Bovis Endocarditis Research Articles

S2188 Streptococcus Bovis Bacteremia and Endocarditis Leading to the Diagnosis of Synchronous Colon and Appendiceal Adenocarcinoma

Introduction: Colon adenocarcinoma has been shown to be associated with appendiceal adenocarcinoma and Streptococcus bovis infection. An association between appendiceal cancer and S. bovis infection has not been reported. This is a case of S. bovis bacteremia prompting colonoscopy and subsequent diagnosis of colon adenocarcinoma and incidental diagnosis of appendiceal adenocarcinoma. Case Description/Methods: A 77-year-old male with a history of metabolic syndrome, coronary artery bypass graft surgery, abdominal aortic aneurysm, heart failure with preserved ejection fraction, and aortic stenosis came to the emergency department for dyspnea and chest pressure. Vital signs were stable with a temperature of 103.2 °F. Physical exam revealed diffuse lung rales and bilateral lower extremity trace edema. Labs are show in the Table. ECG was equivocal for acute myocardial infarction and cardiac catheterization was negative. Blood cultures grew S. bovis. TTE showed no valvular vegetations. TEE showed a mitral valve vegetation consistent with infective endocarditis (IE). Lower extremity vein thrombosis was diagnosed; anticoagulation was started which led to anemia and melena. Colonoscopy showed a large mass in the ascending colon (AC), a large villous appearing mass in the sigmoid colon (SC), multiple polyps, and severe diffuse diverticulosis (Figure A, B). CT abdomen/pelvis showed no evidence of metastasis. He underwent SC and AC resections. Pathology of the SC showed tubulovillous adenoma with high-grade dysplasia and negative for submucosal invasion (Figure C). Pathology of the AC showed well-differentiated appendiceal adenocarcinoma of the distal appendix invading the muscularis propria with appendiceal serosa and fat negative for invasion. Pathology of the AC also showed intramucosal adenocarcinoma without lymphovascular space invasion (Figure D). Lymph nodes were negative for metastasis. Discussion: Appendiceal cancer is rare. It affected only 2900 individuals in the US from 2012-2016. It is usually diagnosed after appendectomy for appendicitis. It has been proposed that patients with appendiceal adenocarcinoma carry an increased risk of colon adenocarcinoma and should be screened with colonoscopy at time of diagnosis. In this case, S. bovis bacteremia and IE prompted a colonoscopy. It remains unknown if there is an association between appendiceal adenocarcinoma and S. bovis infection. This report illustrates one case of concomitant colon and appendiceal adenocarcinoma with S. bovis bacteremia and IE.Figure 1.: Image A: Colonoscopy image showing ascending colon mass with diverticulosis and other polyps. Image B: Colonoscopy image showing sigmoid colon mass. Image C: Histological image of sigmoid colon resection showing tubulovillous adenoma with high-grade dysplasia. Image D: Histological image of right hemicolectomy specimen showing in-situ adenocarcinoma. Table 1. - Laboratory Values Laboratory test Value Reference range Troponin I 4.270 0.000-0.450 ng/mL Lactic acid 2.2 0-2 mmol/L WBC 9.00 4.40-11.00 103/μL

S2010 Colonic Carcinoma With Neuroendocrine Features Diagnosed in the Setting of Enterococcus faecalis Bacteremia, Endocarditis and Embolic Phenomenon

