Septicaemia in a pig-farm worker

S suis is a Gram positive, catalase negative, encapsulated coccus that causes a wide range of clinical disease syndromes in pigs and other domestic animals. It occurs mainly in Northern Europe and Southeast Asia. Little is known about the pathogenesis of S suis infection in human beings, but the entry site is probably most commonly a minor occupational wound.1 S suis infections in human beings were reviewed in 1988 by [Arends JP] and Zanen.1 Many serotypes of S suis have been identified. Type 2 causes most human infections, almost exclusively in people exposed to pigs or unprocessed pig meat.2 It usually causes purulent meningitis1 and is the commonest cause of bacterial meningitis in Hong Kong. Septic shock is a rare complication but is commonly fulminant and fatal. S suis type 14 has been reported in one human being previously, and we believe that our case is the first reported isolation of this serotype from a human being in the UK.1,4 Purpura fulminans has been associated with S suis in only one reported case previously, and this was with the more commonly pathogenic serotype 2.(3) Serious infections, frequently with encapulated bacteria (S pneumoniae, Haemophilus influenzae, Neisseria meningitidis), are more common within 5 years of splenectomy and especially during the first year. UK Department of Health guidelines Information about splenectomy for patients (May, 1999) recommended several prophylactic measures against infection. They advise prophylactic antibiotics after splenectomy as "essential in the first few years ... and for children up to the age of 16 years". No prophylactic regimen can be totally effective but the sensitivity of this S suis isolate to penicillin suggests that penicillin prophylaxis would have been effective.