Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BMC Infect Dis. 2024 Nov 14;24(1):1304. doi: 10.1186/s12879-024-10180-y.
Streptococcus suis (S. suis) is a zoonotic disease that is transmitted to humans via contact or oral route. Although the major clinical presentation of this pathogen is known to be meningitis, S. suis infective endocarditis (IE) has recently emerged as a clinical manifestation of increasing interest. Echocardiography may be an underutilized modality for evaluating patients with S. suis bacteremia.
The primary objective was to estimate the prevalence of S. suis IE in patients with S. suis bacteremia. The secondary objective was to investigate the predictors, echocardiographic features, and clinical outcomes of S. suis IE in patients with S. suis bacteremia.
This single-center retrospective study was conducted at Siriraj Hospital - Thailand's largest university-based tertiary referral center. Adult patients (aged > 18 years) who were admitted to our center with confirmed diagnosis of S. suis bacteremia during January 2007 to September 2023 were included. Prevalence is reported as percentage and confidence interval. Baseline characteristics and clinical manifestation were compared between the IE and non-IE groups. Factors found to be statistically significant were further analyzed using binary logistic regression analysis to identify univariate predictors of S. suis IE.
A total of 71 patients with S. suis bacteremia were included in this study. The prevalence of S. suis IE was 26.8% (95% confidence interval: 17.85-38.05). Perivalvular complications and significant valvular regurgitation were found in 52.6% and 80.0% of patients, respectively. Thirteen of 19 patients (68.4%) required valvular surgery according to standard guidelines. By univariate analysis, dyspnea, new murmur, immunologic phenomenon, and heart failure were predictors of S. suis IE in patients with S. suis bacteremia.
The results of this study revealed a sizable prevalence of S. suis IE in patients with S. suis bacteremia, and there were high rates of both valvular damage and perivalvular complications. Our results strongly suggest that echocardiography may be indicated to evaluate for S. suis IE in patients diagnosed with S. suis bacteremia. Reclassification of S. suis from an atypical organism to a typical organism should be considered.
猪链球菌（S. suis）是一种人畜共患病，可通过接触或口腔途径传播给人类。尽管该病原体的主要临床表现为脑膜炎，但猪链球菌感染性心内膜炎（IE）最近已成为一种越来越受关注的临床表现。超声心动图可能是评估猪链球菌菌血症患者的一种未充分利用的手段。
主要目的是估计猪链球菌菌血症患者中猪链球菌 IE 的患病率。次要目的是探讨猪链球菌菌血症患者中猪链球菌 IE 的预测因素、超声心动图特征和临床结局。
这是一项在泰国最大的大学附属医院——诗里拉吉医院进行的单中心回顾性研究。纳入 2007 年 1 月至 2023 年 9 月期间我院确诊为猪链球菌菌血症的成年患者（年龄＞18 岁）。患病率以百分比和置信区间报告。比较 IE 组和非 IE 组的基线特征和临床表现。对有统计学意义的因素进行二元逻辑回归分析，以确定猪链球菌 IE 的单因素预测因素。
本研究共纳入 71 例猪链球菌菌血症患者。猪链球菌 IE 的患病率为 26.8%（95%置信区间：17.85-38.05）。52.6%和 80.0%的患者分别存在瓣周并发症和明显的瓣膜反流。根据标准指南，19 例患者中有 13 例（68.4%）需要瓣膜手术。单因素分析显示，呼吸困难、新出现的杂音、免疫现象和心力衰竭是猪链球菌菌血症患者发生猪链球菌 IE 的预测因素。
本研究结果表明，猪链球菌菌血症患者中猪链球菌 IE 的患病率相当高，且瓣膜损伤和瓣周并发症的发生率均较高。我们的研究结果强烈表明，对于诊断为猪链球菌菌血症的患者，超声心动图可能是评估猪链球菌 IE 的一种指征。应考虑将猪链球菌从非典型病原体重新分类为典型病原体。
