Although Streptococcus pyogenes is sensitive to penicillin and other antibiotics, good ward hygiene is still essential for controlling such an outbreak in an institution ref Fournier's gangrene on male genitals Strep-EURO : there had been little surveillance on GAS infections in countries like Italy, Cyprus and Romania. Incidence is more or less the same everywhere: between 3.
Some suspect that the 25 countries of the newly expanded European Union harbour up to 20, cases each year. Evidence from countries where surveillance has always been most efficient, such as Britain, Scandinavia and the Czech Republic, suggests that the incidence rates are increasing : in Britain alone, the number of reported cases has doubled in the past 5 years.
Diversity of the M protein implies that the bacteria are evolving rapidly, making developing a vaccine difficult. Leukocytosis with relative neutrophilia. Self-limiting within days. Maculopapular exanthema and DIC ; rarely necrotizing fasciitis , myositis and gangrene. These fractions have a particular affinity for the glomerulus and have been demonstrated to induce an antibody response type II hypersensitivity. If also type III hypersensitivity occurs, it may cause chronic glomerulonephritis. Acquired immunity to Streptococcus pneumoniae has long been assumed to depend on the presence of anticapsular antibodies.
However, colonization with live pneumococci of serotypes 6B, 7F, or 14 protected mice against recolonization by any of the serotypes and protection from acquisition of a heterologous or homologous strain did not depend on anticapsular antibody. Further, intranasal immunization by live pneumococcal colonization or by a killed, nonencapsulated whole-cell vaccine protected antibody-deficient mice against colonization, suggesting independence of antibodies to any pneumococcal antigens.
Protection in this model was observed beyond 2 months after immunization, arguing against innate or nonspecific immune mechanisms. Web resources :. Toxins : IgA 1 protease. Epidemiology : endemic in swine in most pig-rearing countries in the world. The 1st-ever recorded case was in Denmark in Though endemic in swine, human infections are rare.
In past literature, there have been 1 or 2 cases when people died within 36 hours, but those were exceptions rather than the rule. Germany : a carrier prevalence study was reported to assess the amount of culture-positive throats among workers in swine slaughterhouses and processing plants. In , 25 cases of Streptococcus suis type 2 infection were reported in Jiangsu, China -- characterized by toxic shock-like illness or meningitis ref.
Identical strains were identified in local swine ref. Single hospitals reviewed 8 to ref , 10 and 12 cases to Associated skin and soft tissue infections were common ref. Additional cases have been reported in Greece ref , Spain ref , Japan S. Cases in Germany ref , Netherlands ref and France ref have been acquired from wild boar. Occupational seropositivity has been documented in New Zealand ref and the Netherlands ref.
Pigs develop meningitis, arthritis, pneumonia, septicemia, endocarditis, encephalitis, polyserositis, and abscesses. The disease is not considered to be highly infectious, and most outbreaks are limited to the affected farms. Pig infection is not notifiable on the national or international level. Affected farms may suffer economic loss. Vaccination and antibiotic therapy in pigs have been used with varying success.
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The rarity of human disease to date suggests that the outbreak in China is due to a new strain of the bacterium. Clinical features of S. Deafness is common. Individual reports of peritonitis, endocarditis, rhabdomyolysis, spondylodiscitis , sacroilitis, monoarthritis, endophthalmitis and cranial nerve palsy are documented. Most had been involved in butchering sick pigs or selling the pork. China : the last outbreak of Streptococcus suis in China was in Jiangsu province , and involved 22 people causing 14 deaths.
But in , The area has a population of 7 million, in a km mile belt stretching from the cities of Ziyang to Neijiang. From 24 Jun through 21 Jul , the authorities reported 20 cases of illness of unknown cause admitted to 3 hospitals in that city. WHO was officially informed of the outbreak on 22 Jul , at which time, 20 cases and 9 deaths had been reported. By 22 Aug , 40 patients had died , 58 had been discharged from hospital, are in hospita, with 12 still in a critical condition. They all butchered sick pigs or sheep before coming down with the strange disease, but the detected cases are not interrelated and no infection has been found in any close contact of the patients.
There have been 36 counties districts , towns streets , and villages community offices infected in areas. No new cases have been reported since 5 Aug The data provided by China depict an outbreak that peaked from the 2nd through the 4th week of Jul , and dwindled rapidly thereafter Transfer to humans is rare -- which makes the Sichuan mortality rate alarming.
One differential diagnosis was CCHF , first reported in China in , and is known locally as Xinjiang hemorrhagic fever. Cases are reported from the south west region. This latter information raises the index of suspicion that CCHF is a likely candidate. While CCHF is usually thought of as a tickborne disease, it can also be transmitted through contact with infected bodily fluids from people in nosocomial outbreaks and animals.
