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Alziyadi A, Al Adwani M, Abdulaziz H, Aloufi R, Althagafi A, Alsulaimani A, Alotaibi A. Enterococcus faecalis Infective Endocarditis Associated With Colorectal Cancer. Cureus 2024; 16:e55096. [PMID: 38558637 PMCID: PMC10978460 DOI: 10.7759/cureus.55096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Enterococcus faecalis (E. faecalis) is considered the third most common source of infective endocarditis. Some of the published reports linked its origin to colorectal cancer. We report a 70-year-old male patient diagnosed with E. faecalis infective endocarditis complicated by myocardial infarction. The patient also experienced symptoms of melena and anemia, prompting a colonoscopy. A colon mass was found and a biopsy revealed adenocarcinoma. The patient underwent a left hemicolectomy. In addition to that, he was treated for his cardiac issues. Many studies suggest screening for colonoscopy in patients with E. faecalis infective endocarditis to investigate its origin and potential association with colorectal cancer.
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Affiliation(s)
| | | | - Hamma Abdulaziz
- Colorectal Surgery, Al Hada Armed Forces Hospital, Taif, SAU
| | - Rawan Aloufi
- General Surgery, Al Hada Armed Forces Hospital, Taif, SAU
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2
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Corredoira Sánchez J, Ayuso García B, Romay Lema EM, García-Pais MJ, Rodríguez-Macias AI, Capón González P, Otero López R, Rabuñal Rey R, Alonso García P. Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:4-12. [PMID: 37076331 DOI: 10.1016/j.eimce.2022.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/22/2022] [Indexed: 04/21/2023]
Abstract
OBJECTIVES To describe the clinical features, history and association with intestinal disease in central nervous system (CNS) S. bovis infections. METHODS Four cases of S. bovis CNS infections from our institution are presented. Additionally a systematic literature review of articles published between 1975 and 2021 in PubMed/MEDLINE was conducted. RESULTS 52 studies with 65 cases were found; five were excluded because of incomplete data. In total 64 cases were analyzed including our four cases: 55 with meningitis and 9 with intracranial focal infections. Both infections were frequently associated with underlying conditions (70.3%) such as immunosuppression (32.8%) or cancer (10.9%). In 23 cases a biotype was identified, with biotype II being the most frequent (69.6%) and S. pasteurianus the most common within this subgroup. Intestinal diseases were found in 60.9% of cases, most commonly neoplasms (41.0%) and Strongyloides infestation (30.8%). Overall mortality was 17.1%, with a higher rate in focal infection (44.4% vs 12.7%; p=0.001). CONCLUSIONS CNS infections due to S. bovis are infrequent and the most common clinical form is meningitis. Compared with focal infections, meningitis had a more acute course, was less associated with endocarditis and had a lower mortality. Immunosuppression and intestinal disease were frequent in both infections.
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Affiliation(s)
| | | | | | | | | | | | - Rocio Otero López
- Neurosurgery Department, Universitary Hospital Lucus Augusti, Lugo, Spain
| | - Ramón Rabuñal Rey
- Infectious Disease Unit, Universitary Hospital Lucus Augusti, Lugo, Spain
| | - Pilar Alonso García
- Clinical Microbiology Department, Universitary Hospital Lucus Augusti, Lugo, Spain
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3
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Teh WK, Ding Y, Gubellini F, Filloux A, Poyart C, Givskov M, Dramsi S. Characterization of TelE, a T7SS LXG Effector Exhibiting a Conserved C-Terminal Glycine Zipper Motif Required for Toxicity. Microbiol Spectr 2023; 11:e0148123. [PMID: 37432124 PMCID: PMC10434224 DOI: 10.1128/spectrum.01481-23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023] Open
Abstract
Streptococcus gallolyticus subsp. gallolyticus (SGG) is an opportunistic bacterial pathogen strongly associated with colorectal cancer. Here, through comparative genomics analysis, we demonstrated that the genetic locus encoding the type VIIb secretion system (T7SSb) machinery is uniquely present in SGG in two different arrangements. SGG UCN34 carrying the most prevalent T7SSb genetic arrangement was chosen as the reference strain. To identify the effectors secreted by this secretion system, we inactivated the essC gene encoding the motor of this machinery. A comparison of the proteins secreted by UCN34 wild type and its isogenic ΔessC mutant revealed six T7SSb effector proteins, including the expected WXG effector EsxA and three LXG-containing proteins. In this work, we characterized an LXG-family toxin named herein TelE promoting the loss of membrane integrity. Seven homologs of TelE harboring a conserved glycine zipper motif at the C terminus were identified in different SGG isolates. Scanning mutagenesis of this motif showed that the glycine residue at position 470 was crucial for TelE membrane destabilization activity. TelE activity was antagonized by a small protein TipE belonging to the DUF5085 family. Overall, we report herein a unique SGG T7SSb effector exhibiting a toxic activity against nonimmune bacteria. IMPORTANCE In this study, 38 clinical isolates of Streptococcus gallolyticus subsp. gallolyticus (SGG) were sequenced and a genetic locus encoding the type VIIb secretion system (T7SSb) was found conserved and absent from 16 genomes of the closely related S. gallolyticus subsp. pasteurianus (SGP). The T7SSb is a bona fide pathogenicity island. Here, we report that the model organism SGG strain UCN34 secretes six T7SSb effectors. One of the six effectors named TelE displayed a strong toxicity when overexpressed in Escherichia coli. Our results indicate that TelE is probably a pore-forming toxin whose activity can be antagonized by a specific immunity protein named TipE. Overall, we report a unique toxin-immunity protein pair and our data expand the range of effectors secreted through T7SSb.
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Affiliation(s)
- Wooi Keong Teh
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | - Yichen Ding
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
| | | | - Alain Filloux
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
- Centre for Bacterial Resistance Biology, Department of Life Sciences, Imperial College London, London, United Kingdom
| | - Claire Poyart
- Université de Paris, Assistance Publique Hôpitaux de Paris, Service de Bactériologie, Centre National de Référence des Streptocoques, Groupe Hospitalier Paris Centre site Cochin, Paris, France
| | - Michael Givskov
- Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore, Singapore
- Costerton Biofilm Centre, Department of Immunology and Microbiology, University of Copenhagen, Denmark
| | - Shaynoor Dramsi
- Institut Pasteur, Université Paris Cité, CNRS UMR6047, Biology of Gram-positive Pathogens Unit, Paris, France
- Centre National de la Recherche Scientifique (CNRS) UMR2001, Paris, France
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4
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Corredoira J, Miguez E, Mateo LM, Fernández-Rodríguez R, García-Rodríguez JF, Pérez-González A, Sanjurjo A, Pulian MV, Ayuso-García B. The interaction between liver cirrhosis, infection by Streptococcus bovis, and colon cancer. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04618-5. [PMID: 37145237 DOI: 10.1007/s10096-023-04618-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
Whether cirrhotic patients with Streptococcus bovis bacteremia have an increased risk of colorectal neoplasm is uncertain. A multicentric retrospective cohort study was conducted investigating associations between S. bovis biotype and species, cirrhosis, and colorectal neoplasm. Out of 779 patients with S. bovis bacteremia, 69 (8.7%) had cirrhosis. No differences were found in the prevalence of colorectal neoplasm between cirrhotic and non-cirrhotic patients undergoing colonoscopy. Among cirrhotic patients, prevalence of colorectal neoplasms was higher in S. bovis biotype I (S. gallolyticus) bacteremia (80%) than in S. bovis biotype II (33.3%; p < 0.007). In conclusion, risk of colorectal neoplasm is high among cirrhotic patients with S. gallolyticus bacteremia.