Introduction: A 77-year-old man with a history of hypertension, hyperlipidemia, prior ischemic stroke, and chronic back pain presented with fever and confusion 3 days after undergoing a lumbar epidural steroid injection. Case Description/Methods: A 77-year-old man with a history of hypertension, hyperlipidemia, prior ischemic stroke, and chronic back pain presented with fever and confusion 3 days after undergoing a lumbar epidural steroid injection. Multiple sets of blood cultures grew Enterococcus faecalis. His CRP was elevated at 86. An MRI scan of the spine was negative for epidural abscess. Brain MRI revealed multiple acute embolic infarcts. Transthoracic echocardiography revealed a mobile 8mm vegetation, and transesophageal echocardiography confirmed mitral valve endocarditis. CT of the abdomen and pelvis revealed colonic wall thickening at the hepatic flexure with coexistent fat stranding and lymphadenopathy. Subsequent colonoscopy revealed a 1 cm solitary cratered ulcer with heaped up borders at the hepatic flexure (Figure A). Histopathology demonstrated a high-grade carcinoma immunophenotypically positive for colonic (CDX2+, SATB2+, CK20+, CK7-) and neuroendocrine differentiation (chromogranin+, synaptophysin+) (Figure C, D). The favored diagnosis was colonic high-grade neuroendocrine carcinoma, large cell type. PET/CT Dotatate scan was negative for uptake at the hepatic flexure reflecting poor differentiation of the carcinoma and lack of somatostatin receptors expression. Subsequent PET/CT FDG scan was positive reflecting high FDG avidity in the identified hepatic flexure hypermetabolic lesion, surrounding lymph nodes, and numerous hepatic lesions (Figure B). The patient was treated with antibiotics for endocarditis and started on carboplatin and etoposide. Discussion: Classically, Streptococcus bovis bacteremia and endocarditis are associated with colorectal cancer. Evidence is accumulating for a link between Enterococcus faecalis, a component of gut flora, and colorectal adenocarcinoma. The biopsies of the ulcerated mass at the hepatic flexure, in our patient with Enterococcus faecalis bacteremia and endocarditis, suggested a primary colonic neuroendocrine carcinoma, large cell type. Neuroendocrine tumors of the colon arise from enterochromaffin cells in the crypts of Lieberkuhn. Colon carcinoid tumors are rare, with an annual incidence of approximately 0.2 per 100,000. Most neuroendocrine tumors are asymptomatic at the time of diagnosis and often present with metastatic disease.Figure 1.: A: Colonoscopy revealing a 1 cm solitary cratered ulcer at the hepatic flexure. B: PET/CT FDG scan showing high FDG avidity at hepatic flexure. C: Histopathology H&E stain showing poorly differentiated carcinoma. D: Histopathology chromogranin stain positivity confirming neuroendocrine differentiation.

Beware of Drug Interactions Treating Iatrogenic Mycobacterium bovis Endocarditis from Intravesical BCG Instillation.

To consider endocarditis as an extra-pulmonary manifestation of Mycobacterium bovis infection, especially in the presence of predisposing heart conditions and risk factors.To be careful of drug interactions among warfarin, rifampin and amiodarone.

S1837 A Single Patient Case May Illuminate the Pathogenesis of Streptococcus bovis Endocarditis Caused by Colorectal Cancer

INTRODUCTION: The incidence of colorectal cancer (CRC) increases with concurrent bacterial infections, especially Streptococcus bovis. It is unclear whether S. bovis has a carcinogenic effect via toxic byproducts and chronic inflammation or if the invasive cancer leads to disruptions in colonic mucosa and subsequent bacterial translocation. We report a case that sheds light on the underlying disease pathogenesis. CASE DESCRIPTION/METHODS: A 55-year-old male without significant past medical history presented with syncope and septic shock. Patient denied abdominal complaints and bowel habit changes. Labs were significant for leukocytosis and mild iron deficiency anemia. Blood culture indicated a S. bovis infection. An echocardiogram revealed vegetations on aortic and mitral valves. A prior colonoscopy done 4 years ago showed advanced adenomas. Repeat colonoscopy revealed a 1 cm scirrhous-like, ulcerated mass in the cecum burrowing into a fold. Biopsy showed moderately differentiated adenocarcinoma. After medical stabilization, the patient underwent a laparoscopic right hemicolectomy. There was no lymph node involvement. DISCUSSION: S. bovis bacteremia is associated with a 7-fold increase in CRC development. Literature reports a variable degree of association: 18-62% of patients with S. bovis infective endocarditis had colorectal tumors. However, the pathophysiology of S. bovis and CRC is unclear. S. bovis adheres to intestinal cells and can grow in bile, allowing hepatic filtration bypass. S. bovis has a high affinity for matrix proteins at injury sites, such as heart valve vegetations or tumors. The pili of S. bovis allows attachment and plays a role in the generation of biofilm on damaged tissues, including heart valves and precancerous lesions. This case study proposes an underlying association between S. bovis and CRC (Figure 2). Given the patient’s history of advanced adenomas, the cancer most likely developed first. The CRC disrupted mucosal barriers, increasing the likelihood of a S. bovis invasion into tissues. A subsequent inflammatory reaction increased epithelial permeability, leading to S. bovis bacteremia. Because S. bovis has a high affinity for the cardiac endothelium, it most likely formed biofilms on the patient’s aortic and mitral valves, explaining the echocardiogram findings. Our hypothesis is supported by the small tumor size and lack of lymph node involvement. In this case, S. bovis infective endocarditis developed because of the CRC rather than due to the carcinogenic effects of S. bovis.Figure 1.: Endoscopic finding of cecal cancer.Figure 2.: Proposed mechanism for S. Bovis caused by CRC.

