关键词: 猪链球菌, 脑膜炎, 听力障碍, 视力障碍, 脑脊液, 宏基因组测序

Abstract:

Objective To analyze the clinical manifestations， diagnosis and therapeutic course of the patient with visual and hearing impairments caused by Streptococcus suis meningitis， aiming to enhance clinicians’ awareness of this disease. Methods Clinical data were collected from a patient with Streptococcus suis meningitis with visual and hearing impairments. The diagnosis and treatment process were summarized， and relevant literature was reviewed. Results The patient， a 59-year-old male， started with headache accompanied by fever， followed by decreased vision acuity in both eyes and reduced hearing in the right ear. Physical examination： The patient was alerted and oriented， with only light sensation in both eyes and reduced hearing in both ears （more pronounced on the right side）. The neck strength was 3 horizontal fingers， and Kernig sign was positive. Magnetic resonance imaging （MRI） head scan showed patchy abnormal signals in the white matter of the right frontal lobe， while further enhanced MRI scan did not reveal any abnormal signals. The cerebrospinal fluid appeared slightly yellow and turbid after head drip， and the total number of leukocytes and protein level were significantly increased.The glucose and chloride levels were decreased with multinucleated cells accounting for 79% of the cellular components. The CSF IgG level was 82.25 mg·L^-1. Blood culture yielded Streptococcus suis as the causative pathogen. Metagenomic next generation sequencing （mNGS） in cerebrospinal fluid indicated Gram-positive bacteria， with 7 001 Streptococcus suis sequences detected. The patient was diagnosed with Streptococcus suis meningitis and treated with anti-infective therapy complemented by hormone and symptomatic treatment. Follow-up interviews at 6 and 18 months post-discharge revealed a satisfactory recovery of visual acuity， while the hearing did not improve significantly compared to at the time of discharge. Conclusion In the patients with a history of exposure with sick or dead pigs who develop signs of meningitis accompanied by simultaneous involvement of other organs such as eyes and ears， Streptococcus suis meningitis should be considered and empirical anti-infective treatment should be provided as soon as possible. Blood culture and mNGS for definitive diagnosis should be conducted promptly. Combined application of Streptococcus suis-sensitive antibiotics and dexamethasone may help improve hearing impairments in these patients.

Key words: Streptococcus suis, Meningitis, Hearing impairment, Visual impairment, Cerebrospinal fluid, mNGS