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Affiliation(s)
- Juan Corredoira
- Infectious Diseases Unit, University Hospital Lucus Augusti, Lugo, Spain
| | - Enrique Miguez
- Infectious Diseases Unit, A Coruña University Hospital Complex, A Coruña, Spain
| | - Lara María Mateo
- Internal Medicine Department, Santiago de Compostela University Hospital Complex, Santiago de Compostela, Spain
| | | | | | | | - Ana Sanjurjo
- Internal Medicine Department, POVISA Hospital, Vigo, Spain
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Taylor JC, Kumar R, Xu J, Xu Y. A pathogenicity locus of Streptococcus gallolyticus subspecies gallolyticus. Sci Rep 2023; 13:6291. [PMID: 37072463 PMCID: PMC10113328 DOI: 10.1038/s41598-023-33178-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/08/2023] [Indexed: 05/03/2023] Open
Abstract
Streptococcus gallolyticus subspecies gallolyticus (Sgg) is known to be strongly associated with colorectal cancer (CRC). Recent functional studies further demonstrated that Sgg actively stimulates CRC cell proliferation and promotes the development of colon tumors. However, the Sgg factors important for the pro-proliferative and pro-tumor activities of Sgg remain unclear. Here, we identified a chromosomal locus in Sgg strain TX20005. Deletion of this locus significantly reduced Sgg adherence to CRC cells and abrogated the ability of Sgg to stimulate CRC cell proliferation. Thus, we designate this locus as the Sgg pathogenicity-associated region (SPAR). More importantly, we found that SPAR is important for Sgg pathogenicity in vivo. In a gut colonization model, mice exposed to the SPAR deletion mutant showed significantly reduced Sgg load in the colonic tissues and fecal materials, suggesting that SPAR contributes to the colonization capacity of Sgg. In a mouse model of CRC, deletion of SPAR abolished the ability of Sgg to promote the development of colon tumors growth. Taken together, these results highlight SPAR as a critical pathogenicity determinant of Sgg.
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Affiliation(s)
- John Culver Taylor
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, TX, USA
| | - Ritesh Kumar
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, TX, USA
- IFF Health and Biosciences, Madison, USA
| | - Juan Xu
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, TX, USA
| | - Yi Xu
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, TX, USA.
- Department of Microbiology and Molecular Genetics, McGovern Medical School, UT Health, Houston, TX, USA.
- Department of Microbial Pathogenesis and Immunology, College of Medicine, Texas A&M Health Science Center, Texas, USA.
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Corredoira J, Grau I, Garcia-Rodriguez JF, Romay E, Cuervo G, Berbel D, Ayuso B, García-Pais MJ, Rabuñal R, García-Garrote F, Alonso MP, Pallarés R. Species and biotypes of Streptococcus bovis causing infective endocarditis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:215-220. [PMID: 36610830 DOI: 10.1016/j.eimce.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/25/2021] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Streptococcus bovis/equinus complex (SBEC) is a major cause of infective endocarditis (IE), although its incidence varies greatly depending on the geographical area. The characteristics of IE caused by Streptococcus gallolyticus susp. gallolyticus are well known; there are hardly any descriptions of IE caused by other species or biotypes. METHODS Retrospective cohort study, from 1990 to 2019, of all SBEC IE in adults in three Spanish hospitals, Lugo (LH), Barcelona (BH) and Ferrol (FH) where the population is mainly rural, urban and mixed, respectively. The incidence of IE was analyzed in 3 areas. Clinical characteristics of IE (277 cases, 258 biotyped) were compared according to SBEC species and biotypes. RESULTS There are significant differences between the incidence of SBEC IE in HL (27.9/106) vs. HF and HB (8.8 and 7,1, respectively, p<0.001). We found significant differences (SbI vs. SbII) in mean age (68.5 vs. 73 years; p<0.01), duration of symptoms before diagnosis (46.9±46.5 vs. 30.4±40.9 days; p<0.01), presence of comorbidities: 39.1% (78) vs. 54.2% (32; p<0.04), predisposing heart illness:62.3% (124) vs. 81.3% (48; p<0.006), particularly, prosthetic or intravascular devices IE: 24.6% (49) vs. 52.4% (31; p<0.001), bi-valve involvement:23.6% (47) vs. 11.8% (7; p<0.05) and heart failure: 24.6% (49) vs. 38.9% (23; p<0.03). There were no significant differences in embolic events, need for surgery or mortality. The association with CRC was high in both groups: 77.7% vs. 66.6%. CONCLUSIONS IE due to SBEC has geographical variations in incidence and different clinical characteristics among biotypes. The association with CRC was high.
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Affiliation(s)
- Juan Corredoira
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Inma Grau
- Infectious Disease Unit, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain
| | | | - Eva Romay
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Guillermo Cuervo
- Infectious Disease Unit, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain
| | - Damaris Berbel
- Microbiology Department, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain
| | - Blanca Ayuso
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | - Román Rabuñal
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | - Mª Pilar Alonso
- Microbiology Department, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Román Pallarés
- Infectious Disease Unit, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain
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Kasamatsu A, Fukushima K, Horiuchi M, Sekiya N. Streptococcus gallolyticus subspecies pasteurianus bacteremia accompanied by acute pancreatitis. J Infect Chemother 2022; 28:1663-1666. [PMID: 35963602 DOI: 10.1016/j.jiac.2022.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/18/2022] [Accepted: 08/05/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION While Streptococcus gallolyticus subsp. gallolyticus has a well-known association with colorectal cancer, an epidemiological association between S. gallolyticus subsp. pasteurianus (SGSP) and hepatobiliary diseases has been suggested. Here we described a case of gallstone pancreatitis and SGSP bacteremia in which species-identification by Matrix-Assisted Laser Desorption/Ionization Time-Of-Flight Mass Spectrometry (MALDI-TOF MS) helped to diagnose the biliary etiology. CASE REPORT A 61-year-old Japanese man without history of alcohol consumption was hospitalized for acute pancreatitis. His past medical history included endoscopically treated familial adenomatous polyposis. A blood culture grew gram-positive cocci, identified to be SGSP by MALDI-TOF MS. A contrast-enhanced computed tomography scan showed pancreatic enlargement and increased fatty tissue concentration around the perirenal and pararenal space. He was diagnosed with acute pancreatitis and subsequently recovered after appropriate antimicrobial therapy and supportive care. Subsequent magnetic resonance cholangiopancreatography showed gallstones in the gallbladder neck, suggesting the cause of the acute pancreatitis. Seven months after admission, cholecystectomy was performed for cholelithiasis. CONCLUSION This case highlights that the identification of subspecies enabled by MALDI-TOF MS supports the diagnosis of the underlying etiology from the microbiological point of view.
