- Email: [email protected]
HIV and peacekeeping operations in Cambodia
defined in the research in a rural
who had changed their address previous 12 months. Our more recent community adds further evidence on migration as an important risk factor for HIV infection in South Africa. In a community-based sample of 232 subjects, 25 of the 183 persons who had spent 10 or fewer nights per month with their regular partners were HIV infected
migrant
was
as one
Authors’
reply
once or more
whereas none of the 49 individuals who saw their partners more than ten times a month (p<0-01) were infected. Adjustment for age and sex did not materially change this
finding. The AIDS epidemic in South Africa is expanding rapidly, with a national antenatal prevalence of 7-6% in 1994 and a doubling time of 15-4 months.4 Although apartheid has gone, the system of migrant labour will not cease overnight because there is a shortage of urban housing, and the culture of holding an urban job while maintaining a traditional rural home is deeply rooted in some sectors of society. Because of this tradition, interventions need to be designed that will limit the translocation of HIV from urban to rural areas. Unfortunately, migrants are a difficult group to target in rural settings and so, for logistic reasons, interventions such as condom promotion and STD control are likely to be most effective by targeting migrants at the workplace or in urban residential areas. However, such interventions are an immediate but only a part solution since they do not address the social disruption inherent in a system of migrant labour. In the medium to long term, political will and economic resources have to be mobilised to reduce the need for workers to migrate while also addressing the needs of those who wish to continue as migrant workers. *M Colvin, S S Abdool Karim, D Wilkinrion Centre for Epidemiological Research in South Africa, Medical Research Council, PO Box 17120, Congella 4013, South Africa
Migrant labour in South Africa. Johannesburg: SACC/SPROCAS, 1972: 174-202. 2 Abdool Karim Q, Abdool Karim SS, Singh B, Short R, Ngxongo S. Seroprevalence of HIV infection in rural South Africa. AIDS 1992; 6: 1
Wilson F.
3
Jochelson K, Mothibeli M, Leger J-P. Human immunodeficiency virus and migrant labour in South Africa. Int J Health Services 1991; 21:
4
Department of Health. Fifth national HIV survey in women attending antenatal clinics in public health services in South Africa, Oct/Nov, 1994. Epidemiological Comments 1995; 22: 90-100.
1535-39.
157-73.
HIV-associated diarrhoea and
wasting
SiR-The Aug 5 Grand Round (p 352) was a very good summary of some important aspects of HIV infection. I was, however, puzzled as to the decision to do endoscopic retrograde cholangiopancreatography (ERCP). As far as I could determine from the case presentation there was a mild epigastric tenderness that might have been linked to the erythema of the gastric mucosa seen at endoscopy. There was not a picture of right upper quadrant pain and there is no mention of raised alkaline phosphatase or dilation of the common bileduct, which are often seen in AIDS-related sclerosing cholangitis.’ I feel that it would be inappropriate to undertake ERCP on every patient with AIDS and mild upper abdominal discomfort, and that the decision to do this test should be based on the appropriate clinical and
SiR-We thank Malnick for pointing out our failure to justify ERCP in the patient with HIV-associated diarrhoea and weight loss. Unfortunately, the history was summarised and important information was omitted. The patient’s serum alkaline phosphatase, which had been 125 U/L 2 months earlier, proved to be 597 U/L. We agree that ERCP should be used when there is evidence of AIDS cholangiopathy, including dilation of the common bileduct or rising alkaline
phosphatase. Herbert L DuPont, Gailen D Marshall St Luke’s
Episcopal Hospital,
Texas Medical
HIV and peacekeeping Cambodia
Center, Houston, TX 77030. USA
operations in
SiR-Early on, Indonesia and other members of the 21nation United Nations Transition Authority Cambodia (UNTAC) force focused on malaria and other vector-borne and diarrhoeal disease as their principal infectious disease threats during peacekeeping activities in Cambodia. Compliance with malarial chemoprophylaxis doctrine and personal protective measures limited malaria impact significantly. UNTAC personnel were, however, less well prepared to deal with the hazards of sexually transmitted diseases (STDs), the most frequently encountered infectious disease during this deployment. The unconventional nature of this military deployment (ie, largely non-combatant peacekeeping where soldiers stayed in garrison, were well paid, had an abundance of free time, and were encouraged to mix with local populations) created an unanticipated "high risk" situation in an area of the world already beset by explosive HIV spread.’ High reported prevalence of HIV infections among local prostitutes prompted the Indonesian military to screen 3627 soldiers participating in UNTAC. Surveillance involved two groups of peacekepers: 1658 prescreened and postscreened soldiers and 1929 soldiers postscreened only. Specimens positive twice by Pasteur enzyme-linked immunoabsorbent assay (ELISA) were confirmed by western blot. Overall prevalence was 3-3 per 1000 (12 out of 3627) soldiers. The annualised seroconversion rate (negative pre and positive post) resulting from 6 months (mean) of peacekeeping experience in Cambodia was 2-2 per 1000 soldier-years. In the population screened only after their return to Indonesia (in the absence of predeployment data), prevalence was 3-62 per 1000 soldiers screened. Only one soldier (0-5 per 1000) was HIV1 reactive before departing for Cambodia (table). Prescreened soldiers served as historical controls for comparing prevalence with those postscreened only. Negligible prevalence found in predeployment testing, and low level transmission of HIV-1 within high-risk groups in Indonesialed us to conclude that the seven infections detected through post-only screening were likely to have been acquired in Cambodia. Follow-up testing by and ELISA polymerase-chain-reaction genotyping serotyping, with confirmatory DNA sequencing (actual sequence analysis of DNA),’ of six (out of seven) HIV-1
laboratory signs. Stephen
D H Malnick
Department of Internal Medicine C, Kaplan Hospital, Rehovot 76100, Israel
1
Cello JP. Acquired immunodeficiency syndrome spectrum of disease. Am J Med 1989; 86: 539.
1304
cholangiopathy:
*No prescreening conducted. t40 prescreened soldiers were not included in postscreening follow-up (including the 1 found HIV-1 positive on prescreen). Table: HIV-1 prevalence among Indonesian soldiers participating in peacekeeping operation in Cambodia, 1992 and 1993
post-only screening, found all to E. By contrast, preliminary findings from other Indonesian risk groups overwhelmingly show subtype B as most representative. The genotypic evidence of subtype E among the six soldiers tested is compatible with data from neighbouring Thailand,’ the likely source of HIV-1 spread into Cambodia, where E is the predominate subtype. The actual seroconversion rate (including the seven only postscreened HIV-1 positives as probable seroconverters) was 6-3 per 1000 soldier-years. HIV-1 poses a significant threat to military personnel operating under similar circumstances, and warrants preventive actions. The Indonesian experience is indeed tragic in that the 11 infections identified from
be
subtype
(ultimately fatal) HIV-1 infections far exceeded the only other losses (two non-disease-related deaths) sustained by the Indonesian peacekeepers.
100 J-lmol/L bromocriptine was 1-5times that in its absence. A kinetic study (an Eadie-Hofstee plot) revealed that enhancement of glutamate uptake by bromocriptine was reflected in a decrease in the Michaelis constant for glutamate, not in a change in maximum uptake velocity (Vma) (table), suggesting that bromocriptine modulates glutamate transport through an allosteric effect and enhances the affinity of hGluT-1 for glutamate. Because the cells were not provided with dopamine receptors, the effect was not mediated by dopamine receptors. Our results demonstrate that bromocriptine enhances glutamate uptake, and may be important in enhancing the removal of extracellular glutamate, producing similar effect as those achieved by glutamate-receptor antagonists. Bromocriptine may serve as a prototype for the development of more specific and potent regulators of the glutamate
transporters.
*Soeprapto W, Ertono S, Hudoyo H, Mascola J, Porter K, Gunawan S, Corwin AL *Gatot Subroto Army Hospital J1. Abdulrachman Saleh No 24 Jakarta Pusat, Indonesia; Directorate of Health. Army Headquarters, Indonesia, P2LP (CDC), Jakarta, Indonesia; US Naval Medical Research Institute (NMRI), Bethesda, Maryland, USA; National Institute of Health Research and Development, Ministry of Health Jakarta. Indonesia; and US Naval Medical Research Unit 2
1 Wenige BG, Limpakarnjanarai K, Ungchusak K, et al. The epidemiology of HIV infection and AIDS in Thailand. AIDS 1991; 5 (suppl 2): 571-85. 2 Kosen S, Linnan M. Projection of HIV/AIDS in Indonesia 1990-2005. Berita AIDS Indoensia 1995; I (suppl): 1-4. 3 Pau CP, Lee-Thomas S, Auwanit W, et al. Highly specific V3 peptide enzyme immunoassay for serotyping HIV-1 specimens from Thailand. AIDS 1993; 7: 337-40. 4 Weniger BG, Takebe Y, Ou CY, Yamazaki S. The molecular epidemiology of HIV in Asia. AIDS 1994; 8 (suppl 2): S13-28.
