Clinical characteristics and significance of Streptococcus salivarius bacteremia and Streptococcus bovis bacteremia: a prospective 16-year study
Juan CorredoiraMarı́a Pilar AlonsoJosé Fernando García PérezE. CasariegoAmparo CoiraA. RodríguezJ. PitaC. LouzaoBelén PomboMaría Jesús LópezJ. Varela
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Keywords:
Streptococcus bovis
Bacteremia
Streptococcus salivarius
Lactobacillus salivarius
Clinical Significance
Abstract Background Bacteremia due to the Streptococcus bovis / Streptococcus equinus complex (SBSEC) is associated with specific diseases, such as colorectal cancer and infective endocarditis. This study aimed to evaluate the clinical characteristics of SBSEC bacteremia and the accuracy of identification of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and phenotypic identification systems for SBSEC isolates. Methods We analyzed patients with SBSEC bacteremia retrospectively between 2012 and 2019 at three hospitals in Japan. We re-identified each SBSEC isolate using sequencing superoxide dismutase ( sodA ) analysis, MALDI-TOF MS using the MALDI Biotyper, and phenotypic identification using the VITEK2. Results During the study period, 39 patients with SBSEC bacteremia were identified. S. gallolyticus subsp. pasteurianus (SGSP, n = 29), S. gallolyticus subsp. gallolyticus (SGSG, n = 5), S. lutetiensis (SL, n = 4), and S. infantarius subsp. infantarius ( n = 1) were identified using sodA sequencing analysis. Primary bacteremia (36%) was the most common cause of bacteremia, followed by infective endocarditis (26%) and biliary tract infections (23%). Colorectal cancer was associated significantly with SGSG bacteremia, while the sources of bacteremia were similar in each SBSEC subspecies. The MALDI Biotyper was significantly more accurate in identifying the SBSEC isolates at the subspecies level compared to the VITEK2 (92% vs. 67%, P = 0.010). In contrast, there were no significant differences in the rates of correct identification of the SBSEC isolates at the species level between the MALDI Biotyper and the VITEK2 (100% vs. 87%, P = 0.055). Conclusions Bacteremia with SGSG was associated with colorectal cancer, and the sources of bacteremia were similar in each SBSEC subspecies. The MALDI-TOF MS was significantly more accurate in identifying SBSEC isolates at the subspecies level than the phenotypic identification systems. The accurate identification of SBSEC isolates using the MALDI-TOF MS and phenotypic identification systems was sufficient at the species level, but it was insufficient at the subspecies level. Therefore, it may be reasonable for clinicians to perform echocardiographies and colonoscopies in all patients with SBSEC bacteremia.
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Streptococcus bovis bacteremia is well known to be associated with colorectal tumor. But most physicians are unaware of the association between Streptococcus sanguis bacteremia and colorectal malignancy. In this case report, we highlight this association and discuss a case of Streptococcus sanguis bacteremia complicating endocarditis associated with a late stage invasive colonic adenocarcinoma
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Purpose. Colon cancer is increasing in incidence and is the leading cause of cancer-related death worldwide. S. bovis bacteremia frequently occurs with colonic neoplasia. The aim of this study is to assess the clinical characteristics of patients with S. bovis bacteremia in VGHKS. Methods. From January 2001 to December 2006, 68 patients hospitalized at Kaohsiung Veterans General Hospital had bacteremia caused by S. bovis. This retrospective clinical evaluation was carried out to evaluate the relationship of these patients with S. bovis bacteremia to the endocarditis, colonic neoplasia and bacteremia of hepatobiliary origin. Data was analyzed using the Student t-test for numberical variables and chi-squared for categorical variables. Differences were considered to be significant at p＜0.05. Results. Of 68 isolates of S. bovis, 25 were biotype Ⅰ and 43 were biotype Ⅱ. We excluded 16 cases because of incomplete survey. The sex and age distributions of patients infected were not significantly different. S. bovis Ⅰ bacteremia had a higher rate of endocarditis than S. bovis Ⅱ (53.3% vs. 13.5%, respectively; p=0.003). S. bovis Ⅰ bacteremia also had a higher rate of colonic neoplasia (60.0% vs. 18.9%, respectively; p=0.004). However, S. bovis Ⅰ had a lower rate of hepatobiliary source (46.7% vs. 59.5%, respectively; p=0.4). Conclusion. Because S. bovis bacteremia is the high incidence of colonic neoplasia, especially biotype Ⅰ, we should complete studies (e.g.: cardiac echo, colonoscopy, upper abdominal sonography or abdominal CT scan) as soon as possible.