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Affiliation(s)
- Ayu Kasamatsu
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kazuaki Fukushima
- Department of Infectious Diseases, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Masao Horiuchi
- Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Noritaka Sekiya
- Department of Infection Prevention and Control, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan; Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan.
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Corredoira Sánchez J, Ayuso García B, Romay Lema EM, García-Pais MJ, Rodríguez-Macias AI, Capón González P, Otero López R, Rabuñal Rey R, Alonso García P. Streptococcus bovis infection of the central nervous system in adults: Report of 4 cases and literature review. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Öberg J, Rasmussen M, Buchwald P, Nilson B, Inghammar M. Streptococcus bovis-bacteremia: subspecies distribution and association with colorectal cancer: a retrospective cohort study. Epidemiol Infect 2021; 150:e8. [PMID: 38751047 PMCID: PMC8753481 DOI: 10.1017/s0950268821002533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/06/2021] [Accepted: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
This study aimed to describe the incidence of Streptococcus bovis/Streptococcus equinus complex (SBSEC) bacteremia, distribution of the SBSEC subspecies, and their respective association with colorectal cancer (CRC). A population-based retrospective cohort study of all episodes of SBSEC-bacteremia from 2003 to 2018 in Skåne Region, Sweden. Subspecies was determined by whole-genome sequencing. Medical charts were reviewed. The association between subspecies and CRC were analysed using logistic regression. In total 266 episodes of SBSEC-bacteremia were identified and the average annual incidence was 2.0 per 100 000 inhabitants. Of the 236 isolates available for typing, the most common subspecies was S. gallolyticus subsp. pasteurianus 88/236 (37%) followed by S. gallolyticus subsp. gallolyticus 58/236 (25%). In order to determine the risk of cancer following bacteremia, an incidence cohort of 174 episodes without a prior diagnosis of CRC or metastasised cancer was followed for 560 person-years. CRC was found in 13/174 (7%), of which 9 (69%) had S. gallolyticus subsp. gallolyticus-bacteremia. In contrast to other European studies, S. gallolyticus subsp. pasteurianus was the most common cause of SBSEC-bacteremia. CRC diagnosis after bacteremia was strongly associated with S. gallolyticus subsp. gallolyticus-bacteremia. Identification of SBSEC subspecies can guide clinical decision-making regarding CRC work-up following bacteremia.
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Affiliation(s)
- Jonas Öberg
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund,Sweden
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund,Sweden
| | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Bo Nilson
- Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund,Sweden
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Corredoira J, Grau I, Garcia-Rodriguez JF, Romay E, Cuervo G, Berbel D, Ayuso B, García-Pais MJ, Rabuñal R, García-Garrote F, Alonso MP, Pallarés R. Species and biotypes of Streptococcus bovis causing infective endocarditis. Enferm Infecc Microbiol Clin 2021. [DOI: 10.1016/j.eimc.2021.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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11
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Taylor JC, Gao X, Xu J, Holder M, Petrosino J, Kumar R, Liu W, Höök M, Mackenzie C, Hillhouse A, Brashear W, Nunez MP, Xu Y. A type VII secretion system of Streptococcus gallolyticus subsp. gallolyticus contributes to gut colonization and the development of colon tumors. PLoS Pathog 2021; 17:e1009182. [PMID: 33406160 PMCID: PMC7815207 DOI: 10.1371/journal.ppat.1009182] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/19/2021] [Accepted: 11/23/2020] [Indexed: 02/06/2023] Open
Abstract
Streptococcus gallolyticus subspecies gallolyticus (Sgg) has a strong clinical association with colorectal cancer (CRC) and actively promotes the development of colon tumors. However, the molecular determinants involved in Sgg pathogenicity in the gut are unknown. Bacterial type VII secretion systems (T7SS) mediate pathogen interactions with their host and are important for virulence in pathogenic mycobacteria and Staphylococcus aureus. Through genome analysis, we identified a locus in Sgg strain TX20005 that encodes a putative type VII secretion system (designated as SggT7SST05). We showed that core genes within the SggT7SST05 locus are expressed in vitro and in the colon of mice. Western blot analysis showed that SggEsxA, a protein predicted to be a T7SS secretion substrate, is detected in the bacterial culture supernatant, indicating that this SggT7SST05 is functional. Deletion of SggT7SST05 (TX20005Δesx) resulted in impaired bacterial adherence to HT29 cells and abolished the ability of Sgg to stimulate HT29 cell proliferation. Analysis of bacterial culture supernatants suggest that SggT7SST05-secreted factors are responsible for the pro-proliferative activity of Sgg, whereas Sgg adherence to host cells requires both SggT7SST05-secreted and bacterial surface-associated factors. In a murine gut colonization model, TX20005Δesx showed significantly reduced colonization compared to the parent strain. Furthermore, in a mouse model of CRC, mice exposed to TX20005 had a significantly higher tumor burden compared to saline-treated mice, whereas those exposed to TX20005Δesx did not. Examination of the Sgg load in the colon in the CRC model suggests that SggT7SST05-mediated activities are directly involved in the promotion of colon tumors. Taken together, these results reveal SggT7SST05 as a previously unrecognized pathogenicity determinant for Sgg colonization of the colon and promotion of colon tumors. Colorectal cancer (CRC) is a leading cause of cancer-related death. The development of CRC can be strongly influenced by specific gut microbes. Understanding how gut microbes modulate CRC is critical to developing novel strategies to improve clinical diagnosis and treatment of this disease. S. gallolyticus subsp. gallolyticus (Sgg) has a strong clinical association with CRC and actively promotes the development of colon tumors. However, the specific Sgg molecules that mediate its pro-tumor activity are unknown. Here we report the first characterization of a type VII secretion system (T7SS) in Sgg, designated as SggT7SST05. We further demonstrate that SggT7SST05-mediated activities are important for Sgg to colonize the colon and to promote the development of colon tumors. These findings reveal SggT7SST05 as a novel pathogenicity determinant of Sgg and provide a critical breakthrough in our efforts to understand how Sgg influences the development of CRC. Future investigations of the biological activities of specific effectors of SggT7SST05 will likely lead to the discovery of Sgg molecules that can be used as diagnostic markers and intervention targets aimed at mitigating the harmful effect of Sgg.
