A Case of Streptococcus gallolyticus subsp. gallolyticus Bacteremia in Liver Cirrhosis

Streptococcus bovis bacteremia in humans has been traditionally associated with infective endocarditis, colorectal cancer, and liver cirrhosis. S. bovis strains were previously categorized by biotype, but since the 2000s, they have been reclassified by DNA homology. We report a case of S. gallolyticus subsp. gallolyticus bacteremia, identified by 16S rRNA sequencing, in a patient diagnosed with liver cirrhosis. A 61-yr-old man with a history of liver cirrhosis presented to the hospital with a complaint of fever. Blood culture revealed the presence of gram-positive cocci, and the isolated organism was identified as S. bovis by the MicroScan identification kit (Beckman Coulter, USA), but as Enterococcus saccharolyticus by the Vitek 2 identification kit (bioMérieux, USA). The organism was finally confirmed as S. gallolyticus subsp. gallolyticus by 16S rRNA sequencing.

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.

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.

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..

Molecular identification and thermoresistance to boiling of Nocardia farcinica and Nocardia cyriacigeorgica from bovine bulk tank milk

Two strains of Nocardia spp. were isolated from bovine milk of two individual bulk tank. Molecular identification classified the strains as Nocardia farcinica and Nocardia cyriacigeorgica. The thermorresistance to boiling of the isolates was carried out and was observed bacterial growth after boiling. Our findings indicate the potential risk of pathogen transmission to humans through contaminated milk with Nocardia spp.

Endocardite trivalvar por streptococcus bovis / Trivalve endocarditis caused by streptococcus bovis

Endocardite infecciosa (EI) é uma doença grave em que micro-organismos causam inflamação e danos àssuperfícies endocárdicas. Seu principal acometimento é visto na forma univalvar ou comumente em duasválvulas na mesma câmara cardíaca. EI multivalvares, especialmente com acometimento de válvulas à direitae à esquerda, são raras. Cardiopatia congênita é o principal fator de risco para endocardite multivalvar e, em pacientes sem cardiopatia estrutural alguns fatores de risco clínicos podem ser identificados. Neste relatoapresenta-se caso de paciente com EI por Streptococcus bovis com raro padrão de acometimento – trivalvar(valvas aórtica, mitral e pulmonar).

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.

Aneurisma infectado de artéria braquial após endocardite infecciosa de valva mitral / Infected aneurysm of brachial artery after mitral valve infective endocarditis

Apresentamos um caso de aneurisma infectado de artéria braquial em paciente com endocardite infecciosa por Streptococcus bovis. Homem de 49 anos de idade se apresentou com febre, dispnéia e sopro regurgitativo em foco mitral com irradiação para axila. O ecocardiograma demonstrou vegetação em valva mitral nativa. Após troca valvar mitral com implante de prótese biológica, observou-se massa pulsátil de cinco centímetros de diâmetro em fossa antecubital direita. Foi feito o diagnóstico de aneurisma infectado de artéria braquial, e o tratamento cirúrgico foi realizado com sucesso. O objetivo desse relato de caso é apresentar uma complicação pouco comum após endocardite infecciosa.

We present a case of brachial artery infected aneurysm in a patient with infective endocarditis caused by Streptococcus bovis. A 49-year-old man presented with fever dyspnea and a pansystolic murmur with irradiation to axilla. The echocardiogram revealed vegetation in native mitral valve. After mitral valve replacement with bioprosthesis, it was observed pulsatile mass of five centimeters in diameter at antecubital fossa of right upper limb. It was made the diagnosis of infected aneurysm of the brachial artery, and the surgery was performed successfully. The aim of this case report is to show a rare complication after infective endocarditis.

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).

Resistencia a antibióticos no betalactamicos de aislamientos invasores de streptococcus pneumaniae en niños latinomaricanos: Sivera II, 200-2005 / Resistance to beta-lactam antibiotics are not invasive isolates of streptococcus latinomaricanos pneumaniae in children: Sivera II, 200-2005

Determinar la evolución de la esistencia a la eritromicina, el cloranfenicol, el trimetoprim-sulfametozaxol (SXT) yla vancomicina de aislamientos invasores de Streptococcus pneumoniaeobtenidos de niños de 10 países de América Latina y del Caribe en seis años de vigilancia.

