Streptococcus suis infection: An emerging/reemerging challenge of bacterial infectious diseases?

Feng, Youjun; Zhang, Huimin; Wu, Zuowei; Wang, Shihua; Cao, Min; Hu, Dan; Wang, Changjun

Others In addition to the above two major forms of SS2-caused diseases, there are some other clinical types that occur less frequently in the cases of human SS2 infections, including arthritis, endocarditis, streptococcal toxic shock-like syndrome (STSLS), etc. Since STSLS is a newly-described disease form of SS2 infections (Fig. 4) , here we have discussed it in detail. Toxic-shock syndrome refers to a highly invasive infection of deep tissues, and can be correlated with production of bacterial super-antigens (e.g., staphylococcal and streptococcal exotoxins). 183, 184 Before Tang et al. 18 formally proposed that SS2 is another bacterial non-GAS agent responsible for STSLS, we had been aware that Staphylococcus 185, 186 and Streptococcus pyogenes, a group A streptococcus (GAS) 183, 184 are both leading pathogens with a capability of causing STSLS. The clinical criteria for diagnosis of STSLS disease can be described as follows: (1) clear erythematous blanching rash (Fig. 4) , (2) sudden onset of high fever, (3) hypotension diarrhea, (4) blood spots and petechiae, and (5) dysfunction of multiple organs (e.g., disseminated intravascular coagulation and acute renal failure). 8, 9, 18 According to above clinical criteria, two independent research groups in China reported two big outbreaks of human SS2-caused STSLS, which occurred in Jiangsu Province, 1998, and Sichuan Province, 2005, respectively. 9, [17] [18] [19] 34 Two models have been proposed to explain the molecular mechanism by which SS2 triggers STSLS in its infected patients, one of which is a two-stage hypothesis, 94 the other is a specific 89K PAI. 23, 160 Although we came to know that similar findings were also recorded in Thailand, 187 France, 188 and Australia, 84 we did not gain any information on difference of these SS2 strains abroad in comparison with Chinese STSLS-causing isolates. Given that the above two models are based on evidence from studying the Chinese SS2 strains, we can't conclude presently that they represent common or strain-specific mechanisms.