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Affiliation(s)
- John Culver Taylor
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, Texas, United States of America
| | - Xinsheng Gao
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, Texas, United States of America
| | - Juan Xu
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, Texas, United States of America
| | - Michael Holder
- Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, Texas, United States of America
| | - Joseph Petrosino
- Center for Metagenomics and Microbiome Research, Baylor College of Medicine, Houston, Texas, United States of America
| | - Ritesh Kumar
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, Texas, United States of America
| | - Wen Liu
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, Texas, United States of America
| | - Magnus Höök
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, Texas, United States of America
| | - Chris Mackenzie
- Department of Microbiology and Molecular Genetics, McGovern Medical School, UT Health, Houston, Texas, United States of America
| | - Andrew Hillhouse
- Texas A&M Institute for Genome Sciences and Society, Texas A&M, Texas, United States of America
| | - Wesley Brashear
- Texas A&M Institute for Genome Sciences and Society, Texas A&M, Texas, United States of America
| | - Maria Patricia Nunez
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, Texas, United States of America
| | - Yi Xu
- Center for Infectious and Inflammatory Diseases, Texas A&M Health Science Center Institute of Biosciences of Technology, Houston, Texas, United States of America
- Department of Microbiology and Molecular Genetics, McGovern Medical School, UT Health, Houston, Texas, United States of America
- Department of Microbial Pathogenesis and Immunology, College of Medicine, Texas A&M Health Science Center, Texas, United States of America
- * E-mail:
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12
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Gboko KDT, Traoré SG, Sanhoun AR, Kirioua J, Otaru N, Kurt F, Jaeger FN, Isenring J, Kaindi DWM, Kreikemeyer B, Renault P, Hattendorf J, Meile L, Jans C, Nguetta R, Bonfoh B. Risk factors for the carriage of Streptococcus infantarius subspecies infantarius isolated from African fermented dairy products. PLoS One 2019; 14:e0225452. [PMID: 31774832 PMCID: PMC6881063 DOI: 10.1371/journal.pone.0225452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 11/05/2019] [Indexed: 02/07/2023] Open
Abstract
Streptococcus infantarius subsp. infantarius (Sii) has been identified as predominant lactic acid bacteria in spontaneously fermented dairy products (FDPs) in sub-Saharan Africa including Côte d'Ivoire. However, Sii belongs to the Streptococcus bovis/Streptococcus equinus complex (SBSEC). Most SBSEC members are assumed to be involved as opportunistic pathogens in serious diseases in both humans and animals. A population-based cross-sectional survey, including 385 participants was conducted in Korhogo, northern Côte d'Ivoire, to identify risk factors for Sii fecal carriage, including consumption of local FDPs. A structured questionnaire was used to gather participant's socio-demographic and economic characteristics, their relation to livestock and dietary habits. In addition, fresh stool and milk samples were collected. The identification of Sii was done using a SBSEC-specific PCR assay targeting 16S rRNA and groEL genes. The overall prevalence of SBSEC and Sii carriage was 23.2% (confidence interval CI 95% = 18.9-27.5) and 12.0% (CI 95% = 8.4-15.5) for stool, respectively. Prevalence of Sii was significantly higher in consumers of artisanal butter compared with non-consumers (57.1% vs 10.1%, odds ratio OR: 11.9, 95% CI: 3.9-36.6), as well as in persons handling livestock (OR = 3.9; 95% CI = 1.6-9.3) and livestock primary products (OR = 5.7; 95% CI = 2.3-14.3). The closer contact with livestock was a risk factor for Sii fecal carriage. Sii strains were isolated from fresh and fermented milk products with a prevalence of 30.4% and 45.4%, respectively. Analysis of Sii population structure through the SBSEC multi locus sequence typing assay revealed a close relationship across human and dairy isolates, possibly linked to a Kenyan human isolate. All these outcomes underline the interest of in-depth investigations on the ecology, potential reservoirs and pathways of contamination by Sii at the human-animal-environment interface in comparison to yet to be collected data from Europe, Asia and the Americas to further elucidate the various roles of Sii.
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Affiliation(s)
- Kossia D T Gboko
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), Adiopodoumé Yopougon, Abidjan, Côte d'Ivoire
| | - Sylvain G Traoré
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), Adiopodoumé Yopougon, Abidjan, Côte d'Ivoire.,University of Peleforo Gon Coulibaly, Korhogo, Côte d'Ivoire
| | - Aimé R Sanhoun
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), Adiopodoumé Yopougon, Abidjan, Côte d'Ivoire.,University of Nangui Abrogoua, Abidjan, Côte d'Ivoire
| | - Jérôme Kirioua
- University of Peleforo Gon Coulibaly, Korhogo, Côte d'Ivoire
| | - Nize Otaru
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Fabienne Kurt
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Fabienne N Jaeger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Julia Isenring
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Dasel W M Kaindi
- Department of Food Science, Nutrition and Technology, University of Nairobi, Nairobi, Kenya
| | - Bernd Kreikemeyer
- Institute of Medical Microbiology, Virology, and Hygiene, Rostock University Medical Centre Rostock, Germany
| | - Pierre Renault
- Institut National de la Recherche Agronomique, UMR 1319 MICALIS, Jouy-en-Josas, France
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Leo Meile
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Christoph Jans
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, Zurich, Switzerland
| | - Roland Nguetta
- Institut de cardiologie d'Abidjan (ICA), Abidjan, Côte d'Ivoire.,Université Felix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), Adiopodoumé Yopougon, Abidjan, Côte d'Ivoire.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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13
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Microbiota and gastrointestinal cancer. J Formos Med Assoc 2019; 118 Suppl 1:S32-S41. [PMID: 30655033 DOI: 10.1016/j.jfma.2019.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 01/02/2019] [Indexed: 12/12/2022] Open
Abstract
Gut microbiota plays important roles in many diseases, including cancer. It may promote carcinogenesis by inducing oxidative stress, genotoxicity, host immune response disturbance, and chronic inflammation. Colorectal cancer, hepatocellular carcinoma, and gastric cancer are the major gastrointestinal tract cancers in Taiwan. The microbiota detected in patients with tubular adenoma and villous/tubulovillous polyps is different from that in healthy controls and patients with hyperplastic polyps. Normalization of the microbiota is observed in patients after colorectal cancer treatment. Furthermore, the liver is exposed to microbiota-associated molecular patterns (MAMPs), bacterial metabolites, and toxins, as it is anatomically connected to the gut via the portal vein. Patients with cirrhosis have significantly higher plasma endotoxin levels than healthy controls. Helicobacter pylori is a well-established risk factor for gastric cancer. Some nitrosating bacteria convert nitrogen compounds in gastric fluid to potentially carcinogenic N-nitroso compounds, which also contribute to gastric cancer development. Growing evidence demonstrates that gut microbiota promotes carcinogenesis. In this review, we discuss the mechanisms and types of microbiota changes involved in these gastrointestinal cancers and the future treatment choices.