A Case of Streptococcus gallolyticus subsp. gallolyticus Infective Endocarditis with Colon Cancer: Identification by 16S Ribosomal DNA Sequencing / 대한진단검사의학회지

Although the association between Streptococcus bovis endocarditis and colon carcinoma is well known, very few cases of S. bovis infection associated with underlying malignancies have been reported in Korea. The S. bovis group has been recently reclassified and renamed as Streptococcus gallolyticus and Streptococcus infantarius subspecies under a new nomenclature system. We report a case of infective endocarditis with colon cancer caused by S. gallolyticus subsp. gallolyticus (previously named S. bovis biotype I). A 59-yr-old woman presented with a 1-month history of fever. Initial blood cultures were positive for gram-positive cocci, and echocardiography showed vegetation on mitral and aortic valves. Antibiotic treatment for infective endocarditis was started. The infecting strain was a catalase-negative and bile-esculin-positive alpha-hemolytic Streptococcus susceptible to penicillin and vancomycin. The strain was identified as S. gallolyticus subsp. gallolyticus with the use of the Vitek 2 GPI and API 20 Strep systems (bioMerieux, USA). The 16S rDNA sequences of the blood culture isolates showed 100% homology with those of S. gallolyticus subsp. gallolyticus reported in GenBank. The identification of the infecting organism, and the subsequent communication among clinical microbiologists and physicians about the changed nomenclature, led to the detection of colon cancer. The patient recovered after treatment with antibiotics, valve surgery, and operation for colon cancer. This is the first report of biochemical and genetic identification of S. gallolyticus subsp. gallolyticus causing infective endocarditis associated with underlying colon cancer in a Korean patient.

Neoplasia de esôfago com endocardite infecciosa: relato de caso / Esophagus cancer and infectious endocarditis

Paciente do sexo masculino, 55 anos de idade, com dor lombar intensa e febre vespertina há 20 dias, relatava perda ponderal de 30 quilos em três meses. Exame físico sem alterações na admissão no Hospital Servidor Público Estadual Francisco Morato de Oliveira (HSPE-FMO), em São Paulo. Na investigação etiológica desta febre foi colhida hemocultura, sendo esta positiva para Streptococcus bovis (que é frequentemente associado com malignidade do trato gastrointestinal e pólipos colônicos). Solicitado, por isso, um ecocardiograma transesofágico, pois o ecocardiograma transtorácico era normal. O ecocardiograma transesofágico evidenciou, além de insuficiência mitral e aórtica importante, presença de vegetações nas mesmas valvas, tendo como diagnóstico final uma endocardite bacteriana infecciosa. Foi iniciada antibioticoterapia adequada para o paciente com teicoplamina e gentamicina. O paciente apresentou melhora clínica e permaneceu afebril por 28 dias. Com base na positividade da hemocultura para Streptococcus bovis, foi indicada colonoscopia, a qual evidenciou: moléstia diverticular hipertônica dos cólons, pólipos sésseis de cólon direito e pólipo séssil de reto (realizada polipectomia). O exame anatomopatológico evidenciou adenoma tubular com displasia epitelial de baixo grau em cólon direito e adenoma tubuloviloso com displasia epitelial de baixo grau em reto. O paciente realizou ainda endoscopia digestiva alta (EDA) com cicatriz e úlcera em atividade no esôfago distal, hérnia hiatal, gastrite leve de antro e úlcera bulbar em atividade. Foram realizadas biópsias das úlceras, as quais revelaram adenocarcinoma moderadamente diferenciado com embolização linfática multifocal de esôfago.

Streptococcus bovis endocarditis: Clinical, Echocardiographic and prognostic features.

The aim of this study was to determine clinic and echocardiographic characteristics of Streptococcus bovis endocarditis [El] and its prognosis. We studied the clinic and echocardiographic characteristics of 54 patients with a Streptococcus bovis El among 350 cases of El. We included 44 men and 10 women, 64 +/- 15 years of age, with a native valvular disease in 31.5% of cases and a valvular prosthesis in 13%. 74% had a worsened general state; 48% presented with signs of cardiac insufficiency. 12 patients [22%] were followed for cancer including 7 digestive colic localizations [confirmed by coloscopy and histology]. Vegetation was identified in all patients. It was a left localization in 98.1%. Vegetation diameter was>10 mm in 37 patient s [68.5%] and>20 mm in 9 patients [16%]. During the follow-up, 59.3% developed an embolic accident, 17 cases of CVA and 7 cases of spondylodiscitis [7 out of 11 cases of spondylodiscitis described in the 350 cases of El]. Mortality reached 7%. The statistical analysis showed that Streptococcus Bouis was the major predictive factor for embolic complications, especially for spondylodiscitis. Streptococcus bovis El is more frequent in patients with digestive colic neoplasia. It is characterized by large vegetation which has a high embolic potential worsening the prognosis

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.