Multifocal extracranial mycotic aneurysms in a patient with endocarditis

This report describes the case of a 44-year-old man with Streptococcus gallolyticus (formerly S. bovis) endocarditis requiring surgical mitral valve replacement who developed multifocal extracranial mycotic aneurysms after the resolution of infection.

An acute ischemic stroke presenting as rectal adenocarcinoma and streptococcus bovis endocarditis: A case report

An acute ischemic stroke presenting as rectal adenocarcinoma and streptococcus bovis endocarditis: A case report

79-Year-Old Man With Shortness of Breath and Fevers

79-Year-Old Man With Shortness of Breath and Fevers

Streptococcus bovis prosthetic valve endocarditis associated with silent colonic carcinoma

A 75-year-old woman was admitted to our hospital with a 3-month history of fever. Of note, she had a bioprosthetic mitral valve replacement 1 year prior to admission. Streptococcus bovis...

Bioprosthetic Valve Streptococcus bovis Endocarditis Secondary to Colon Cancer Presenting with a Lacunar Stroke

Background:Streptococcus bovis endocarditis is an uncommon but reported complication of colon cancer. Studies show that approximately 50% of patients with S. bovis infection have underlying colonic neoplasm. Case Presentation: An 82-year-old woman presented to the hospital with a lacunar stroke resulting from S. bovis endocarditis of her bioprosthetic aortic valve, ultimately leading to the diagnosis of colonic malignant disease. The patient's neurologic deficits resolved and she completed a course of intravenous antibiotics followed by a successful right hemicolectomy to remove the colonic neoplasm. We review recent literature on the association between S. bovis endocarditis and colon cancer and discuss the implications for the clinical management of this condition. Conclusion: Because of the high rate of association between S. bovis infection and colonic neoplasms, the presence of S. bovis bacteremia should prompt a work-up for occult malignant disease by colonoscopy.

INFECTIVE ENDOCARDITIS IN ELDERLY: FROM ETIOLOGY TO TREATMENT AND PREVENTION

The review reflects the changes of epidemiological profile of infective endocarditis (IE) with an increase of prevalence in elderly. The risk factors are discussed, including anamnesis of various endocardium diseases, artificial valves implantation, different treatments or diagnostic procedures and especially cardiosurgical interventions. Among risk factors, predisposing to the infectious involvement of endocardium in elderly, are calcification of leaflets, age-related changes, diabetes, inflammatory diseases of gastrointestinal and urogenital tracts. The specifics of etiological spectrum of IE microbes is presented, with increased prevalence of S. bovis endocarditis, enterococcus, coagulase-negative staphylococci, in comparison with younger patients. The review focuses on microbiological diagnostics as one of the main criteria of IE. Approaches to treatment of the disease are shown with general principles, selection of empirical therapy and prescription of relevant antibacterial drugs after obtaining of bacteriological results of hemoculture. The principles of treatment of the elderly are based upon expert Guidelines of European Society of Cardiology and American Heart Association, published in 2015. The importance underlined of prevention in higher risk groups and procedures of high risk, as of following general hygienic and sanitation norms.

Differences between endocarditis caused by Streptococcus bovis and Enterococcus spp. and their association with colorectal cancer.