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15
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Correlation between Streptococcus bovis bacteremia and density of cows in Galicia, northwest of Spain. Infection 2018; 47:399-407. [PMID: 30498902 DOI: 10.1007/s15010-018-1254-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND There are few data on the epidemiology of infections caused by Streptococcus bovis (Sb). Some studies suggest that both residence in rural areas and contact with livestock could be potential risk factors. METHODS We performed a retrospective study for the period 2005-2016 of all cases of bacteremia caused by Sb in Galicia (a region in the northwest of Spain). The association between the incidence rate of Sb bacteremia and the number of cattle by province and district was analyzed. RESULTS 677 cases were included with a median age of 76 years, 69.3% males. The most frequent infections were endocarditis (234 cases, 34.5%), primary bacteremia (213 cases, 31.5%) and biliary infection (119 cases, 17.5%). In 252 patients, colon neoplasms were detected (37.2%). S. gallolyticus subsp. gallolyticus was the predominant species (52.3%). Mortality was 15.5% (105 cases). The annual incidence rate was 20.2 cases/106 inhabitants and was correlated with the density of cattle (p < 0.001), but not with rurality. When comparing the two provinces with a strong predominance of rural population, but with important differences in the number of cattle, such as Orense and Lugo, with 6% and 47.7% of Galician cattle, respectively, the rates were very different: 15.8 and 43.6 cases/106, respectively, with an RR of 2.7 (95% CI, 2.08-3.71). Some districts of the province of Lugo had rates higher than 100 cases/106 inhabitants. CONCLUSIONS Our study shows a significant correlation between the rates of Sb bacteremia and cattle density, suggesting a possible transmission of Sb from cows to people.
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Identification of Streptococcus gallolyticus subsp. gallolyticus (Biotype I) Competence-Stimulating Peptide Pheromone. J Bacteriol 2018; 200:JB.00709-17. [PMID: 29440256 DOI: 10.1128/jb.00709-17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/07/2018] [Indexed: 02/02/2023] Open
Abstract
Streptococcus gallolyticus subsp. gallolyticus, a member of the group D streptococci, is normally found in the bovine rumen and human gut. It is an opportunistic pathogen that was recently determined to be a bacterial driver of colorectal cancer, in addition to causing other diseases, such as infective endocarditis, bacteremia, neonatal meningitis, and septicemia. As an emerging pathogen, not much is known about this bacterium, its virulence mechanisms, or its virulence regulatory pathways. Previous studies suggest that S. gallolyticus subsp. gallolyticus uses a ComRS pathway, one of many Streptococcus quorum-sensing circuitries, for competence. However, thus far, the ubiquitous ComABCDE pathway has not been studied, nor has its regulatory role in S. gallolyticus subsp. gallolyticus We therefore sought to study the S. gallolyticus subsp. gallolyticus ComABCDE quorum-sensing pathway and have identified its peptide pheromone, which is termed the competence-stimulating peptide (CSP). We further determined that this peptide regulates the production of bacteriocin-like inhibitory substances (BLISs), a phenotype that has been linked with the ComABCDE pathway in both Streptococcus pneumoniae and Streptococcus mutans Our data show that S. gallolyticus subsp. gallolyticus TX20005 produces a 21-mer CSP signal, which differs from CSP signals of other Streptococcus species in that its active form begins three residues after the double-glycine leader signal of the ComC precursor peptide. Additionally, our data suggest that this peptide might not be related to competence induction, as opposed to CSP signaling peptides in other Streptococcus species. This study provides the first evidence that S. gallolyticus subsp. gallolyticus utilizes quorum sensing to eliminate competitors, presenting a potential pathway to target this emerging human pathogen.IMPORTANCEStreptococcus gallolyticus subsp. gallolyticus is an emerging human pathogen known as a causative agent of infective endocarditis, and recently, of colorectal cancer. In this work, we revealed a functional quorum-sensing circuitry in S. gallolyticus subsp. gallolyticus, including the identification of the central signaling peptide pheromone, competence-stimulating peptide (CSP), and the regulatory role of this circuitry in the production of bacteriocin-like inhibitory substances (BLISs). This work uncovered a mechanism by which this bacterium outcompetes other bacterial species and thus provides a potential tool to study this opportunistic pathogen.
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Khan Z, Siddiqui N, Saif MW. Enterococcus Faecalis Infective Endocarditis and Colorectal Carcinoma: Case of New Association Gaining Ground. Gastroenterology Res 2018; 11:238-240. [PMID: 29915636 PMCID: PMC5997476 DOI: 10.14740/gr996w] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/26/2018] [Indexed: 01/04/2023] Open
Abstract
Mostly Streptococcus bovis (S. bovis) bacteremia and endocarditis (60%) has been found to be associated with underlying colorectal cancer (CRC). Enterococcus faecalis (E. faecalis) bacteremia and endocarditis has no identifiable source in most of the cases. E. faecalis is part of normal gut flora that can translocate through the intestine and cause the systemic infection. With any intestinal lesion or tumor, the barrier is breached and the gut flora like E. faecalis can translocate and cause infection. A 55-years-old male known to have non-ischemic cardiomyopathy with implantation of automated implantable cardioverter defibrillator (AICD) and atrial fibrillation presented with weight loss, fever and back pain. He was diagnosed to have E. faecalis bacteremia and subsequent endocarditis and osteomyelitis of T7 - T8 and L4 - L5 vertebrae. He underwent colonoscopy for screening of malignancy because of his age and presenting symptoms suggestive of one. The colonoscopy found pedunculated polyp in sigmoid colon, and after biopsy the histology revealed an invasive well differentiated mucinous adenocarcinoma, with focal squamous differentiation. He underwent removal of AICD and antibiotic treatment for infective endocarditis and osteomyelitis. He underwent sigmoid colectomy with pathology of removed specimen showing adenocarcinoma with negative margins and lymph nodes. In many of the patients with E. faecalis endocarditis, if identifiable the source is genitourinary tract. But in most of the cases the source of E. faecalis bacteremia is unidentified. There is some evidence to suggest that in patients with unidentified source, colonoscopy may reveal a hidden early stage CRC or adenoma. We conclude that in cases of E. faecalis bacteremia and endocarditis with unidentified source, colonoscopy should be considered if feasible to rule out the diagnosis of CRC.