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Twenty-six adults with Streptococcus bovis endocarditis and ten with bacteremia alone were studied to determine possible portals of entry. Of 36 patients (17 with endocarditis, eight with bacteremia alone), 25 had gastrointestinal lesions or manipulation. In 22, the gastrointestinal tract appeared to be the source of S bovis bacteremia. Four patients had either carcinoma of the colon (two) or potentially malignant villous adenomas (two) when first seen because of S bovis bacteremia. None of these, nor two other patients with benign colonic polyps, had bowel-related symptoms or signs prior to admission. Since S bovis is a normal intestinal tract inhabitant, bacteremia may frequently be associated with bowel lesions. Streptococcus bovis bacteremia may provide an early clue to the presence of serious and clinically unexpected gastrointestinal disease. Gastrointestinal tract evaluation should be part of S bovis bacteremia patient management, with or without endocarditis.
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The genetic relationships among 33 streptococci that were identified as Streptococcus salivarius or Streptococcus bovis and were isolated from humans were determined by deoxyribonucleic acid-deoxyribonucleic acid hybridization on membrane filters. The phenotypic characteristics of these bacteria were determined by their action on 20 substrates in a commercially prepared system, as well as by colony morphology and conventional tests. The S. salivarius strains were biochemically heterogeneous but genetically homogeneous. Although there were some phenotypic similarities between S. bovis and S. salivarius, these two species were genetically distinct. Within S. bovis there was genetic heterogeneity. Typical S. bovis strains (S. bovis biotype I) were genetically homologous with some, but not all, of the S. bovis variant strains (S. bovis biotype II). Other S. bovis biotype II strains formed a separate genetic group, the members of which were biochemically somewhat different from other S. bovis biotype II strains.
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Streptococcus bovis
Bacteremia
Streptococcus salivarius
Lactobacillus salivarius
Clinical Significance
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We prospectively studied five patients with a remote history of Streptococcus bovis bacteremia who had not previously been evaluated for colonic pathology. This study was prompted by several reports of concomitant neoplasia in patients with recent S. bovis bacteremia. The patients were studied at a mean of 32 months after bacteremia. Despite the absence of other signs or symptoms suggestive of bowel disease, a negative test for occult blood in stool and a negative fecal culture for S. bovis, two patients were found to have neoplastic polyps of the colon. These findings suggest that the risk of colonic neoplasia in patients with remote S. bovis septicemia is similar to that found in patients with recent bacteremia, but evaluation of a larger group of these patients will be necessary to establish this risk.
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Streptococci identified as Streptococcus bovis, S. bovis variant, and Streptococcus salivarius were examined with respect to physiological and serological characteristics and cellular fatty acid content. Similarities in physiological reactions and problems encountered in serological analysis were noted, suggesting that an expanded battery of physiological tests is needed to definitively identify these streptococci. Cellular fatty acid analysis provided an accurate method for distinguishing S. salivarius from S. bovis and S. bovis variant.
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Abstract Two patients are described in whom Streptococcus bovis bacteremia was the only clue to the presence of a colonic neoplasm. A third patient had the rare association of gastric carcinoma and Streptococcus bovis bacteremia that followed an operation for the carcinoma. The need for both complete gastrointestinal survey in patients with Streptococcus bovis bacteremia and administration of appropriate antibiotic prophylaxis during surgical manipulation is emphasized.
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Two biotypes of Streptococcus bovis can be identified by laboratory testing and can be distinguished from the phenotypically similar organism Streptococcus salivarius. We assessed the clinical relevance of careful identification of these organisms in 68 patients with streptococcal bacteremia caused by these similar species. S. bovis was more likely to be clinically significant when isolated from blood (89%) than was S. salivarius (23%). There was a striking association between S. bovis I bacteremia and underlying endocarditis (94%) compared with that of S. bovis II bacteremia (18%). Bacteremia with S. bovis I was also highly correlated with an underlying colonic neoplasm (71% of patients overall, 100% of those with thorough colonic examinations) compared with bacteremia due to S. bovis II or S. salivarius (17% overall, 25% of patients with thorough colonic examinations). We conclude that careful identification of streptococcal bacteremic isolates as S. bovis biotype I provides clinically important information and should be more widely applied.
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