Case report: Relaps of Streptococcus suis infection in patient with Meningoencephalitis at Prof. Ngoerah Hospital, Bali

Background: S. suis is a facultative anaerobic Gram-positive bacterium that causes human infection. It is a primary health problem in the swine industry. Ceftriaxone is a therapeutic option for meningitis besides Ampicillin. Recently, the incidence of resistance to ceftriaxone was reported. The recurrence of S. suis in this patient is thought to be caused by ceftriaxone resistance due to inadequate initial therapy. Case Presentation: A 43-year-old male patient came to the ER with headaches in the head and neck. The patient had a history of meningitis due to S. suis twice before. While in the ER, the patient was given ceftriaxone while awaiting culture results. Blood cultures showed S. suis infection using VITEK 2 COMPACT (Biomeriuex®) and ceftriaxone resistance. The patient was successfully managed with Ampicillin following these culture results, leading to good outcomes. Discussion: S. suis is a gram-positive bacterial pathogen in pigs that can cause severe human infection, including meningitis, septicemia, endocarditis and deafness the most common complications. The patient experienced three relapses due to S. suis. On the third visit, blood culture results identified ceftriaxone-resistant S. suis. The patient's recurrent relapses could be attributed to several factors, including inadequate antibiotic administration, antibiotic resistance, weak immune system, contact with the source of infection and environmental variables, highlighting the complexity and challenges in treating S. suis infection. Conclusion: The use of antibiotics in relapse cases has the potential to cause antibiotic resistance, so it’s necessary to make guidelines for antibiotic therapy in S. suis infection to prevent recurrent infections.