Deafness due to haemorrhagic labyrinthitis and a review of relapses in Streptococcus suis meningitis

Tan JH, Yeh BI, Seet CSR
Correspondence: Dr June Tan, june_tan@nuhs.edu.sg

ABSTRACT
Deafness is a common and often permanent neurological sequel of Streptococcus (S.) suis meningitis. Suppurative labyrinthitis, rather than direct auditory nerve infection, has been found to be the site responsible for deafness. Neuroimaging is important to localise the site involved in hearing loss and to assess the feasibility of a cochlear implantation. S. suis is very sensitive to penicillin. Although a relapse of S. suis meningitis is uncommon, it can occur despite an adequate duration of appropriate antibiotic therapy. We describe a patient with S. suis meningitis, who developed permanent deafness from haemorrhagic labyrinthitis, as shown on magnetic resonance imaging. She suffered a relapse despite a seven-week course of intravenous antibiotics. A review on six cases of relapse reported in the literature shows that relapses occurred despite two to four weeks of antibiotics being administered to the patients. The clinical implications and treatment of relapse are discussed.

Keywords: deafness, meningitis, neuroimaging, relapse, Streptococcus suis
Singapore Med J 2010; 51(2): e30-e33