*Hiroshi Yamashita, Hideshi Kawakami, Kohichi Tanaka, Shigenobu Nakamura
*Third Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3, Kasumi, Minami-Ku, Hiroshima 734, Japan; and Department of Degenerative Neurological Diseases, National Institute of Neuroscience, NCNP Kodaira 187,
Japan
1 2
3 4
5
Neuroprotective mechanism of bromocriptine SiR-Most patients with Parkinson’s disease are treated with levodopa or with dopamine agonists. Long-term complications of levodopa, especially motor fluctuation, abnormal involuntary movement, and effects on disease progression, limit its usefulness. Dopamine agonists, particularly bromocriptine, have been used in previously untreated patients with Parkinson’s disease to prolong levodopa treatment and delay its complications. Deprenyl also has a neuroprotective effect, and acts by preventing dopamine oxidation by monoamine oxidase B.’ Studies have shown that deprenyl delays the need for levodopa by 1-11 years (0-3-3-0) and bromocriptine by 2-3 years (05-60).2 Bromocriptine is a free-radical scavenger3or an inhibitor of glutamate uptake into synaptic vesicules in vitro,4 but the molecular basis for its neuroprotective action is not understood. We studied the effect of bromocriptine on glutamate transport via the human glutamate transporter, hGIuT-1. Glutamate transporters play an essential role in keeping extracellular glutamate concentrations below neurotoxic levels and their blockade causes neuronal death in both acute and chronic models. We established a hGluT-HeLaS3 cell line, which stably expressed high levels of hGluT-1. The initial velocity of glutamate uptake in the presence of
Mean (SD) *p
transport
Student t test, n=3
bromocriptine
on
kinetics of
glutamate
Yu-xiang Zhang,
Tetrud JW, Langston W. The effect of deprenyl (selegiline) on the natural history of Parkinson’s disease. Science 1989; 245: 519-22. Liebermann AN, Goldstein M. Dopamine agonists: historical perspective. In: Olanow CW, Lieberman AN, eds. The scientific basis for the treatment of Parkinson’s disease. New Jersey: Parthenon Publishing, 1992: 139-56. Yoshikawa T, Minamiyama Y, Naito Y, et al. Antioxidant properties of bromocriptine, a dopamine agonist. J Neurochem 1994; 62: 1034-38. Carlson MD, Kish PE, Ueda T. Glutamate uptake into synaptic vesicles: competitive inhibition by bromocriptine. J Neurochem 1989; 53: 1889-94. Kawakami H, Tanaka K, Nakayama T, et al. Cloning and expression of a human glutamate transporter. Biochem Biophys Res Commun 1994; 199: 171-76.
Streptococcus suis meningitis
in
an
Italian
blood donor SIR-A 52-year-old farmer was referred for fever, vomiting, stiff neck, and bilateral hearing loss. Neurological examination showed only neck rigidity. Cerebrospinal fluid (CSF) was turbid, containing 1107 white cells per uL (95% neutrophils), with a protein concentration of 4-6 g/L and gram-positive cocci on staining. A diagnosis of purulent meningitis was made and benzylpenicillin 24 MU per day by continuous intravenous infusion was started. CSF culture showed a penicillin-sensitive Streptococcus suis type II (identified by Rapid ID 32 Strept, Bio-Merieux, Rome, Italy). Blood culture was negative. The patient, a voluntary blood donor, gave blood at our hospital 5 days before becoming ill. The blood unit (fortunately still in store) was sent to the microbiology unit for culture, leading to the isolation of S suis. Our patient recovered well, but at an 18month follow-up, bilateral perceptive deafness persists. S suis is responsible for meningitis through occupational exposure or, mainly in the Far East, through consumption of pork meat. Prevention is difficult because in pigs there are no signs or symptoms specific for S suis infection. In man, the signs are those of purulent meningitis responding to penicillin; ataxia and deafness occur in 50 to 75% of patients, persisting in half of the cases.’ A fatal outcome has been occasionally reported.2 Although only few pathogens survive prolonged storage periods at the low temperatures of blood-bank refrigerators, these microorganisms are involved in serious and sometimes deadly complications in patients receiving contaminated units.3 S suis is known to survive in frozen meat;’ in our case we isolated it from the blood unit 1305
who had changed their address previous 12 months. Our more recent community adds further evidence on migration as an important risk factor for HIV infection in South Africa. In a community-based sample of 232 subjects, 25 of the 183 persons who had spent 10 or fewer nights per month with their regular partners were HIV infected
