Here, we describe another case in a 60-year-old man from San Francisco who had consumed raw pork while traveling in the Philippines.
In June 2003, this man became ill with fever, diaphoresis, headache, nausea, and anorexia.
He had just returned from a 7-month vacation in the Philippines.
Three days after symptoms onset, his physician prescribed doxycycline.
Symptoms continued and he was admitted to a local hospital 5 days later with a fever of 38.9°C, nuchal rigidity, headache, and general malaise.
The patient described no recent contact with sick persons; past medical history was unremarkable.
On physical examination, he was somnolent but fully oriented, with no focal findings on neurologic examination and only slight nuchal rigidity.
He had a leukocyte count of 21,000/mm3, including 16,400/mm3 neutrophils.
Cerebrospinal fluid (CSF) showed leukocyte count of 487/μL with 80% polymorphonuclear cells and 18% lymphocytes, and glucose and protein levels <20 mg/dL and <167 mg/dL, respectively.
Gram stain of CSF showed gram-positive cocci in pairs (Figure).
Empiric therapy (ceftriaxone, vancomycin, and ampicillin) for bacterial meningitis was begun.
Computed tomographic scan of the head showed only sinusitis; findings of chest radiograph and transesophageal echocardiogram were negative.
On hospital day 2, blood cultures grew gram-positive cocci in pairs and chains.
The organism was catalase-negative, bile esculin-negative, and pyrrolidonyl aminopeptidase-negative, consistent with Streptococcus spp.
A latex agglutination test did not detect Streptococcus pneumoniae antigen.
Antimicrobial susceptibility testing showed that the isolate was sensitive to penicillin (MIC = 0.03), ceftriaxone, and vancomycin but resistant to tetracycline and clindamycin.
Antimicrobial therapy was changed to penicillin G, 24 million units intravenously per day.
On hospital day 5, the patient complained of hearing loss in his left ear.
Results of nasopharyngeal endoscopy were negative.
By hospital day 7, the organism was identified by the API 20 Strep System (bioMerieux, Marcy l’Etoile, France), as S. suis serotype 2.
The patient subsequently stated that he was a butcher with a culinary preference for partially cooked pork, which he had eaten in the Philippines until the week prior to onset of symptoms.
On hospital day 9, a formal audiology evaluation showed severe bilateral sensorineural high-frequency hearing loss (–70 dB).
The patient completed a 10-day course of parenteral antimicrobial drugs and was discharged on continued oral therapy with close followup.
Two months after discharge, the patient reported much improved hearing without other sequelae.