A Streptococcus suis isolate from a German hunter with streptococcal toxic shock-like syndrome (STSLS) and four additional zoonotic isolates were genotyped as mrp ؉ epf* (variant 1890) sly ؉ cps2 ؉ . All five zoonotic German strains were characterized by high multiplication in human blood samples ex vivo, but induction of only low levels of proinflammatory cytokines compared to a Chinese STSLS strain.
Streptococcus suis is an important porcine and human pathogen causing septicemia, meningitis, and other pathologies (1, 2). More than 90% of the strains isolated from humans belong to serotype 2 (3-5), although other serotypes, such as 9 and 7, are epidemiologically also very important in pigs (6). In addition to domesticated pigs, wild boars are an important reservoir for S. suis serotype 2 strains in Germany (7). Accordingly, zoonotic cases have been described in hunters (8)(9)(10)(11)(12).In August 2005, a zoonotic outbreak of S. suis diseases occurred in China, including at least 37 cases of streptococcal toxic shocklike syndrome (STSLS) (13). Multilocus sequence typing (MLST) revealed that the Chinese STSLS isolates belong to sequence type (ST) 7 within clonal complex (CC) 1 (14). An 89-kb region designated a pathogenicity island was described as a hallmark of the genome of the Chinese STSLS isolates (15) but was later identified as an integrative conjugative element present also in a similar form in S. suis isolates in Vietnam not associated with STSLS (16).This study was initiated after a fatal case of STSLS in a German hunter. The hunter showed rapid clinical deterioration marked by hypotension (70/50 mm Hg) and multiorgan failure, including severe hepatic and renal impairment despite hospitalization in an intensive care unit. Furthermore, cardiomyopathy and coagulopathy with severe thrombocytopenia (platelets of 14/nl) as well as disseminated intravascular coagulation associated with petechiae were diagnosed (Quick value of 5% and partial thromboplastin time of Ͼ200 s). S. suis (strain BK52339) was isolated in pure culture from this patient's blood sample. The diagnosis of STSLS is in accordance with the clinical criteria defined by others (17).The MLST analysis (18) revealed that the German STSLS isolate BK52339, four additional German zoonotic strains, and 3 of 4 cps2 ϩ S. suis strains from wild boars belonged to ST1 (Table 1). Differentiation of virulence-associated genes using a multiplex (MP)-PCR (19) and a PCR for detection of the 89-kb region demonstrated that BK52339 is an mrp ϩ sly ϩ cps2 ϩ strain lacking the 89-kb region present in the genome of Chinese STSLS strains like O5ZYH33 (results not shown). The European serotype 2 strains causing problems in the pig industry belong mainly to ST1 and carry, in addition to mrp and sly, an epf gene encoding a 110-kDa extracellular factor (EF) (20). The genotypic analysis of the zoonotic German strains also included an epf PCR (19) for determination of specific variants of this highly variable gene (Fig. 1). Interestingly, the STSLS strain BK52339 as well a...