Streptococcus gallolyticus bacteremia detected in apheresis platelets and its link to colonic neoplasms

Introduction: Streptococcus gallolyticus belongs to theStreptococcus bovis complex, and it is a common bacterium colonizing the gastrointestinal tract. Its presence in the blood may suggest an underlying pathology such as a colonic neoplasm. We report herein a case of S. bovis bacteremia in an apheresis platelet donor, review similar cases in the literature, and suggest a flowchart for the management of similar cases in other blood donation centers. Case Presentation: A 61-year-old subject presented to a Hemotherapy Service to make an apheresis platelet donation. On quality control testing, S. gallolyticus was identified in hemoculture, and the donor was called back for follow-up. At first, a new hemoculture was requested, and the patient was referred to the outpatient department of infectious diseases to further investigate pathologies associated with S. gallolyticus. A subsequent colonoscopy investigation evidenced a polypoid structure in the ascending colon. Pathology reported the resected specimen as a low-grade tubular adenoma. Conclusion: Isolation of S. bovis in blood products requires further investigation and should be managed with precision by Hemotherapy Services. A standard protocol for the management of asymptomatic patients with S. bovis positive hemoculture, with the requests of a new blood culture, a colonoscopy, and an echocardiogram is crucial, as it may ensure early diagnosis and reduce morbidity and mortality. (AU)

Presencia de Streptococcus bovis en muestras de orina de sujetos con síntomas de infección del aparato urinario / Presence of Streptococcus bovis in urine samples from patients experiencing symptoms of urinary tract

Dada la importancia de la correcta validación clínica de los aislamientos de Streptococcus bovis, nos planteamos la revisión de su presencia en muestras de orina con el objetivo de conocer su frecuencia relativa y su patrón de sensibilidad antibiótica. Se revisó retrospectivamente la sensibilidad a los antibióticos de 91 aislados de S. bovis recuperados de muestras de orina durante un período de 4 años (2012-2015). La media de la edad de los pacientes fue de 55 años y en su mayoría fueron mujeres (81%). El 37,4% eran pacientes hospitalizados con enfermedades urológicas (61%). La sensibilidad a penicilina, vancomicina y teicoplanina fue del 97,8%. Aunque S. bovis puede ser poco común en los aislamientos de orina, su presencia en sujetos con enfermedades de base justifica la realización de estudios de patogenicidad que demuestren la verdadera capacidad de producir enfermedad de este grupo de bacterias.

Given the relevance of proper clinical validation of Streptococcus bovis, we here consider revising its presence in urine samples in order to determine its relative frequency and the pattern of antibiotic susceptibility. The susceptibility to antibiotics of 91 isolates of S. bovis from urine samples was retrospectively reviewed over a period of 4 years (2012-2015). The mean age of patients was 55 years, 81% of whom were women and 37.4% were hospitalized patients suffering from urological diseases (61%). Susceptibility to penicillin, vancomycin and teicoplanin was 97.8%. Due to the fact that S. bovis can be infrequent in urine isolates and given its presence in patients suffering from urological diseases, further pathogenic studies, showing the true ability of this group of bacteria to produce disease, are required.

Bacteriemias por Streptococcus gallolyticus (ex S. bovis) y su relación con patología colónica o hepatobiliar y endocarditis / Streptococcus gallolyticus (ex S. bovis) bacteremia and its relationship with colonic or hepatobiliary disease and endocarditis

Background: Bacteremia due to Streptococcus bovis (now S. gallolyticus) has been traditionally associated to colon or hepatobiliar disease and endocarditis but there is no information on this matter in Chile. Aims: To describe clinical features of adult patients suffering bacteremia by S. bovis/S. gallolyticus, identify the source of the bacteremia and the frequency of endocarditis. Methods: Retrospective-descriptive study using laboratory records. Results: Between January 2003 and August 2014, 23 S. bovis/S. gallolyticus bacteremic events were identified among 22 patients. Mean age was 72.7 years (range 46-96). Co-morbidities were frequent (9.1 to 47.6%). The primary source of bacteremia was intestinal in 52.2%; hepatobiliar in 17.4% and in 34.8% it was not elucidated. Six patients had infective endocarditis (26.1%) and one patient had espondylodiscitis (4.3%). S. bovis represented 39.1% of isolates (all until 2008), S. gallolyticus subsp pasteurianus 39.1% and, S. gallolyticus subsp infantarius and S. gallolyticus subsp gallolyticus 8.7% each one, respectively. Association studies between the bacteremic source or endocarditis with specific S. gallolyticus subspecies were limited by the small number of isolates. Seven patients (30.4%) underwent surgical interventions. In-hospital mortality reached 21.7% (n = 5). Conclusions: Although infrequent, bacteremic events by S. gallolyticus/S. bovis have increased in-hospital mortality, require surgical intervention and affect older patients with co-morbidities. Near two-thirds suffer from colonic or hepatobiliary disease that act as the primary source of bacteremia. In addition, near one fourth is affected by infective endocarditis. Detection of S. gallolyticus/S. bovis in blood cultures prompts a thorough clinical evaluation in order to clarify the source of the bloodstream infection and the presence of complications.