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Affiliation(s)
- Zubair Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Nauman Siddiqui
- Department of Hematology and Oncology, Tufts Medical Center, Boston, MA, USA
| | - Muhammad Wasif Saif
- Department of Hematology and Oncology, Tufts Medical Center, Boston, MA, USA
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18
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Kaindi DWM, Kogi-Makau W, Lule GN, Kreikemeyer B, Renault P, Bonfoh B, Schelling E, Zinsstag J, Lacroix C, Meile L, Jans C, Hattendorf J. Investigating the association between African spontaneously fermented dairy products, faecal carriage of Streptococcus infantarius subsp. infantarius and colorectal adenocarcinoma in Kenya. Acta Trop 2018; 178:10-18. [PMID: 29079186 PMCID: PMC5766739 DOI: 10.1016/j.actatropica.2017.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 10/18/2017] [Accepted: 10/22/2017] [Indexed: 12/22/2022]
Abstract
Consumption of traditional fermented dairy products (tFDP) in Africa leads to the ingestion of up to 108Streptococcus infantarius subspecies infantarius (Sii) per millilitre of spontaneously fermented milk. Sii is a member of the Streptococcus bovis/Streptococcus equinus complex (SBSEC) for which some members are associated particularly with colorectal cancer or endocarditis. The extent of health risks to tFDP consumers is largely unknown. A hospital-based unmatched case-control study was conducted at Kenyatta National Hospital, Nairobi (Kenya) on 80 cases and 193 controls that were selected exhaustively from patients attending colonoscopy at the hospital. Logistic regression models adjusted for age, sex and residency were used in the statistical analysis. Consumption of tFDP was not associated with CRC (odds ratio (OR) 1.4; 95% Confidence interval (CI) 0.7-2.7; p=0.34). Risk factors associated with CRC included age above 40 years, and consumption of processed meat and alcohol. Faecal carriage of Sii was significantly higher in persons with colon tumours and polyps compared to controls (8.4% vs 21.6%: OR: 4.6; CI 1.3-15.9). Patients with haemorrhoids represented an unexpected carrier group with significantly higher Sii faecal carriage (30.4%, CI: 17.7-45.8). Consumption of tFDP does not represent risk factors for CRC whereas Sii seems to be associated with CRC. However, there is urgent need to assess this finding also in the general population, investigate the causality of SBSEC, Sii and CRC as well as compare the phylogenetic, functional and genomic relationship between human and dairy Sii with regards to the ongoing application of Sii in FDP production.
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Affiliation(s)
- Dasel W M Kaindi
- Department of Food Science, Nutrition and Technology, University of Nairobi, P. O. Box 29053 - 00625, Nairobi, Kenya.
| | - Wambui Kogi-Makau
- Department of Food Science, Nutrition and Technology, University of Nairobi, P. O. Box 29053 - 00625, Nairobi, Kenya.
| | - Godfrey N Lule
- School of Medicine, University of Nairobi, P. O. Box 19676, Nairobi, Kenya.
| | - Bernd Kreikemeyer
- Institute of Medical Microbiology, Virology, Hygiene and Bacteriology, Rostock University Medical Center Rostock, Schillingallee 70, 18055 Rostock, Germany.
| | - Pierre Renault
- Micalis Institute, INRA, AgroParisTech, Université Paris-Saclay, 78350 Jouy-en-Josas, France.
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), Km 17, Adiopodoumé, Rte Dabou, 01 BP 1303 Abidjan 01, Cote d'Ivoire; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
| | - Esther Schelling
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
| | - Jakob Zinsstag
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
| | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food Nutrition and Health, Department of Health Science and Technology, ETH Zurich, LFV C22, Schmelzbergstrasse 7, 8092 Zurich, Switzerland.
| | - Leo Meile
- Laboratory of Food Biotechnology, Institute of Food Nutrition and Health, Department of Health Science and Technology, ETH Zurich, LFV C22, Schmelzbergstrasse 7, 8092 Zurich, Switzerland.
| | - Christoph Jans
- Laboratory of Food Biotechnology, Institute of Food Nutrition and Health, Department of Health Science and Technology, ETH Zurich, LFV C22, Schmelzbergstrasse 7, 8092 Zurich, Switzerland.
| | - Jan Hattendorf
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002 Basel, Switzerland; University of Basel, Petersplatz 1, 4003 Basel, Switzerland.
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Kumar R, Herold JL, Taylor J, Xu J, Xu Y. Variations among Streptococcus gallolyticus subsp. gallolyticus strains in connection with colorectal cancer. Sci Rep 2018; 8:1514. [PMID: 29367658 PMCID: PMC5784120 DOI: 10.1038/s41598-018-19941-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/10/2018] [Indexed: 12/16/2022] Open
Abstract
Streptococcus gallolyticus subsp. gallolyticus (Sg) has long been reported to display a strong association with colorectal cancer (CRC). It was recently demonstrated to actively promote the development of CRC, underscoring the importance of Sg in both clinical correlation and functional relevance in CRC. Here we investigated several clinical isolates of Sg in their interactions with human colon cancer cells and in mouse models. Some Sg strains were able to stimulate host cell proliferation (proliferation-promoting Sg, PP-Sg) whereas others were not (non-proliferation-promoting Sg, NP-Sg). PP-Sg strains adhered to colon cancer cells much better than NP-Sg strains, suggesting that close contact between Sg and host cells is important. In mice, PP-Sg is significantly better at colonizing the colon tissues of A/J mice compared to NP-Sg, however this difference was not observed in C57BL/6 mice, suggesting that Sg colonization of mouse colon tissues involves specific interactions between bacterial and host factors on the colonic epithelium. Finally, in an azoxymethane-induced mouse model of CRC, PP-Sg promoted tumor development whereas NP-Sg did not. These findings provide clues to the mechanism underlying the Sg-CRC association and have important implications to clinical studies that aim to correlate Sg with clinical and pathological features of CRC.
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Affiliation(s)
- Ritesh Kumar
- Center for Infectious and Inflammatory Diseases, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, USA
| | - Jennifer L Herold
- Center for Infectious and Inflammatory Diseases, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, USA
| | - John Taylor
- Center for Infectious and Inflammatory Diseases, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, USA
| | - Juan Xu
- Center for Infectious and Inflammatory Diseases, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, USA
| | - Yi Xu
- Center for Infectious and Inflammatory Diseases, Institute of Biosciences and Technology, Texas A&M Health Science Center, Houston, TX, USA.
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Streptococcus gallolyticus subsp. gallolyticus promotes colorectal tumor development. PLoS Pathog 2017; 13:e1006440. [PMID: 28704539 PMCID: PMC5509344 DOI: 10.1371/journal.ppat.1006440] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/31/2017] [Indexed: 02/07/2023] Open
Abstract
Streptococcus gallolyticus subsp. gallolyticus (Sg) has long been known to have a strong association with colorectal cancer (CRC). This knowledge has important clinical implications, and yet little is known about the role of Sg in the development of CRC. Here we demonstrate that Sg promotes human colon cancer cell proliferation in a manner that depends on cell context, bacterial growth phase and direct contact between bacteria and colon cancer cells. In addition, we observed increased level of β-catenin, c-Myc and PCNA in colon cancer cells following incubation with Sg. Knockdown or inhibition of β-catenin abolished the effect of Sg. Furthermore, mice administered with Sg had significantly more tumors, higher tumor burden and dysplasia grade, and increased cell proliferation and β-catenin staining in colonic crypts compared to mice receiving control bacteria. Finally, we showed that Sg is present in the majority of CRC patients and is preferentially associated with tumor compared to normal tissues obtained from CRC patients. These results taken together establish for the first time a tumor-promoting role of Sg that involves specific bacterial and host factors and have important clinical implications.
