Acute cholecystitis and bacteraemia due to Streptococcus bovis biotype II

Perforated emphysematous cholecystitis and Streptococcus bovis

Streptococcus bovis is an uncommon cause of biliary tract infection, being acute cholecystitis including this microorganism extremely rare. This entity is more frequent in older patients with cardiovascular disease, diabetes, hepatitis, or neoplasms as colon cancer.

Streptococcus bovis Bacteremia in Neonates in a Predominantly Hispanic Population

BACKGROUND

Streptococcus bovis bacteremia has been associated with gastrointestinal diseases, especially colon cancer, neoplastic colon polyps, and other malignancies of the GI tract in adults. Sporadic cases of S. bovis disease have also been reported in neonates and young infants. Although uncommon, S. bovis infection can cause fulminant neonatal sepsis and meningitis.

OBJECTIVES

We report a series of pediatric patients with S. bovis bacteremia in a county hospital in a United States-Mexico border city in order to examine the demographic and clinical associations.

METHODS

We characterized the demographic and clinical features in all pediatric patients with blood cultures positive for S. bovis at University Medical Center in El Paso, TX, USA between January 2000 and December 2010. Hospital records were systematically reviewed by using a standardized protocol.

RESULTS

A total of seven episodes of S. bovis bacteremia were documented in seven pediatric patients (four female and three male). Mean age was 1.2 days (range 1-3 days), all were Hispanic, average birth weight (3.25 kg). Mode of delivery was spontaneous vaginal delivery (five) and Caesarian section (two). All of our patients developed early (<1 week) onset disease and presented with signs of respiratory distress. Five out of seven babies presented with abdominal distention and diarrhea. Six had clinical evidence of sepsis at presentation. Respiratory distress was the most common manifestation of sepsis (seven). Aspiration pneumonia was diagnosed in two of them. Most patients were treated with a combination of antibiotics (six), either ampicillin and gentamicin or ampicillin and cefotaxime, and one with ampicillin alone. None of the pediatric patients had endoscopy and none of them died.

CONCLUSION

Streptococcus bovis is considered as an uncommon pathogen in the newborn, but can be associated with substantial morbidity and mortality if not identified and treated early. Physicians should be alert to the less common presentation of neonatal bacteremia due to S. bovis.

Streptococcus bovis group and biliary tract infections: an analysis of 51 cases

Streptococcus bovis is a well-known cause of endocarditis, but its role in other infections has not been well described. We analysed prospectively all patients with biliary tract infections caused by S. bovis group during the period 1988-2011. We selected those cases associated with cholangitis and cholecystitis, defined according to Tokyo guidelines. Identification of the strains was performed using the API 20 Strep and the GP card of the Vitek 2 system, and was confirmed by molecular methods. Our series included 51 cases (30 cholangitis and 21 cholecystitis). The associated microorganisms were: Streptococcus infantarius (biotype II/1) 29 cases (57%), Streptococcus gallolyticus subsp. pasteurianus (biotype II/2) 20 cases (39%) and Streptococcus gallolyticus subsp. gallolyticus (biotype I) two cases (4%). The only difference found between S. infantarius and S. gallolyticus subsp. pasteurianus was a greater association of the first with malignant strictures of the bile ducts: 48% (14/29) versus 5% (1/20), p <0.001. Thirty-seven of the cases also had bacteraemia, causing 20% (37/185) of all S. bovis bacteraemia, with differences between S. gallolyticus subsp. gallolyticus (2/112; 2%) and the other two microorganisms: S. infantarius and S. gallolyticus subsp. pasteurianus (35/73; 48%; p <0.001). The vast majority of biliary tract infections due to S. bovis group are caused by S. infantarius and S. gallolyticus subsp. pasteurianus (S. bovis biotype II), and nearly half of the bacteraemia due to these two species has a biliary source (43% of the S. infantarius and 56% of S. gallolyticus subsp. pasteurianus).

Streptococcus bovis-related cholecystitis

Acute cholecystitis is a common inflammatory condition of the gallbladder caused most commonly by Escherichia coli, Enterococcus, and Klebsiella organisms. Streptococcus bovis is a Gram-positive, catalase-negative, anaerobic coccus found as a commensal inhabitant of the digestive system in 16% of healthy people. We report a rare case of acute cholecystitis caused by S bovis and discuss its implications with regard to the two known S bovis biotypes (I & II) both of which are associated with a number of other gastrointestinal diseases.