migrant
was
as one
Authors’
reply
once or more
whereas none of the 49 individuals who saw their partners more than ten times a month (p<0-01) were infected. Adjustment for age and sex did not materially change this
finding. The AIDS epidemic in South Africa is expanding rapidly, with a national antenatal prevalence of 7-6% in 1994 and a doubling time of 15-4 months.4 Although apartheid has gone, the system of migrant labour will not cease overnight because there is a shortage of urban housing, and the culture of holding an urban job while maintaining a traditional rural home is deeply rooted in some sectors of society. Because of this tradition, interventions need to be designed that will limit the translocation of HIV from urban to rural areas. Unfortunately, migrants are a difficult group to target in rural settings and so, for logistic reasons, interventions such as condom promotion and STD control are likely to be most effective by targeting migrants at the workplace or in urban residential areas. However, such interventions are an immediate but only a part solution since they do not address the social disruption inherent in a system of migrant labour. In the medium to long term, political will and economic resources have to be mobilised to reduce the need for workers to migrate while also addressing the needs of those who wish to continue as migrant workers. *M Colvin, S S Abdool Karim, D Wilkinrion Centre for Epidemiological Research in South Africa, Medical Research Council, PO Box 17120, Congella 4013, South Africa
Migrant labour in South Africa. Johannesburg: SACC/SPROCAS, 1972: 174-202. 2 Abdool Karim Q, Abdool Karim SS, Singh B, Short R, Ngxongo S. Seroprevalence of HIV infection in rural South Africa. AIDS 1992; 6: 1
Wilson F.
3
Jochelson K, Mothibeli M, Leger J-P. Human immunodeficiency virus and migrant labour in South Africa. Int J Health Services 1991; 21:
4
Department of Health. Fifth national HIV survey in women attending antenatal clinics in public health services in South Africa, Oct/Nov, 1994. Epidemiological Comments 1995; 22: 90-100.
1535-39.
157-73.
HIV-associated diarrhoea and
wasting
SiR-The Aug 5 Grand Round (p 352) was a very good summary of some important aspects of HIV infection. I was, however, puzzled as to the decision to do endoscopic retrograde cholangiopancreatography (ERCP). As far as I could determine from the case presentation there was a mild epigastric tenderness that might have been linked to the erythema of the gastric mucosa seen at endoscopy. There was not a picture of right upper quadrant pain and there is no mention of raised alkaline phosphatase or dilation of the common bileduct, which are often seen in AIDS-related sclerosing cholangitis.’ I feel that it would be inappropriate to undertake ERCP on every patient with AIDS and mild upper abdominal discomfort, and that the decision to do this test should be based on the appropriate clinical and
SiR-We thank Malnick for pointing out our failure to justify ERCP in the patient with HIV-associated diarrhoea and weight loss. Unfortunately, the history was summarised and important information was omitted. The patient’s serum alkaline phosphatase, which had been 125 U/L 2 months earlier, proved to be 597 U/L. We agree that ERCP should be used when there is evidence of AIDS cholangiopathy, including dilation of the common bileduct or rising alkaline
phosphatase. Herbert L DuPont, Gailen D Marshall St Luke’s
Episcopal Hospital,
Texas Medical
HIV and peacekeeping Cambodia
Center, Houston, TX 77030. USA
operations in
SiR-Early on, Indonesia and other members of the 21nation United Nations Transition Authority Cambodia (UNTAC) force focused on malaria and other vector-borne and diarrhoeal disease as their principal infectious disease threats during peacekeeping activities in Cambodia. Compliance with malarial chemoprophylaxis doctrine and personal protective measures limited malaria impact significantly. UNTAC personnel were, however, less well prepared to deal with the hazards of sexually transmitted diseases (STDs), the most frequently encountered infectious disease during this deployment. The unconventional nature of this military deployment (ie, largely non-combatant peacekeeping where soldiers stayed in garrison, were well paid, had an abundance of free time, and were encouraged to mix with local populations) created an unanticipated "high risk" situation in an area of the world already beset by explosive HIV spread.’ High reported prevalence of HIV infections among local prostitutes prompted the Indonesian military to screen 3627 soldiers participating in UNTAC. Surveillance involved two groups of peacekepers: 1658 prescreened and postscreened soldiers and 1929 soldiers postscreened only. Specimens positive twice by Pasteur enzyme-linked immunoabsorbent assay (ELISA) were confirmed by western blot. Overall prevalence was 3-3 per 1000 (12 out of 3627) soldiers. The annualised seroconversion rate (negative pre and positive post) resulting from 6 months (mean) of peacekeeping experience in Cambodia was 2-2 per 1000 soldier-years. In the population screened only after their return to Indonesia (in the absence of predeployment data), prevalence was 3-62 per 1000 soldiers screened. Only one soldier (0-5 per 1000) was HIV1 reactive before departing for Cambodia (table). Prescreened soldiers served as historical controls for comparing prevalence with those postscreened only. Negligible prevalence found in predeployment testing, and low level transmission of HIV-1 within high-risk groups in Indonesialed us to conclude that the seven infections detected through post-only screening were likely to have been acquired in Cambodia. Follow-up testing by and ELISA polymerase-chain-reaction genotyping serotyping, with confirmatory DNA sequencing (actual sequence analysis of DNA),’ of six (out of seven) HIV-1
laboratory signs. Stephen
D H Malnick
Department of Internal Medicine C, Kaplan Hospital, Rehovot 76100, Israel
1
Cello JP. Acquired immunodeficiency syndrome spectrum of disease. Am J Med 1989; 86: 539.
1304
cholangiopathy:
*No prescreening conducted. t40 prescreened soldiers were not included in postscreening follow-up (including the 1 found HIV-1 positive on prescreen). Table: HIV-1 prevalence among Indonesian soldiers participating in peacekeeping operation in Cambodia, 1992 and 1993
post-only screening, found all to E. By contrast, preliminary findings from other Indonesian risk groups overwhelmingly show subtype B as most representative. The genotypic evidence of subtype E among the six soldiers tested is compatible with data from neighbouring Thailand,’ the likely source of HIV-1 spread into Cambodia, where E is the predominate subtype. The actual seroconversion rate (including the seven only postscreened HIV-1 positives as probable seroconverters) was 6-3 per 1000 soldier-years. HIV-1 poses a significant threat to military personnel operating under similar circumstances, and warrants preventive actions. The Indonesian experience is indeed tragic in that the 11 infections identified from
be
subtype
(ultimately fatal) HIV-1 infections far exceeded the only other losses (two non-disease-related deaths) sustained by the Indonesian peacekeepers.
100 J-lmol/L bromocriptine was 1-5times that in its absence. A kinetic study (an Eadie-Hofstee plot) revealed that enhancement of glutamate uptake by bromocriptine was reflected in a decrease in the Michaelis constant for glutamate, not in a change in maximum uptake velocity (Vma) (table), suggesting that bromocriptine modulates glutamate transport through an allosteric effect and enhances the affinity of hGluT-1 for glutamate. Because the cells were not provided with dopamine receptors, the effect was not mediated by dopamine receptors. Our results demonstrate that bromocriptine enhances glutamate uptake, and may be important in enhancing the removal of extracellular glutamate, producing similar effect as those achieved by glutamate-receptor antagonists. Bromocriptine may serve as a prototype for the development of more specific and potent regulators of the glutamate
transporters.
*Soeprapto W, Ertono S, Hudoyo H, Mascola J, Porter K, Gunawan S, Corwin AL *Gatot Subroto Army Hospital J1. Abdulrachman Saleh No 24 Jakarta Pusat, Indonesia; Directorate of Health. Army Headquarters, Indonesia, P2LP (CDC), Jakarta, Indonesia; US Naval Medical Research Institute (NMRI), Bethesda, Maryland, USA; National Institute of Health Research and Development, Ministry of Health Jakarta. Indonesia; and US Naval Medical Research Unit 2
1 Wenige BG, Limpakarnjanarai K, Ungchusak K, et al. The epidemiology of HIV infection and AIDS in Thailand. AIDS 1991; 5 (suppl 2): 571-85. 2 Kosen S, Linnan M. Projection of HIV/AIDS in Indonesia 1990-2005. Berita AIDS Indoensia 1995; I (suppl): 1-4. 3 Pau CP, Lee-Thomas S, Auwanit W, et al. Highly specific V3 peptide enzyme immunoassay for serotyping HIV-1 specimens from Thailand. AIDS 1993; 7: 337-40. 4 Weniger BG, Takebe Y, Ou CY, Yamazaki S. The molecular epidemiology of HIV in Asia. AIDS 1994; 8 (suppl 2): S13-28.