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Corredoira J, Grau I, Garcia-Rodriguez JF, García-País MJ, Rabuñal R, Ardanuy C, García-Garrote F, Coira A, Alonso MP, Boleij A, Pallares R. Colorectal neoplasm in cases of Clostridium septicum and Streptococcus gallolyticus subsp. gallolyticus bacteraemia. Eur J Intern Med 2017; 41:68-73. [PMID: 28236516 DOI: 10.1016/j.ejim.2017.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/12/2017] [Accepted: 02/14/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Bacteremia with Clostridium septicum (CS) and Streptococcus gallolyticus subsp. gallolyticus (SGG) have both been associated with colorectal neoplasms (CRN) and colonoscopic examination is advised, however the differences and similarities in colorectal findings are not well known. METHODS This is a multicenter, comparative study of patients with CS bacteremia [44 of 664 cases (6.6%) of Clostridium spp.] and SGG bacteremia [257 of 596 cases (44.2%) of S. bovis group], carried out in three hospitals from Spain. Clinical findings related to bacteremia and associated CRN were collected. RESULTS The main sources of infection were abdominal (77.7%) for CS bacteremia and endovascular (75%) for SGG bacteremia. CS bacteremia was more often associated with malignancies, (72.6% vs. 19.4%) and neutropenia (29.5% vs. 3.1%), and was more acute, with shock at presentation (63.6% vs. 3.9%) and higher 30-day mortality (47.7% vs. 9.7%) compared to SGG (P<0.05 for all). Both, patients with CS and SGG bacteremia often had concomitant CRN (43.1% vs. 49.8%) and most of them presented as occult CRN (73.7% vs. 91.4%; P=0.02). CS cases more often had invasive carcinomas (94.7% vs. 19.5%), location of CRN in the right colon (73.7% vs. 23.4%), larger tumor size (median 7 vs. 1.5cm), and a higher overall CRN related mortality rate (68.4% vs. 7.8%) compared to SGG cases (P<0.05 for all). CONCLUSIONS Both, CS and SGG bacteremia are associated with occult CRN. CS cases more often had advanced carcinomas than SGG cases, suggesting a distinct temporal association with CRN.
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Affiliation(s)
- Juan Corredoira
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Imma Grau
- Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain.
| | | | - María Jose García-País
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Ramón Rabuñal
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Carmen Ardanuy
- Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain.
| | - Fernando García-Garrote
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Amparo Coira
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Maria Pilar Alonso
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Annemarie Boleij
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Roman Pallares
- Infectious Disease and Microbiology Departments, Hospital Bellvitge, Ciberes, Idibell, University of Barcelona, L'Hospitalet, Barcelona, Spain.
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Asociación entre la endocarditis infecciosa por Enterococcus faecalis y la neoplasia de colon: resultados preliminares a partir de una cohorte de 154 pacientes. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.09.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Dumke J, Vollmer T, Akkermann O, Knabbe C, Dreier J. Case-control study: Determination of potential risk factors for the colonization of healthy volunteers with Streptococcus gallolyticus subsp. gallolyticus. PLoS One 2017; 12:e0176515. [PMID: 28459818 PMCID: PMC5411088 DOI: 10.1371/journal.pone.0176515] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 04/12/2017] [Indexed: 12/23/2022] Open
Abstract
Streptococcus gallolyticus subsp. gallolyticus was identified in humans and animals as commensal of the gut and can act as a causative agent of endocarditis and septicemia. A case-control study was performed to identify yet unknown risk factors for the transmission of this facultative pathogen. The prevalence in the gut of 99 healthy volunteers was determined using real-time polymerase chain reaction resulting in 62.5% S. gallolyticus subsp. gallolyticus positive excrements. Subsequent cultivation offered three isolates and epidemiological analysis based on MLST revealed sequence type (ST) 3 and ST 7, previously detected from bovine and endocarditis patients. These results support the hypotheses of the zoonotic potential of this bacterium. Participant questionnaires were evaluated concerning personal characteristics, nutritional habits and animal contact. Specifically, closer contact between participants and animals influenced the colonization of the human gut significantly and was further affected if volunteers used excrement for the fertilization of plants.
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Affiliation(s)
- Jessika Dumke
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Tanja Vollmer
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | - Cornelius Knabbe
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Jens Dreier
- Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Pericàs JM, Corredoira J, Moreno A, García-País MJ, Falces C, Rabuñal R, Mestres CA, Alonso MP, Marco F, Quintana E, Almela M, Paré JC, Llopis J, Castells A, Miró JM. Relationship Between Enterococcus faecalis Infective Endocarditis and Colorectal Neoplasm: Preliminary Results From a Cohort of 154 Patients. ACTA ACUST UNITED AC 2017; 70:451-458. [PMID: 27916708 DOI: 10.1016/j.rec.2016.10.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/28/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES The association between Streptococcus bovis group infective endocarditis and colorectal neoplasm (CRN) is well-known. However, no studies have assessed the association between Enterococcus faecalis infective endocarditis (EFIE) and CRN. We aimed to determine whether the prevalence of CRN is higher in patients with EFIE and an unclear source of infection than in patients with EFIE and a known source of infection or in the general population. METHODS Retrospective analysis of a cohort of 154 patients with definite EFIE (109 with an unclear source of infection and 45 with an identified source) from 2 Spanish teaching hospitals to determine the prevalence of CRN and other colorectal diseases. RESULTS In the group with an unknown source of infection, 61 patients (56%) underwent colonoscopy; of these, 31 (50.8%) had CRN. Nonadvanced colorectal adenoma was detected in 22 patients (36%), advanced adenoma in 5 (8.2%), and colorectal carcinoma (CRC) in 4 (6.6%). Among patients who survived the EFIE episode with ≥ 2 years of follow-up, 1 case of CRC was subsequently diagnosed. Only 6 patients (13.3%) with an identified focus of infection underwent colonoscopy; 1 of these patients (16.7%) was diagnosed with CRN. The prevalence of adenomas was slightly higher than that of the Spanish population in the same age range, whereas that of CRC was 17-fold higher. CONCLUSIONS CRN was found in more than half of patients with EFIE and an unclear focus of infection who underwent colonoscopy. Colonoscopy should be recommended in patients with EFIE and an unclear source of infection.
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Affiliation(s)
- Juan M Pericàs
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - Juan Corredoira
- Unidad de Enfermedades Infecciosas, Hospital Lucus Augusti, Lugo, Spain
| | - Asunción Moreno
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | | | - Carlos Falces
- Servicio de Cardiología, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ramón Rabuñal
- Unidad de Enfermedades Infecciosas, Hospital Lucus Augusti, Lugo, Spain
| | - Carlos A Mestres
- Servicio de Cirugía Cardiaca, Hospital Clínic de Barcelona, Barcelona, Spain; Servicio de Cirugía Cardiaca, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - M Pilar Alonso
- Servicio de Microbiología, Hospital Lucus Augusti, Lugo, Spain
| | - Francesc Marco
- ISGlobal, Fundació Privada Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Servicio de Microbiología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Eduard Quintana
- Servicio de Cirugía Cardiaca, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Manel Almela
- Servicio de Microbiología, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Juan C Paré
- Servicio de Cardiología, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Jaume Llopis
- Departamento de Estadística, Facultad de Biología, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Castells
- Departamento de Gastroenterología, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - José M Miró
- Servicio de Enfermedades Infecciosas, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.
