Streptococcus bovis Bacteremia: Association with Gastrointestinal and Liver Disease in a Predominantly Hispanic Population.

Abstract

Streptococcus bovis bacteremia has been associated with gastrointestinal diseases, especially colon cancer, neoplastic colon polyps, and other malignancies of the gastrointestinal tract. Studies have suggested an association with chronic liver parenchymal and biliary tract disorders. We report a series of patients with S. bovis bacteremia in a county hospital in a US city on the border of Mexico to examine the demographic and clinical associations. We characterized the demographics, clinical features, and the endoscopic and histopathologic findings in all patients with blood cultures positive for S. bovis at University Medical Center in El Paso, Texas, between January 2000 and December 2010. Hospital records were systematically reviewed using a standardized protocol. A total of 21 episodes of S. bovis bacteremia were documented in 21 adult patients. The mean age was 61 (range 25-97), 12 were women, and 20 were Hispanic. Presenting illnesses in these patients were gastrointestinal bleed (4), sepsis (4), cholangitis (3), hepatic encephalopathy (2), altered mental status (2), spontaneous bacterial peritonitis (1), septic abortion (1), diarrhea (1), others (3). Chronic liver disease was present in 7 cases (33%), 6 of which were alcohol related (5 with concomitant hepatitis C infection). Infective endocarditis was found in 1 patient. Overall, 10 patients underwent either colonoscopy alone (3), upper endoscopy alone (3), or both (4), and 2 underwent endoscopic retrograde cholangiopancreatography. Of the 7 (33%) patients who had colonoscopy, pathology was identified in 4 of them, including colon polyps in 3 (43%) and colitis in 1 (14%). Mortality was 19% (4 patients). Our finding in a series of predominantly Hispanic patients with S. bovis bacteremia in a county hospital setting was consistent with the previously reported association with gastrointestinal disease. Findings on colonoscopy included colonic polyps and colitis, although no cases of colon cancer were found. Chronic liver disease was a common concurrent illness and cholangitis also occurred. There was a significant mortality rate in adults.