Streptococcus bovis group and Enterococcus spp. share phenotypic characteristics and intestinal habitat. Both have been associated with endocarditis and colorectal neoplasm (CRN). We studied all cases of endocarditis diagnosed between 1988 and 2014 in our centre and caused by S. bovis (109, 48.8 % of the bacteremia) and by Enterococcus spp. (36, 3.4 % of the bacteremia). Patients were seen until death or during a long-term follow-up, in order to rule out a concomitant CRN. The 109 cases of S. bovis endocarditis (SbIE) compared with the 36 caused by enterococci showed: a higher proportion of males (91 % vs. 72 %, p=0.005), more multivalvular involvement (28 % vs. 6 %, p=0.004), embolic complications (44 vs. 22 %, p=0.02) and colorectal neoplasm (64 % vs. 25 %, p=0.001). SbIE showed fewer co-morbidities (32 vs. 58 %, p=0.005), and less frequently urinary infection source (0 vs. 25 %, p=0.001) and healthcare-related infection (2 vs. 44 %, p=0.001). A total of 123 patients were followed up for an extended period (mean: 65.9 ± 57.5 months). During the follow-up, 6 of 28 (21 %) cases with enterococcal endocarditis and 43 of 95 (45.2 %, p=0.01) cases with SbIE developed a new CRN. These neoplasiae appeared a mean of 60.4 months later (range 12-181 months). Among the 43 cases with SbIE and CRN, 12 had had a previously normal colonoscopy and 31 had had a previous CRN and developed a second neoplasm. Cases of SbIE present important differences with those caused by Enterococcus spp. Colonoscopy must be mandatory both in the initial evaluation of SbIE, as during the follow-up period.

Streptococcus bovis endocarditis: analysis of cases between 2005 and 2014

BackgroundStreptococcus bovis is a classical etiology of endocarditis and is associated with colonic lesions. No series of cases from Brazil has been described. ObjectivesTo describe aspects of S. bovis endocarditis. MethodsThis is a case series of patients admitted to a cardiac surgery referral center, during the years 2005–2014. Clinical, laboratory, echochardiographic, colonoscopic, treatment, surgical and outcome variables were studied. ResultsNine patients with S. bovis endocarditis were included; all cases fulfilled the modified Duke criteria. Incidence was 8/220 (4%) in years 2006–2014. There were seven male and two female patients; mean age was 56.7 years, standard deviation 13.4. All patients had native aortic valve involvement. Presentation was subacute in 7/9 (71%). Fever was present in 7/9 (77.7%), embolic lesions to solid organs occurred in three, and perivalvular abscess in two patients. All echocardiograms showed moderate to severe valvular regurgitation and vegetations. Microcytic anemia was seen in 7/7 patients. Colonoscopy showed abnormal findings in 7/9 (77.7%). Surgery was indicated for 6/9 patients due to acute aortic regurgitation and left ventricular failure. All patients were discharged home. ConclusionsS. bovis most frequently affected the aortic valve of male patients. Colon disease was frequent. Surgery was indicated frequently due to hemodynamic compromise.

A Case of Streptococcus bovis Endocarditis Presenting as a Neurosurgical Emergency

Rheumatic manifestations have been reported to occur in as many as of 41% in patients with infective endocarditis (IE) [1]. Back pain is the second most common rheumatic manifestation of IE, although, the occurrence of both infective endocarditis and spondylodiscitis is rare, with an estimated general incidence of 2.5% [2,3]. Among such cases, Streptococcus bovis is the most frequently isolated etiologic agent due to its specific tropism for vertebra [4]. Streptococcus bovis endocarditis usually presents with an indolent course and tends to occur in older males with underlying colonic pathology [5]. Streptococcus bovis spondylodiscitis commonly affects the lumbar spine, has a slow and insidious onset and is usually managed successfully with intravenous antibiotics [6-8].

Renal involvements in reported cases of Streptococcus bovis endocarditis

Renal involvements in reported cases of Streptococcus bovis endocarditis

Streptococcus anginosus Septicemia, Sole Presentation of Silent Colorectal Tumor: A Case Report

Introduction:Streptococcus anginosus (S. anginosus is a subgroup of viridans streptococci). Considered to be of low virulence, their ability to cause systemic abscesses sets them apart from the other streptococci groups. The association of Streptococcus bovis endocarditis with colonic adenocarcinoma is well known; however, other species of viridans streptococci, especially S. anginosus, can be associated with an underlying colonic malignancy. This is relevant for patients without GI screening, as it can be an early sign of colonic neoplasm. Case Report: We present a case of a 62-year-old male with PMH of HTN, type 2 DM, HLP with history of rectal polyps s/p resection, who presented with 1-2-day c/o fever, chills, fatigue, and watery diarrhea. On presentation, he was septic and was resuscitated with fluids. Blood cultures were drawn and empiric antibiotics were started. