Streptococcus equi subspecies zooepidemicus: an emergent cause of meningoencephalitis in Northeastern Brazil

Farias, Luis Arthur Brasil Gadelha; Sousa, Marcos Maciel; Cavalcante, Karene Ferreira; Jucá, Marina Pinheiro Catunda; Castro, Aldenise de Olinda; Mello, Liana Perdigão; Mesquita, Rafael Ferreira; Bandeira, Silviane Praciano; Marchi, Ana Paula; Coelho, Tânia Mara Silva; Lima Neto, Antônio Silva; Arruda, Érico Antonio Gomes de; Costa, Silvia Figueiredo; Oliveira, Maura Salaroli de; Perdigão Neto, Lauro Vieira

doi:10.1590/S1678-9946202466051

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BRIEF COMMUNICATION • Rev. Inst. Med. trop. S. Paulo 66 • 2024 • https://doi.org/10.1590/S1678-9946202466051 copy

Streptococcus equi subspecies zooepidemicus: an emergent cause of meningoencephalitis in Northeastern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

This study describes an outbreak of Streptococcus equi subspecies zooepidemicus infections that caused meningoencephalitis and bacteremia related to unpasteurized milk consumption in northeastern Brazil. Epidemiological investigations and a brief literature review were conducted. Strains with possible neurotropism had not been identified in Brazil before these cases; however, in 2023, another case of meningoencephalitis caused by Streptococcus equi sp. zooepidemicus was described, revealing the need to maintain surveillance and highlighting that these neurotropic strains continue to circulate in the environment.

KEYWORDS
Meningoencephalitis; Streptococcus equi ; Streptococcus zooepidemicus ; Bacteremia; Outbreak

Patient	Year	Age	Sex	Clinical Syndrome	Origin	Epidemiological Link	Outcome
1	2019	59	M	Meningoencephalitis	Horizonte municipality - Ceara State (rural area)	Artisanal cheese factory worker	Death
2	2019	32	F	Meningoencephalitis	Fortaleza municipality - Ceara State (urban area)	Consumption of cheese without sanitary control	Cure
3	2019	29	M	Meningoencephalitis and Infectious Endocarditis	Horizonte municipality - Ceara State (rural area)	Artisanal cheese factory worker and brother of Patient 1	Cure
4	2019	48	M	Pericarditis	Fortaleza municipality - Ceara State (urban area)	Unknown, but cousin of Patient 3	Cure
5	2023	49	M	Meningoencephalitis	Itapaje municipality - Ceara State (rural area)	Consumption of cheese without sanitary control	Cure

Patient	Cell count (cells/mm³) (RV< 5)	Differential (%)	Proteins (mg/dL) (RV 15–45)	Glucose (mg/dL) (RV >2/3 serum glucose)	Gram Stain	Culture	Susceptibility Profile
1	350	71% neutrophils	155	54	Gram-positive cocci arranged in chains	S. zooepidemicus	Ceftriaxone (MIC 0.25μg/mL) Cefotaxime (MIC 0.25μg/mL) Vancomycin (MIC 0.5μg/mL) Linezolid (MIC ≤2 μg/mL) Levofloxacin (MIC 1 μg/mL) Chloramphenicol (MIC 2 μg/mL)
2	13,884	90% neutrophils	45	56	Negative	S. zooepidemicus	Penicillin (MIC 0.06μg/mL) Ceftriaxone (MIC 0.25μg/mL) Cefotaxime (MIC 0.25μg/mL)
3	11	95.1% lymphocytes	85	28.1	Negative	S. zooepidemicus	Penicillin (MIC 0.06μg/mL) Ceftriaxone (MIC 0.25μg/mL) Cefotaxime (MIC 0.25μg/mL)
5	13,800	92% neutrophils	868.5	0	Gram-positive cocci arranged in chains	S. zooepidemicus	Susceptible to Penicillin G, ceftriaxone, chloramphenicol, and vancomycin (MICs were not available)

Article	Study type	Study year	Place	Year of Outbreak/Case	Number of affected individuals	Clinical Syndrome	Diagnostic Methods	Strain
Sesso et al.⁴	Case-control	2005	Nova Serrana municipality - Minas Gerais State	1998	135	Glomerulonephritis	Cultures of oropharyngeal swabs	N/A
Torres et al.⁵	Retrospective study	2018	Monte Santo municipality - Minas Gerais State	2012	175	Glomerulonephritis	Cultures of oropharyngeal swabs, PCR, and sequencing analysis	SzPHV5
This article	Case series	2024	Fortaleza municipality - Ceara State	2019 and 2023	5	Meningoencephalitis; Pericarditis, and Infectious endocarditis	CSF and blood Cultures	N/A

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[1] Correspondence to: Luís Arthur Brasil Gadelha Farias Hospital São José de Doenças Infecciosas, Rua Nestor Barbosa, 315, CEP 60455-610, Fortaleza, CE, Brazil E-mail: luisarthurbrasilk@hotmail.com