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25
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Corredoira J, Rabuñal R, Alonso MP. Streptococcus bovis: 100 Years of an Intriguing Pathogen. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.clinmicnews.2016.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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26
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Corredoira J, García-Pais MJ, Rabuñal R, Alonso MP. Streptococcus bovis endocarditis: Epidemiological differences depending on geographical source. Am Heart J 2016; 177:e1-2. [PMID: 27297864 DOI: 10.1016/j.ahj.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Jans C, de Wouters T, Bonfoh B, Lacroix C, Kaindi DWM, Anderegg J, Böck D, Vitali S, Schmid T, Isenring J, Kurt F, Kogi-Makau W, Meile L. Phylogenetic, epidemiological and functional analyses of the Streptococcus bovis/Streptococcus equinus complex through an overarching MLST scheme. BMC Microbiol 2016; 16:117. [PMID: 27329036 PMCID: PMC4915170 DOI: 10.1186/s12866-016-0735-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 06/08/2016] [Indexed: 12/20/2022] Open
Abstract
Background The Streptococcus bovis/Streptococcus equinus complex (SBSEC) comprises seven (sub)species classified as human and animal commensals, emerging opportunistic pathogens and food fermentative organisms. Changing taxonomy, shared habitats, natural competence and evidence for horizontal gene transfer pose difficulties for determining their phylogeny, epidemiology and virulence mechanisms. Thus, novel phylogenetic and functional classifications are required. An SBSEC overarching multi locus sequence type (MLST) scheme targeting 10 housekeeping genes was developed, validated and combined with host-related properties of adhesion to extracellular matrix proteins (ECM), activation of the immune responses via NF-KB and survival in simulated gastric juice (SGJ). Results Commensal and pathogenic SBSEC strains (n = 74) of human, animal and food origin from Europe, Asia, America and Africa were used in the MLST scheme yielding 66 sequence types and 10 clonal complexes differentiated into distinct habitat-associated and mixed lineages. Adhesion to ECMs collagen I and mucin type II was a common characteristic (23 % of strains) followed by adhesion to fibronectin and fibrinogen (19.7 %). High adhesion abilities were found for East African dairy and human blood isolate branches whereas commensal fecal SBSEC displayed low adhesion. NF-KB activation was observed for a limited number of dairy and blood isolates suggesting the potential of some pathogenic strains for reduced immune activation. Strains from dairy MLST clades displayed the highest relative survival to SGJ independently of dairy adaptation markers lacS/lacZ. Conclusion Combining phylogenetic and functional analyses via SBSEC MLST enabled the clear delineation of strain clades to unravel the complexity of this bacterial group. High adhesion values shared between certain dairy and blood strains as well as the behavior of NF-KB activation are concerning for specific lineages. They highlighted the health risk among shared lineages and establish the basis to elucidate (zoonotic-) transmission, host specificity, virulence mechanisms and enhanced risk assessment as pathobionts in an overarching One Health approach. Electronic supplementary material The online version of this article (doi:10.1186/s12866-016-0735-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Jans
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Tomas de Wouters
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Bassirou Bonfoh
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire (CSRS), KM 17 route de Dabou, Adiopodoumé Yopougon, Abidjan - 01B.P. 1303, Abidjan, Côte d'Ivoire
| | - Christophe Lacroix
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Dasel Wambua Mulwa Kaindi
- Department of Food Science, Nutrition and Technology, College of Agriculture and Veterinary Sciences, University of Nairobi, P.O. Box 29053, Nairobi, Kenya
| | - Janine Anderegg
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Désirée Böck
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Sabrina Vitali
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Thomas Schmid
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Julia Isenring
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Fabienne Kurt
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland
| | - Wambui Kogi-Makau
- Department of Food Science, Nutrition and Technology, College of Agriculture and Veterinary Sciences, University of Nairobi, P.O. Box 29053, Nairobi, Kenya
| | - Leo Meile
- Laboratory of Food Biotechnology, Institute of Food, Nutrition and Health, ETH Zurich, Schmelzbergstrasse 7, 8092, Zurich, Switzerland.
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García-País MJ, Rabuñal R, Armesto V, López-Reboiro M, García-Garrote F, Coira A, Pita J, Rodríguez-Macías AIB, López-Álvarez MJ, Alonso MP, Corredoira J. Streptococcus bovis septic arthritis and osteomyelitis: A report of 21 cases and a literature review. Semin Arthritis Rheum 2016; 45:738-46. [PMID: 26992635 DOI: 10.1016/j.semarthrit.2016.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/25/2016] [Accepted: 02/02/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Streptococcus bovis group (SBG) is a well-known cause of endocarditis, but its role in osteoarticular infections (OAIs) has not been well described. METHODS We analyzed all patients with OAIs by SBG diagnosed in our hospital (1988-2014). We selected those cases with septic arthritis and osteomyelitis, as defined according to clinical, microbiological, and imaging studies. Identification of the strains was performed by using the API 20 Strep and the GP card of the Vitek 2 system, and confirmed the identification by molecular methods. In addition, we reviewed the literature to select all cases of OAI by SBG during the period 1980-2015. RESULTS From the 83 cases of OAI included in the analysis (21 from our center and 62 from the literature review), 59 were osteomyelitis (57 of them spondylodiscitis) and 24 were arthritis (2 with associated spondylodiscitis). The mean age was 66.9 years, and 79.2% of the patients were men. Endocarditis (IE) was associated with 59% of the cases and this association was greater for osteomyelitis than for arthritis (78.9% vs. 13.6%; P = 0.001). OAI was a presenting symptom in 63% of the cases of IE. Colonoscopy was performed in 64 cases, which detected colorectal neoplasm (CRN) in 46 patients (71.8%), almost all asymptomatic. Some 69.5% of these neoplasm were carcinomas or advanced adenomas. The blood cultures were positive in 78.3% cases. In 45 cases, the S. bovis species was identified; in 82.2% of the cases the cause was Streptococcus gallolyticus subsp. gallolyticus. The mortality was 7.2%, which in no case was attributable to the OAI. CONCLUSIONS OAIs are frequently the initial manifestation of IE caused by SBG. S. gallolyticus causes most of these infections. Echocardiogram and colonoscopy are therefore mandatory, given the species' close association with IE and CRN.
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Affiliation(s)
| | - Ramón Rabuñal
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain.
| | - Victor Armesto
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | - Amparo Coira
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Julia Pita
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | | | | | - María Pilar Alonso
- Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Juan Corredoira
- Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain
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