SEVERE EVOLUTION WITH MULTIPLE SEPTIC DETERMINATIONS IN A PATIENT DIAGNOSED WITH STREPTOCOCCUS GALLOLYTICUS INFECTION

Marilena Constantin,Mihai Enyedi,Cristina Voinea,Petre Calistru,Eliza Acatrinei,Aurelia Bumbu,Liliana Ștefan,Mădălina Neața,Maria Nica

doi:10.37897/rjid.2016.3.6

Abstract

Streptococcus gallolyticus, member of streptococcus bovis group colonizes digestive tubes of birds, cows and human (2.5-15%). Literature describes the association between bacteriemia with Streptococcus gallolyticus and colon tumours but also extracolonic lesions (bacterial endocarditis, vertebral osteomyelitis, dyscitis, colangitis, lung tumors, ovarian tumors). We report the case of a 60 years old male caucasian patient who was diagnosed with vertebral osteomyelitis as the first lesion of Streptococcus gallolyticus infection identified by blood culture. Other lesions were diagnosed on aortic valve (bacterian endocarditis), right popliteal artery (popliteal artery thrombosis), right knee (arthritis). Even if there was a clinical and biological improvement during the treatment, the imaging tests done after 30 and 45 days from the diagnosis showed severe aortic insuficiency so surgical intervention for aortic valvuloplasty was done in a short time. Vertebral and popliteal artery lesions have improved within two months of antibiotic treatment. Colonoscopy, which was done 6 weeks from the diagnosis showed colonic polyps – risk factors of Streptococcus gallolyticus bacteriemia. This case proves that Streptococcus gallolyticus infection has a silent period followed by severe evolution by multiple septic lesions inspite of the precocious treatment and warn of the necessity of digestive investigations at these patients.

Highlights

Streptococcus Gallolyticus, a member of Streptococcus Bovis group is an opportunistic microorganism that colonizes digestive tube of birds, cows and human, but in the presence of predisposing factors may induce bacteriemia with multiple septic determinations
Streptococcus Gallolitycus infection is associated with gastrointestinal neoplasia usually diagnosed after an episode of endocarditis and responds to Penicillin treatment [5]
Data from literature shows that 25-80% of patients with cu S.Bovis have colorectal tumours, 18-62% of the patients have bacterial endocarditis and colon neoplasia, 94% of S.Bovis bacteriemia are due to type 1 (Streptococcus Gallolyticus) and are associated with colorectal tumors [1]

Summary

INTRODUCTION

Streptococcus Gallolyticus, a member of Streptococcus Bovis group is an opportunistic microorganism that colonizes digestive tube of birds, cows and human, but in the presence of predisposing factors (incipient colonic lesions) may induce bacteriemia with multiple septic determinations. Streptococcus Gallolitycus infection is associated with gastrointestinal neoplasia (polyps and colon carcinoma) usually diagnosed after an episode of endocarditis and responds to Penicillin treatment [5]. Data from literature shows that 25-80% of patients with cu S.Bovis have colorectal tumours, 18-62% of the patients have bacterial endocarditis and colon neoplasia, 94% of S.Bovis bacteriemia are due to type 1 (Streptococcus Gallolyticus) and are associated with colorectal tumors [1]. In 1951 Mc Coy and Mason suggested the relationship between colon carcinoma and bacterial endocarditis but in 1974 the association between S.Bovis and colorectal cancer was recognized [1]. Possible mechanisms for Streptococcus Gallolyticus to induce colon cancer and bacterial endocarditis are described in literature: chronic inflammation, promotion of angiogenesis, increasing vascular permeability, uncontrolled cellular proliferation [1]. Streptococcus Gallolyticus remains in circulation and adheres to endocardium with biofilm formation [2]

CASE PRESENTATION

Ce riaxon

Infec ous

Findings

DISCUSSION