Presentazione di PowerPoint

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SAPUVETNET
MENINGITIS STREPTOCOCICA PORCINA ANTIBIOTIC
RESISTANCE FROM PIGS PUBLIC HEALTH INVOLVEMENTS
Additional material Manual on DISEASE OUTBREAK
INVESTIGATION Manual on PRUDENT USE OF
ANTIBIOTICS
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SAPUVETNET
The case a little region of a developing country
where stock breeding is trying to develop to
improve the economy of the region
First case of disease in humans appeared on 15th
June of 2005 In the next week, 12 cases were
described - Slight cutaneous symptoms on hands
and arms - Inflammation and red skin in these
zones. - Little grazes On the 21th June, one
person died with septicaemia, toxic shock,
meningitis and subcutaneous haemorrhage
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SAPUVETNET

• A bacterial cause was suspected, so
• A treatment with broad spectrum penicillin was
  carried out
• It wasnt effective and three days later the
  treatment was changed to a quinolone
• It wasnt effective too, so doctors started to
  look for a antibiotic of third generation
• While this was happening, another person died. He
  also had a septicaemia

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SAPUVETNET
As a Veterinary Public Health (VPH) expert do
you think they (doctors) have acted in a right
way to deal with the human cases? In case they
did not Which mistakes do you think they made?
What do you think they should do?
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SAPUVETNET
The microbiological investigation of the two dead
patients detected the presence of Streptococcus
suis. Moreover this micro-organism was resistant
to almost all antibiotic assessed

• As public concern was growing, a working team
  involving doctors, veterinarians and politicians
  was created. The veterinarians suggested to study
  if this micro organism had an animal origin

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SAPUVETNET
How would you carry out the STUDY OF THE
DISEASE? Which aspects do you think would be
important to study?
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SAPUVETNET
The investigation showed that

• Before 15th June, some more 20 (minor) cases have
  came up during the year. Those people got better
  in 12-15 days
• There have been higher mortality than normal in
  two pig farms during the last months. The pigs
  died with meningitis. No cause was found for
  these deaths, but it was thought that it happened
  because of over-crowding and very humid and hot
  weather

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SAPUVETNET
The investigation showed that

• One of the dead patients worked in the pig farm
  and the other worked in the slaughterhouse. Most
  of the affected people had taken part in domestic
  pig slaughtering (which is a tradition in the
  area)
•         Other affected people were slaughterhouse
  workers and the others were close relatives of
  the affected people
•   In the last years some people had been sick
  with similar but less severe symptoms, and cases
  in pigs had been also described

What is your conclusion with the information so
far available?
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SAPUVETNET
The study in pigs of the region showed that
Streptococcus suis type 2 was detected in the 70
of the farms

• This bacteria has the same serotype and genotype
  as the bacteria isolated from the dead people
• Also the same antibiotic resistance patterns were
  showed
• All these strains were multi-resistant.
• Pig farms related people were also investigated
  and the bacteria was isolated in 40 of them.

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SAPUVETNET
Do you still held your previous conclusion with
the available information? Could you now think
of a new / different conclusion?
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SAPUVETNET
The study at the pig farms showed that

• Most of the famers didnt have veterinary advice
• There were a constant movement and mixing of
  animals amongst the farms
• The farmers gave antibiotics to animals in order
  to prevent diseases
• Antibiotics are given with food and half of the
  standard dosis
• During the last two years, at the farms a mix of
  two penicillins and a tetracicline had been used

Cont. ?
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SAPUVETNET

• The farms were cleaned with running water once a
  month
• When a animal died, the carcases were disposed
  of (thrown away) without any treatment

With all these information Do you consider that
these practices are appropriate? Cont.
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SAPUVETNET
Do you think these practices are related with
Public Health problems or may have something to
do with it in future? In that case, explain
which practices, why and how
How would you suggest to solve this problem both
in animals and humans?
Case study developed by the SAPUVETNET II member
University of Zaragoza, Fac. Veterinary
Medicine
(contact Carmelo Ortega/ola Gimeno
epidemio_at_unizar.es)