ABSTRACT
Infective endocarditis (IE) is a life-threatening condition often associated with various complications. A unique subset of IE cases involves the Streptococcus gallolyticus group, which has a well-documented but sometimes poorly understood association with colonic neoplasms. Specifically, colon cancer has a well-established association with IE caused by S. gallolyticus subspecies (spp.) gallolyticus. However, finding colon cancer in cases of IE due to S. gallolyticus spp. pasteurianus is rather unexpected. Herein, we present a rare instance of IE caused by S. gallolyticus spp. pasteurianus in a 62-year-old male, which led to the discovery of an underlying colorectal carcinoma. Considering the overall elevated risk of colon cancer in patients with endocarditis and in patients with S. bovis/S. equinus complex (SBSEC) bacteremia, we decided to proceed to colonoscopy, which revealed adenocarcinoma. The patient was administered a targeted antibiotic regimen and underwent a successful surgical resection, followed by valve replacement surgery. The outcome of this case supports the recommendation of routine colonoscopic evaluation in patients diagnosed with S. gallolyticus bacteremia, including those with subspecies pasteurianus, particularly when there are other associated findings. It strengthens the argument for conducting a colonoscopy in individuals diagnosed with SBSEC endocarditis, while carefully considering the specifics of each clinical situation. Our report highlights the need for heightened clinical vigilance and an integrated approach to treatment in similar cases.
ABSTRACT
In December 2019, a new Coronavirus (SARS-CoV-2) emerged in China, causing the pandemic disease COVID-19. The clinical presentation is variable, but the predominant symptoms are those of the upper respiratory tract. AIM: The aim of the current study is to describe the incidence and type of the gastrointestinal injury (GI) in COVID-19, as well as their prognostic value. MATERIALS AND METHODS: We conducted a coincidental search on this topic in PubMed, Web of Science and EMBASE. We also followed a group of 31 Bulgarian COVID-19 patients throughout the course of their disease and analyzed their symptoms (catarrhal and other) and outcome. RESULTS: The publications concerning our survey followed a total of 1509 COVID-19 patients. In the Bulgarian cohort, only 14 from the 31 patients were laboratory-confirmed COVID-19 cases. Approximately 1/3 of the infected individuals presented with GI. In some patients this was the first, or only, symptom of the disease. It was also indicative of a more severe disease course. CONCLUSION: GI may be an important symptom and prognostic factor in COVID-19. Therefore, patients with acute gastrointestinal symptoms must be actively tested for SARS-CoV-2.
