Streptococcus bovis Bacteremia: Clinical Correlates in a Retrospective Analysis
DOI:
https://doi.org/10.24950/rspmi/original/69/4/2018Keywords:
Bacteremia, Colorectal Neoplasms, Streptococcal Infections, Streptococcus bovisAbstract
Introduction: An association between colorectal neoplasm and Streptococcus bovis bacteremia was first suggested in 1951. Decades later, the extent and nature of this association are still not completely understood. The aim of this study was to review all Streptococcus bovis bacteremic episodes documented at a tertiary-care centre.
Material and Methods: Retrospective analysis of patients with Streptococcus bovis bacteremia admitted to a portuguese centre from January 2000 to December 2016.
Results: There were 46 patients with Streptococcus bovis bacteremia within this period. Nearly one third presented endocarditis. Colonoscopic examination was performed in 56.6% of patients, of whom 61.5% had colorectal neoplasm. Streptococcus bovis molecular identification was held in 27 of the isolates: 19 Streptococcus gallolyticus subsp. gallolyticus, 7 Streptococcus gallolyticus subsp. pasteurianus and one Streptococcus gallolyticus subsp. infantarius. In Streptococcus gallolyticus subsp. gallolyticus infection cases, endocarditis was the main source of infection (42.1%). Most of these patients developed colorectal neoplasm (83.3%). Conversely, bacteremia cases due to Streptococcus gallolyticus subsp. pasteurianus were more likely to have a hepatobiliary source (57.1%) and only 20.0% developed colorectal neoplasm (p < 0.05).
Discussion: Though the clinical relationship between Streptococcus bovis bacteremia and underlying GI diseases has been well-known for years, to date there has been no satisfactory explanation regarding the pathophysiologic mechanism for this association. Subjects infected with Streptococcus gallolyticus subsp. gallolyticus tended to present with endocarditis and to have colorectal neoplasm.
Conclusion: Further research is required to determine the pathogenic mechanisms in which different subspecies of Streptococcus bovis may be implicated in the development of CRN.
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