

On the 21th June, one person died with septicaemia, toxic shock, meningitis and

subcutaneous haemorrhage

• A bacterial cause was suspected, so:

• A treatment with broad spectrum penicillinpenicillin was carried out

• It wasn’t effective and three days later the treatment was changedwas changed to a

quinolonequinolone

• It wasn’t effective too, so doctors started to look for a antibiotic of third antibiotic of third

generationgeneration

• While this was happening, another another person diedperson died. He also had a septicaemiasepticaemia

As a Veterinary Public Health (VPH) expert

do you think they (doctors) have acted in a right way to deal with the human

cases?

In case they did notIn case they did not:Which mistakes do you think they made?

What do you think they should do?

The microbiological investigation of the two dead patients detected the presence of

Streptococcus suis. Moreover this micro-organism was resistant to almost all

antibiotic assessed

• As public concern was growing, a working team involving doctors, veterinarians and politicians was

created. The veterinarians suggested to study if this micro organism had an

animal origin

How would you carry out the STUDY OF THE DISEASE?

Which aspects do you think would be important to study?

The investigation showed that:

• Before 15th June, some more 20 (minor) cases have came up during the year. Those people got

better in 12-15 days

• There have been higher mortality than normal in two pig farms during the last months. The pigs died with meningitis. No cause was found for

these deaths, but it was thought that it happened because of over-crowding and very

humid and hot weather

• One of the dead patients worked in the pig farm and the other worked in the

slaughterhouse. Most of the affected people had taken part in domestic pig slaughtering

(which is a tradition in the area)        Other affected people were

slaughterhouse workers and the others were close relatives of the affected people

  In the last years some people had been sick with similar but less severe symptoms, and

cases in pigs had been also described

The investigation showed that:

What is your conclusion with the information so far available?

The study in pigs of the region showed that Streptococcus suis type 2 was detected

in the 70% of the farms

• This bacteria has the same serotype and genotype as the bacteria isolated from the dead

people

• Also the same antibiotic resistance patterns were showed

• All these strains were multi-resistant.

• Pig farms related people were also investigated and the bacteria was isolated in 40% of them.

Do you still held your previous conclusion with the available

information?

Could you now think of a new / different conclusion?

The study at the pig farms showed that:

• Most of the famers didn’t have veterinary advice

• There were a constant movement and mixing of animals amongst the farms

• The farmers gave antibiotics to animals in order to prevent diseases:

– Antibiotics are given with food and half of the standard dosis

– During the last two years, at the farms a mix of two penicillins and a tetracicline had been used

…Cont.

• The farms were cleaned with running water once a month

• When a animal died, the carcases were disposed of (thrown away) without any treatment

With all these information:

Do you consider that these practices are appropriate?

Cont.

How would you suggest to solve this problem both in animals and

humans?Case study developed by the SAPUVETNET II member – University

of Zaragoza, Fac. Veterinary Medicine (contact: Carmelo Ortega/ola Gimeno epidemio@unizar.es)

Do you think these practices are related with Public Health problems or may have something to do with it in future? In that case, explain which practices, why and how