Antecedentes: Los cuadros de bacteriemia por Streptococcus bovis (actualmente S. gallolyticus) han sido tradicionalmente asociados a patología colónica o hepatobiliar y endocarditis pero no se conoce de estudios en Chile que hayan abordado este tema. Objetivos: Describir aspectos clínicos de pacientes adultos afectados por bacteriemias por S. bovis/S. gallolyticus, identificar la fuente de la bacteriemia y la frecuencia de endocarditis. Métodos: Diseño de tipo retrospectivo, descriptivo, con el registro de casos bacteriemia. Resultados: Entre enero de 2003 y agosto de 2014 se identificaron 23 eventos de bacteriemia por S. bovis/S. gallolyticus en 22 pacientes. La edad promedio fue de 72,7 años (rango 46-96). La prevalencia de diferentes co-morbilidades fue elevada (9,1 a 47,6%). El foco primario de la bacteriemia fue intestinal en 52,2%, hepatobiliar en 17,4% y, en 34,8% no se aclaró el foco. Seis pacientes presentaron endocarditis infecciosa (26,1%) y uno espondilodiscitis (4,3%). S. bovis representó 39,1% de los aislados (todos hasta el 2008), S. gallolyticus subsp pasteurianus 39,1%, S. gallolyticus subsp infantarius y S. gallolyticus subsp gallolyticus 8,7%, respectivamente. Los estudios de asociación estuvieron limitados por el bajo número de aislados. Siete pacientes (30,4%) debieron ser intervenidos quirúrgicamente. La mortalidad hospitalaria fue de 21,7% (n: 5). Conclusiones: Aunque infrecuentes, los eventos de bacteriemia por S. gallolyticus/S. bovis tienen una elevada mortalidad hospitalaria, requieren con frecuencia procedimientos quirúrgicos y afectan a pacientes mayores con co-morbilidades. Cerca de dos tercios padecen de una patología colónica o hepatobiliar que actúa como foco primario y cerca de un cuarto presenta endocarditis infecciosa. La detección de este grupo bacteriano en los hemocultivos requiere una evaluación para establecer el origen de la bacteriemia y la presencia de complicaciones.

Neonatal invasive Streptococcus gallolyticus subsp. pasteurianus infection with delayed central nervous system complications / 소아과

Group D streptococci are known to cause newborn septicemia and meningitis, but the Streptococcus bovis group strains rarely cause serious neonatal infections in Korea. Central nervous system (CNS) complications of neonatal S. bovis group infection have rarely been reported. In adults, S. bovis group strains cause bacteremia and endocarditis, and are associated with gastrointestinal malignancy. However, only a few studies have reported meningitis and septicemia in infants. Here, we describe a case of bacteremia and meningitis due to Streptococcus gallolyticus subsp. pasteurianus with a delayed CNS complication in an infant. A 28-day-old male infant was admitted to the hospital with a 1-day history of fever. Cultures of blood, cerebrospinal fluid, and urine showed the presence of S. bovis group strain-S. gallolyticus subsp. pasteurianus. He was discharged after 21 days of intravenous ampicillin and cefotaxime administration. Two weeks later, he was readmitted with a fever and short episodes of tonic-clonic movements. Brain magnetic resonance imaging showed marked bilateral frontal subdural effusion. He was discharged after 31 days of antibiotic therapy, and no neurological sequelae were observed at the 9-month follow-up. In conclusion, we present a rare case of neonatal S. gallolyticus subsp. pasteurianus infection causing urinary tract infection, septicemia, meningitis, and delayed CNS complications. This case emphasizes the need for physicians to be aware of S. bovis infection in infants.

