Streptococcus bovis endocarditis: analysis of cases between 2005 and 2014

Streptococcus gallolyticus endocarditis on a prosthetic tricuspid valve: a case report and review of the literature

Background

Streptococcus gallolyticus subspecies gallolyticus is a known pathogen that causes infective endocarditis, and most cases involve the left heart valves. We present the first reported case of prosthetic tricuspid valve endocarditis caused by this microorganism. Relevant literature is reviewed.

Case presentation

A 67-year-old Jewish female with a history of a prosthetic tricuspid valve replacement was admitted to the emergency department because of nonspecific complaints including effort dyspnea, fatigue, and a single episode of transient visual loss and fever. No significant physical findings were observed. Laboratory examinations revealed microangiopathic hemolytic anemia and a few nonspecific abnormalities. Transesophageal echocardiogram demonstrated a vegetation attached to the prosthetic tricuspid valve. The involved tricuspid valve was replaced by a new tissue valve, and Streptococcus gallolyticus subspecies gallolyticus was grown from its culture. Prolonged antibiotic treatment was initiated.

Conclusions

Based on this report and the reviewed literature, Streptococcus gallolyticus should be considered as a rare but potential causative microorganism in prosthetic right-sided valves endocarditis. The patient’s atypical presentation emphasizes the need for a high index of suspicion for the diagnosis of infective endocarditis.

Referral for Colonoscopy in Patients with Streptococcus bovis Bacteremia and the Association with Colorectal Cancer and Adenomatous Polyps: A Quality Assurance Study

The association between Streptococcus bovis (S. bovis) bacteremia and colorectal cancer is well established. We aimed to review patients with S. bovis bacteremia at our local hospital system and determine the percentage of patients referred for colonoscopy. Methods: We searched the regional database to identify S. bovis-positive blood cultures from 2002 to 2016 and the clinical characteristics and outcomes of those patients. Results: A total of 86 patients with S. bovis bacteremia were identified. From the 86 patients, 14 were excluded. The mean age of the 72 remaining patients was 74.5 (SD 13), 42/72 (58%) were male, 12/72 (17%) had infective endocarditis, and 19 (26%) died during admission. Of the 53 patients who survived, 37 (70%) were referred for colonoscopy or CT colonography, of which 30 had a colonoscopy. Thus, 3/30 (10%) cases showed adenocarcinoma and 11/30 (37%) cases showed adenomatous polyps. Age, gender, or the presence of infective endocarditis were not associated with adenocarcinoma or adenomatous polyps. Discussion: In our local centers, a significant proportion of patients with S. bovis were found to have colon cancer or significant polyps, and thus the importance of referral to colonoscopy remains paramount.

Tricuspid Valve Endocarditis due to Streptococcus bovis in a Patient with Ventricular Septal Defect: A Rare Manifestation-Case Report and Review of the Literature

Streptococcus bovis endocarditis has 18%-62% association with colonic neoplasms with multivalvular involvement and affects mainly elderly males leading to severe cardiac dysfunction, septic embolization, and neurological complications. The aortic valve is the commonest valve to be affected followed by aortic and mitral valves together. However, involvement of tricuspid valve is extremely rare. There are no reported cases of Streptococcus bovis endocarditis affecting the tricuspid valve in the presence of ventricular septal defect with left to right shunt. We report the case of a 25-year-old female with ventricular septal defect who was diagnosed to have tricuspid valve endocarditis caused by Streptococcus bovis. Her detailed colonoscopy, upper gastrointestinal endoscopy, liver biochemistry, and ultrasound scan of the abdomen were normal. She made a very good recovery with six weeks of intravenous antibiotics. This is the first case of tricuspid valve endocarditis caused by Streptococcus bovis in association with ventricular septal defect without any colonic lesions.

Infectious Endocarditis from Enterococcus faecalis Associated with Tubular Adenoma of the Sigmoid Colon

Introduction

Enterococcus faecalis (E. faecalis), a constituent of the gut microbiota, can be associated with both colonic lesions and endocarditis. Since this microorganism is one of the endocarditis etiological agents, there is a need for greater study in regard to the association with endocarditis and colonic lesions.

Case Presentation

This is the case description of a 53-year-old man with history of prolapse of the anterior mitral valve leaflet who was diagnosed with endocarditis by E. faecalis and treated with ampicillin and gentamicin. Upon investigation by colonoscopy, he was found to have a tubular adenoma with low grade dysplasia.

Conclusion

There are a few descriptions in scientific literature of an association between endocarditis by E. faecalis and colonic lesions. However, further studies with significant correlation between the two pathologies are required, so that proper measures can be implemented in clinical practice.