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2022 Jun

One Health


A large cluster of human infections of in Bali, Indonesia.


Tarini NMA, Susilawathi NM, Sudewi AAR, Soejitno A, Fatmawati NND, Mayura IPB, Lestari AAW, Suputra G, Subrata IK, Astiti CISD, Besung INK, Mahardika GN
One Health. 2022 Jun; 14:100394.
PMID: 35686153.


A cluster of 18 inpatients and 21 outpatients with a major complaint of meningitis and a history of sharing traditional delicacies of raw pork and pig blood in a village festival led to the suspicion of meningitis in Sibang Kaja Village, Badung, Bali, Indonesia. We conducted an investigation and case finding to prevent human fatalities. Demography and laboratory examinations of the inpatients were recorded. Bacterial culture, identification, and sensitivity tests were conducted using a VITEK 2 Compact machine (Biomeriuex®) with cerebrospinal fluid (CSF) or blood from the inpatients. The bacterial species were confirmed via PCR. A subsequent investigation was also conducted to identify the source of the meat, the presence of in slaughtered pigs, and the zoosanitary measures at pig farms and slaughterhouses. The five most common clinical signs were fever (92.3%), myalgia (46.1%), neck stiffness (25.6%), headache (23.1%), and nausea/vomiting (20.5%). was confirmed in two CSF and one blood specimens. All inpatients recovered following intravenous treatment with ceftriaxone every 12 h for 14 days and dexamethasone every 6 h for 4 days, while the outpatients were treated with 500 mg of amoxicillin three times daily for 7 days. The veterinary and environmental investigation identified the source of the pork for the festival, confirmed the presence of in the slaughtered pigs, and elucidated the sanitary measures applied at the pig farms and slaughterhouses. We conclude that infections of in humans can spread in cluster phenomena following the sharing of high-risk food. A prompt and early response, as well as early treatment of patients, is paramount in case finding to enable a favourable outcome of full recovery. Additionally, the implementation of the "One Health" approach provides a comprehensive picture of the management of infection in humans.