Aislamiento de Streptococcus bovis en paciente con cáncer de colon no diagnosticado. Presentación de un caso / Isolation of Streptococcus bovis in a Patient with Undiagnosed Colon Cancer. A Case Report

Uno de los agentes bacterianos que ha sido regularmente asociado con el cáncer colorectal es el Streptococcus bovis. Del 25 al 80 % de los pacientes con bacteremia por Streptococcus bovis tienen tumores colorrectales y la incidencia de asociación de neoplasia de colon con endocarditis por S. bovis ha sido mostrada del 18 al 62 %. Por tales razones se decidió la presentación del caso de un paciente de 57 años, de procedencia urbana, con antecedentes de alcoholismo y diabetes mellitus tipo I, desde hacía seis años, que ingresó en el Hospital de Cienfuegos con sangrado digestivo alto y fiebre de 39 a 40 o C. En hemocultivo se aisló Streptococcus bovis. El paciente falleció a las 72 hora de ingresado. Los resultados de la necropsia mostraron adenocarcinoma de colon derecho, moderadamente diferenciado.

One of the bacterial agents commonly associated with colorectal cancer is Streptococcus bovis. Twenty five to 80 % of patients with Streptococcus bovis bacteremia develop colorectal tumors and the incidence of colonic neoplasia associated with S. bovis endocarditis has been shown to be 18 to 62 %. Hence, it was decided to present the case of a 57-year-old patient from an urban area with a 6-year history of diabetes mellitus type I and alcoholism, who was admitted to the hospital in Cienfuegos because of significant gastrointestinal bleeding and fever (39-40 o C). Streptococcus bovis was isolated from the blood culture. The patient died 72 hours after his admission. Autopsy results showed a moderately differentiated adenocarcinoma of the right colon.

A Case of Late Onset Neonatal Bacteremia and Meningitis Caused by Streptococcus lutetiensis / 소아감염

Invasive infection of the Streptococcus bovis group in a neonate is rare. In cases reported to date, the pathogen of neonatal S. bovis infections is usually Streptococcus gallolyticus subsp. pasteurianus (S. bovis biotype II/2). Streptococcus lutetiensis (S. bovis biotype II/1) was identified using 16S rRNA and tuf gene sequence analysis of the isolates from blood and cerebrospinal fluid (CSF) of a fever-presenting 28-day-old male. Blood culture analysis was performed using automatic equipment (VITEK 2) and identified Streptococcus infantarius supsp. infantarius, yet we were unable to get accurate results from the CSF culture. The fever subsided on the second day of hospitalization, and the patient was discharged without neurologic complication after 14 days of antibiotic therapy. In this case, we were able to accurately identify the pathogen using molecular genetic methods. To our knowledge, this is the first case of late onset neonatal bacteremia and meningitis caused by S. lutetiensis.

Streptococcus pasteurianus septicemia.

Streptococcus pasteurianus is part of the normal flora of the intestine. It has also been isolated from various infection sites. However, to date it has not been reported as a cause of fulminant septicemia and death. We report the post-mortem findings in a splenectomized hemophiliac patient with cirrhosis and concurrent human immunodeficiency virus (HIV), hepatitis B and hepatitis C infections.

A Case of Colon Cancer Associated with Streptococcus gallolyticus Subspecies pasteurianus Bacteremia / 대한내과학회지

Streptococcus Gallolyticus subspecies pasteurianus is a biotype II/2 of Streptococcus bovis. Although there is a clear correlation between Streptococcus bovis bacteremia and the risk of developing colon cancer, the relationship between Streptococcus gallolyticus subspecies pasteurianus bacteremia and colon cancer is not clear. We report a 53-year-old female who initially presented with fever and low back pain. Streptococcus gallolyticus subspecies pasteurianus was isolated in blood cultures, so we performed a colonoscopy and discovered colon cancer.

Endocarditis infecciosa por Streptococcus bovis asociada a instrumentación gastrointestinal / Infective endocarditis caused by Streptococcus bovis

La endocarditis por Streptococcus bovis representa el 10% de los casos de endocarditis bacteriana, siendo frecuente su asociación con enfermedades intestinales y hepáticas. Se presenta el caso de una mujer de 36 años con antecedentes de fiebre reumática en la niñez, quien hace un año comenzó con sintomatología digestiva, para la cual fue sometida a estudios clínicos invasivos como endoscopia y colonoscopia, desarrollando posteriormente una endocarditis con aislamiento microbiológico de Streptococcus bovis. Se detalla la fisiopatología, clínica, diagnóstico y los aspectos terapéuticos de esta entidad. Además se discuten las posibles relaciones de las enfermedades intestinales, las instrumentaciones del tubo digestivo y las hepatopatías con la bacteriemia por Streptococcus bovis biotipoI. Esta asociación sugiere un posible mecanismo de adherencia biotipo-específica que aún no ha sido fehacientemente demostrado. Por último se resalta la conveniencia de someter a exploración digestiva y ecocardiografía a todo paciente con hemocultivos positivos a este tipo de germen..

