IDENTIFICATION OF MAJOR STREPTOCOCCUS SUIS SEROTYPES 2, 7, 8 AND 9 ISOLATED FROM PIGS AND HUMANS IN UPPER NORTHEASTERN THAILAND

Abstract. Streptococcus suis serotype 2 infections occur in many provinces of northeastern Thailand. However, knowledge concerning the prevalence of the common S. suis serotypes (1, 1/2, 2, 5, 7, 8, 9, 14 and 16) among healthy and diseased pigs in upper northeastern Thailand remains limited. This study investigated S. suis isolates from pigs (healthy and diseased) and also from humans using 11 conventional biochemical tests, 16S rDNA PCR and sequence analysis and multiplex PCR genotyping of porcine cps and gdh. Thirty-three isolates were obtained between 2009 and 2012 from blood or cerebrospinal fluid of patients from northeastern Thailand previously diagnosed with S. suis infection, based on clinical symptoms and laboratory diagnosis using 11 biochemical tests and PCR detection of 16S rDNA and cps. Eleven S. suis isolates were obtained between 2006 and 2009 from diseased pigs with clinical signs and laboratory diagnoses. In addition, 43 isolates obtained from 741 nasal swab cultures of slaughtered pigs between 2011 and 2012 were included. All three methods showed similar sensitivity in detection of S. suis from clinical and diseased pig specimens, although in healthy pigs, the 11 conventional biochemical methods yielded 2.3% false positives, and the gdh PCR detection method exhibited 31% false negatives. S. suis was present among healthy pigs in 8 of 10 provinces in upper northeastern Thailand, giving an average prevalence of 5.7% (range 1%-17%) using conventional methods together with 16S rDNA PCR assay. False positives by conventional methods were due to species with similar phenotypes, such as viridian streptococci, and are not statistically different from those obtained with the 16S rDNA PCR method, and the false negatives using gdh PCR assay will require further investigation. As S. suis was recovered from both diseased and healthy pigs, raw or undercooked pork products should be considered unsafe for handling or consumption in these regions of Thailand

Population-Based Study of Streptococcus suis Infection in Humans in Phayao Province in Northern Thailand

BACKGROUND: Streptococcus suis infection in humans has received increasing worldwide recognition. METHODS AND FINDINGS: A prospective study of S. suis infection in humans was conducted in Phayao Province in northern Thailand to determine the incidence and the risk behaviors of the disease in this region in 2010. Thirty-one cases were confirmed. The case fatality rate was 16.1%, and the estimated incidence rate was 6.2 per 100,000 in the general population. The peak incidence occurred in May. The median age of the patients was 53 years and 64.5% were men. Consumption of raw pork products was confirmed in 22 cases and the median incubation period (range) was 2 days (0-11) after consumption of raw pork products. Isolates from 31 patients were confirmed as serotype 2 in 23 patients (74.2%) and serotype 14 in eight patients (25.8%). The major sequence types (STs) were ST1 (n = 20) for serotype 2 and ST105 (n = 8) for serotype 14. The epidemiological analysis suggested three possible clusters, which included 17 cases. In the largest possible cluster of 10 cases in Chiang Kham and its neighboring districts in May, the source of infection in four cases was identified as a raw pork dish served at the same restaurant in this district. Microbiological analysis confirmed that three of four cases associated with consumption of raw pork at this restaurant were attributable to an identical strain of serotype 2 with ST1 and pulsotype A2. CONCLUSIONS: Our data suggest a high incidence rate of S. suis infection in the general population in Phayao Province in 2010 and confirm a cluster of three cases in 31 human cases. Food safety control should be strengthened especially for raw pork products in northern Thailand

Acinetobacter bacteraemia in Thailand: evidence for infections outside the hospital setting

Acinetobacter is a well-recognized nosocomial pathogen. Previous reports of community-associated Acinetobacter infections have lacked clear case definitions and assessment of healthcare-associated (HCA) risk factors. We identified Acinetobacter bacteraemia cases from blood cultures obtained <3 days after hospitalization in rural Thailand and performed medical record reviews to assess HCA risk factors in the previous year and compare clinical and microbiological characteristics between cases with and without HCA risk factors. Of 72 Acinetobacter cases, 32 (44%) had no HCA risk factors. Compared to HCA infections, non-HCA infections were more often caused by Acinetobacter species other than calcoaceticus–baumannii complex species and by antibiotic-susceptible organisms. Despite similar symptoms, the case-fatality proportion was lower in non-HCA than HCA cases (9% vs. 45%, P < 0·01). Clinicians should be aware of Acinetobacter as a potential cause of community-associated infections in Thailand; prospective studies are needed to improve understanding of associated risk factors and disease burden

Persistent Gastric Colonization with Burkholderia pseudomallei and Dissemination from the Gastrointestinal Tract following Mucosal Inoculation of Mice

Melioidosis is a disease of humans caused by opportunistic infection with the soil and water bacterium Burkholderia pseudomallei. Melioidosis can manifest as an acute, overwhelming infection or as a chronic, recurrent infection. At present, it is not clear where B. pseudomallei resides in the mammalian host during the chronic, recurrent phase of infection. To address this question, we developed a mouse low-dose mucosal challenge model of chronic B. pseudomallei infection and investigated sites of bacterial persistence over 60 days. Sensitive culture techniques and selective media were used to quantitate bacterial burden in major organs, including the gastrointestinal (GI) tract. We found that the GI tract was the primary site of bacterial persistence during the chronic infection phase, and was the only site from which the organism could be consistently cultured during a 60-day infection period. The organism could be repeatedly recovered from all levels of the GI tract, and chronic infection was accompanied by sustained low-level fecal shedding. The stomach was identified as the primary site of GI colonization as determined by fluorescent in situ hybridization. Organisms in the stomach were associated with the gastric mucosal surface, and the propensity to colonize the gastric mucosa was observed with 4 different B. pseudomallei isolates. In contrast, B. pseudomallei organisms were present at low numbers within luminal contents in the small and large intestine and cecum relative to the stomach. Notably, inflammatory lesions were not detected in any GI tissue examined in chronically-infected mice. Only low-dose oral or intranasal inoculation led to GI colonization and development of chronic infection of the spleen and liver. Thus, we concluded that in a mouse model of melioidosis B. pseudomallei preferentially colonizes the stomach following oral inoculation, and that the chronically colonized GI tract likely serves as a reservoir for dissemination of infection to extra-intestinal sites