Transcript Swine streptococcic meningitis

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 region
First 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 penicillin was
carried out
• It wasn’t effective and three days later the
treatment was changed to a quinolone
• It wasn’t effective too, so doctors started to
look for a antibiotic of third generation
• While this was happening, another person died.
He also had a septicaemia
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 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 overcrowding and very humid and hot weather
The investigation showed that:
• 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
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.
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
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 [email protected])