*Hiroshi Yamashita, Hideshi Kawakami, Kohichi Tanaka, Shigenobu Nakamura
*Third Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3, Kasumi, Minami-Ku, Hiroshima 734, Japan; and Department of Degenerative Neurological Diseases, National Institute of Neuroscience, NCNP Kodaira 187,
Japan
1 2
3 4
5
Neuroprotective mechanism of bromocriptine SiR-Most patients with Parkinson’s disease are treated with levodopa or with dopamine agonists. Long-term complications of levodopa, especially motor fluctuation, abnormal involuntary movement, and effects on disease progression, limit its usefulness. Dopamine agonists, particularly bromocriptine, have been used in previously untreated patients with Parkinson’s disease to prolong levodopa treatment and delay its complications. Deprenyl also has a neuroprotective effect, and acts by preventing dopamine oxidation by monoamine oxidase B.’ Studies have shown that deprenyl delays the need for levodopa by 1-11 years (0-3-3-0) and bromocriptine by 2-3 years (05-60).2 Bromocriptine is a free-radical scavenger3or an inhibitor of glutamate uptake into synaptic vesicules in vitro,4 but the molecular basis for its neuroprotective action is not understood. We studied the effect of bromocriptine on glutamate transport via the human glutamate transporter, hGIuT-1. Glutamate transporters play an essential role in keeping extracellular glutamate concentrations below neurotoxic levels and their blockade causes neuronal death in both acute and chronic models. We established a hGluT-HeLaS3 cell line, which stably expressed high levels of hGluT-1. The initial velocity of glutamate uptake in the presence of
Mean (SD) *p
transport
Student t test, n=3
bromocriptine
on
kinetics of
glutamate
Yu-xiang Zhang,
Tetrud JW, Langston W. The effect of deprenyl (selegiline) on the natural history of Parkinson’s disease. Science 1989; 245: 519-22. Liebermann AN, Goldstein M. Dopamine agonists: historical perspective. In: Olanow CW, Lieberman AN, eds. The scientific basis for the treatment of Parkinson’s disease. New Jersey: Parthenon Publishing, 1992: 139-56. Yoshikawa T, Minamiyama Y, Naito Y, et al. Antioxidant properties of bromocriptine, a dopamine agonist. J Neurochem 1994; 62: 1034-38. Carlson MD, Kish PE, Ueda T. Glutamate uptake into synaptic vesicles: competitive inhibition by bromocriptine. J Neurochem 1989; 53: 1889-94. Kawakami H, Tanaka K, Nakayama T, et al. Cloning and expression of a human glutamate transporter. Biochem Biophys Res Commun 1994; 199: 171-76.
Streptococcus suis meningitis
in
an
Italian
blood donor SIR-A 52-year-old farmer was referred for fever, vomiting, stiff neck, and bilateral hearing loss. Neurological examination showed only neck rigidity. Cerebrospinal fluid (CSF) was turbid, containing 1107 white cells per uL (95% neutrophils), with a protein concentration of 4-6 g/L and gram-positive cocci on staining. A diagnosis of purulent meningitis was made and benzylpenicillin 24 MU per day by continuous intravenous infusion was started. CSF culture showed a penicillin-sensitive Streptococcus suis type II (identified by Rapid ID 32 Strept, Bio-Merieux, Rome, Italy). Blood culture was negative. The patient, a voluntary blood donor, gave blood at our hospital 5 days before becoming ill. The blood unit (fortunately still in store) was sent to the microbiology unit for culture, leading to the isolation of S suis. Our patient recovered well, but at an 18month follow-up, bilateral perceptive deafness persists. S suis is responsible for meningitis through occupational exposure or, mainly in the Far East, through consumption of pork meat. Prevention is difficult because in pigs there are no signs or symptoms specific for S suis infection. In man, the signs are those of purulent meningitis responding to penicillin; ataxia and deafness occur in 50 to 75% of patients, persisting in half of the cases.’ A fatal outcome has been occasionally reported.2 Although only few pathogens survive prolonged storage periods at the low temperatures of blood-bank refrigerators, these microorganisms are involved in serious and sometimes deadly complications in patients receiving contaminated units.3 S suis is known to survive in frozen meat;’ in our case we isolated it from the blood unit 1305