Endocarditis caused by Streptococcus bovis represents 10% of the cases of bacterial endocarditis and is frequently associated with intestinal and liver diseases. We present the case of a 36-year old female patient with a history of rheumatic fever in childhood. The gastrointestinal symptomatology began one year before the bacterial endocarditis. Several invasive clinical investigations as endoscopy and colonoscopy, were performed and subsequently she developed endocarditis. Streptococcus bovis was isolated in microbiological studies. Pathophysiology, clinical manifestations, diagnosis, and treatment are detailed. The association between bacteremia from Streptococcus bovis biotype I and intestinal diseases, instrumentation of the digestive tract, and hepatopathy is reviewed. This association suggests a possible mechanism of bacteremia and endocarditis associated with biotype I but this has not been definitely confirmed. We have highlighted the importance of performing echocardiography in all patients with blood cultures positive for Streptococcus bovis who have had invasive studies of the gastrointestinal tract..

Artrite séptica por Streptococcus bovis em paciente com cirrose hepática devido ao vírus da hepatite C: relato de caso e revisão de literatura / Septic arthritis due to Streptococcus bovis in a patient with liver cirrhosis due to hepatitis C virus: case report and literature review

A monoartrite continua sendo diagnóstico desafiador para reumatologistas e ortopedistas. O autor descreve um caso de artrite séptica por Streptococcus bovis após vários episódios de derrame articular tratado com ácido hialurônico (hilano G-F 20) e acetato de metilprednisolona em paciente de 69 anos de idade portador de cirrose hepática devido ao vírus da hepatite C, sem presença de adenoma de cólon ou endocardite. Discutem-se as possibilidades diagnósticas para este caso de monoartrite, bem como as patologias associadas às infecções causadas por esse microrganismo de interesse para o reumatologista, e a possível implicação da reação da articulação ao ácido hialurônico como possível fator predisponente do derrame articular.

Monoarthritis remains a diagnostic challenge in Rheumatology and Orthopedics. The author reports a case of septic arthritis due to Streptococcus bovis after several episodes of joint effusion treated with hyaluronic acid (Hylan G-F 20) and methylprednisolone acetate in a 69-year-old patient with liver cirrhosis due to hepatitis C virus. Neither adenoma of the colon nor endocarditis was present. The diagnostic possibilities for this case of monoarthritis, the pathologies related to the microorganism of interest to the rheumatologist, and the possible involvement of joint reaction to hyaluronic acid as a predisposing factor to joint effusion are discussed.

Endocardite infecciosa por Streptococcus bovis em paciente com carcinoma colônico / Infectious endocarditis due to Streptococcus bovis in a patient with colon carcinoma / Endocarditis infecciosa por Streptococcus bovis en paciente con carcinoma colónico

Descrevemos o caso de uma paciente de 66 anos de idade, com endocardite infecciosa por Streptococcus bovis e adenocarcinoma colônico, que desenvolveu insuficiência aórtica grave aguda. Foi submetida à cirurgia de troca valvar aórtica e posteriormente à ressecção tumoral (hemicolectomia direita). É importante ressaltar a necessidade de complementação do estudo do cólon, mesmo em indivíduos assintomáticos, quando diagnosticamos endocardite infecciosa por S. bovis.

We report the case of a 66 year-old female patient with infectious endocarditis due to Streptococcus bovis and adenocarcinoma of the colon that developed acute aortic insufficiency. She was submitted to aortic valve replacement surgery and later to tumor resection (right hemicolectomy). It is important to emphasize the need for complementing the study of the colon, even in asymptomatic individuals, when infectious endocarditis due to S. bovis is diagnosed.

Describimos el caso de una paciente de 66 años de edad, con endocarditis infecciosa por streptococcus bovis y adenocarcinoma colónico, que desarrolló insuficiencia aórtica grave aguda. Fue sometida a cirugía de reemplazo valvular aórtico y posteriormente a resección tumoral (hemicolectomía derecha). Es importante destacar la necesidad de complementación del estudio del colon, aun en individuos asintomáticos, cuando diagnosticamos endocarditis infecciosa por S. bovis.

Spontaneous bacterial peritonitis caused by Streptococcus bovis: case report and review of the literature

Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication that occurs in patient with cirrhosis and ascites. It occurs in 10 percent to 30 percent of patients admitted to hospital. The organisms that cause SBP are predominantly enteric. Escherichia coli is the most frequent recovered pathogen, and Gram-positive bacteria, mainly Staphylococcus spp., are being considered an emerging causative agent of SBP. Streptococcus bovis that may be found as part of the commensal bowel flora in about 10 percent of healthy adults constitute an uncommon cause of peritonitis that was first reported in 1994. We describe the first case of SBP at the University Hospital of Santa Maria (HUSM) caused by S. bovis, resistant to the antibiotics erythromycin and clindamycin (inducible clindamycin resistance detected by disk diffusion test using the D-zone test).