Another of the hemorrhagic fevers seen in the region is hemorrhagic renal syndrome associated with hantavirus infection. The description above makes that diagnosis less likely, although one must recognize that newswire descriptions may not necessarily be representative of the actual clinical picture. Some of the features of these illnesses are not characteristic of avian influenza; in particular, the unrelatedness of the victims, the development of hemorrhagic symptoms and shock, and the association with slaughter of pigs and sheep. The one caution towards that being the diagnosis is the lack of mention of that in the press articles, as one would expect that specimens have been sent for testing of previously known hemorrhagic fever organisms.
Virtually all infection diseases begin with "flu-like" symptoms and this cannot be taken as indicative of avian influenza virus infection. Furthermore the role of pigs as a mixing vessel allowing interactions between human and avian influenza viruses is an attractive hypothesis, but one that has still to be substantiated. If it is the case that the porcine streptococcus is the cause of these illnesses, perhaps the organism has acquired one or more virulence factors from, for instance, the Group A streptococcus or Staphylococcus aureus to increase its transmissibility and virulence in humans.
It would be interesting to assess any medical co-morbidities in the infected cohort. The authorities have dismissed speculation that the deaths were caused by bird flu, a virus that has killed over 50 people in Asia since late The deaths in China are very unusual. Many patients in Sichuan were bleeding under the skin, a symptom that has been cited in only 2 or 3 cases in medical literature on the bacteria.
According to experts with the team sent by the Ministry of Agriculture to the area of the outbreak, the vaccines for Streptococcus suis type II, a bacterium carried by pigs, will soon be batch-produced in south China's Guangdong Province and are expected to reach Sichuan Province in about 1 week after being inspected by the Ministry of Agriculture.
Yongshun biomedical company in Guangdong will be the first to mass-produce the vaccines. The Chinese government responded on Sun 31 Aug by airlifting the 1st batch of a vaccine for the infection -- enough to treat pigs -- from the southern city of Guangzhou to the affected towns. The vaccine's manufacturers will be producing enough vaccine to treat 10 million pigs in the coming days, but vaccines take 3 weeks to produce immunity in the pigs ref.
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It is plausible that the organism and possibly toxin load to which the patients were exposed was higher if the swine had been dug up after being buried, with the possibility of further S. This could explain the different disease observations, which have caused observers to be somewhat unsure if the S. From the perspective of a researcher in human streptococcal infection, this emergence of Streptococcus suis infection in humans resembles the outbreaks of group B streptococcal infection that emerged in human neonates during the s and then in debilitated adults in the s.
Both instances remain unexplained. Indeed, S. Both are encapsulated hemolytic streptococci that have propensity to cause bacteremia and meningitis in newborns after exposure to the organism in vaginal secretions. Most newborns remain asymptomatically colonized but in a minority progress serious infection including sepsis, meningitis, pneumonia and localized infections.
Both organisms remain susceptible to beta-lactam antibiotics and, in humans, control of the infection has been largely achieved by use of antibiotic prophylaxis of maternal carriers of group B strep. Diagnosis of S.
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Clinical details from the current outbreak both from the pigs and the humans are thus far lacking and it is therefore difficult to assess whether some co-infection or other co-morbidity may be accounting for this unprecedented cluster of human disease. Inspectors swooped down on the unregistered abattoir in the city of Gongzhuling in Jilin province in the 1st week August , and found it had been supplying meat to a sausage factory in the provincial capital, Changchun, which had also been shut down.
Inspectors found 6 to 8 tons of pork in the underground slaughterhouse, and our tests showed at least one ton came from pigs who had died of illness ref. Several aspects of the current outbreak still remain unanswered. What are the morbidity and mortality rates in pigs? Is there any differential age susceptibility? What are the pathological and histopathological changes? Have there been any experimental infection trials in animals? All these unanswered questions cloud the perception of transparency in disease reporting.
At this point, might it not be useful to have an international presence on outbreak swine farms so that some of these questions can be answered sooner rather than later? Applying "stamping out" is an unusually severe measure when related to a bacterium which -- at least, according to existing knowledge -- is rather endemic in many countries in piggeries.
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It would be helpful to note how screening is to be applied, and what criteria will be used for farms to be "stamped out. No amendments of Xinhua reports are allowed, including the headline: Xinhua's is currently the only version of events available to both Chinese and overseas reporters alike. Please note that S. Doctor Wang? The previous classification of Ebola in the country used the EBO — location where it was discovered — model; later on, for unknown reasons, the news of classification leaked out.
Therefore the classification method changed, they abandoned EBO, increasing the infection extent, infection speed, etc. The earliest occurrence of this Ebola virus disease can be traced back to Shenzhen city in Guangdong Province. This article mentioned that medical personnel who had been working in hospitals for years said that they had never seen an illness like it.