Infectious Endocarditis due to Streptococcus bovis with Colon Cancer / 日本心臓血管外科学会雑誌

Infectious endocarditis associated with <i>Streptococcus bovis</i>, which is rare in Japan, is a frequently reported complication of gastrointestinal tumors, especially in colon cancer. We report a patient who was successfully treated for the <i>S. bovis</i>-induced infectious endocarditis complication in colon cancer. A 60-year-old man was admitted to our hospital for detailed examination of high fever of unknown origin, that had lasted for 2 months. <i>S. bovis </i>was identified in the venous blood culture. An echocardiogram showed severe aortic valve regurgitation of the third degree and vegetation on the aortic valve. We therefore diagnosed infectious endocarditis. Colonoscopy revealed sigmoid colon cancer. After endoscopic mucosal resection of the lesion, the aortic valve was replaced. The postoperative course was uneventful and he was discharged from the hospital 36 days post operatively.

Infectious Endocarditis due to <i>Streptococcus bovis </i>with Colon Cancer / 日本心臓血管外科学会雑誌

Infectious endocarditis associated with <i>Streptococcus bovis</i>, which is rare in Japan, is a frequently reported complication of gastrointestinal tumors, especially in colon cancer. We report a patient who was successfully treated for the <i>S. bovis</i>-induced infectious endocarditis complication in colon cancer. A 60-year-old man was admitted to our hospital for detailed examination of high fever of unknown origin, that had lasted for 2 months. <i>S. bovis </i>was identified in the venous blood culture. An echocardiogram showed severe aortic valve regurgitation of the third degree and vegetation on the aortic valve. We therefore diagnosed infectious endocarditis. Colonoscopy revealed sigmoid colon cancer. After endoscopic mucosal resection of the lesion, the aortic valve was replaced. The postoperative course was uneventful and he was discharged from the hospital 36 days post operatively.

Underlying Diseases Associated with Streptococcus bovis Bacteremia and Antimicrobial Susceptibility of the Organism / 대한임상미생물학회지

BACKGROUND: The association of Streptococcus bovis biotypes with the type of clinical infection and underlying malignancies and data on antimicrobial susceptibility of S. bovis have rarely been reported in Korea. The aim of this investigation was to characterize the clinical features of patients with S. bovis bacteremia, and to determine the antimicrobial susceptibility of S. bovis strains isolated from blood cultures. METHODS: The clinical data of 67 S. bovis isolates between May 1998 and April 2005 at Wonju Christian Hospital were retrospectively analyzed. The organism was identified by API Strep 32 kit and, for blood isolates, antimicrobial susceptibility testing was performed by the disk diffusion method and penicillin MICs were determined by E test. RESULTS: Of the 67 S. bovis isolates, 18 (27%) were biotype I and 49 (73%) were biotype II. Isolation rates by specimen type were, in decreasing order, wound. 37%; blood, 19%; and urine, 12%. Of the 13 S. bovis bacteremias, 2 were caused by biotype I and 11 were by biotype II; liver diseases (46%) were the most common underlying diseases; none of the 13 patients had gastrointestinal malignancies; one and three isolates were intermediate and resistant to penicillin, respectively; eleven were resistant to erythromycin; two and five were intermediate and resistant to clindamycin, respectively. CONCLUSION: Most of the S. bovis isolates from blood were biotype II. Liver diseases were the most common underlying diseases. S. bovis isolates from blood displayed a high rate of resistance to erythromycin and clindamycin.

A case of subacute infective endocarditis with colon cancer caused by streptococcus bovis / 대한내과학회지

Streptococcus bovis, a group D non-enterococcal organism has recently received increased attention, especially for its role as a cause of infective endocarditis and associated colorectal neoplasm. Infectious endocarditis due to group D streptococci include two non-enterococcal species, S. bovis and S. equinas, which may be mistaken for enterococci in clinical laboratory. However, S. bovis is readily distinguished from the enterococci by screen with bile-esculin hydrolysis and growth in 6.5% NaCl broth. Although endocarditis caused by S. bovis or enterococci share common clinical findings, therapeutically and prognostically, S. bovis endocarditis more resembles infection with viridans group organism. Also the infection of S. bovis significantly increased the prevalence of colorectal cancer in previous report. As discussed above, the patients with S. bovis endocarditis are carried out study of colorectal cancer. We report a case of endocarditis with colon cancer caused by S. bovis in 54 year old female.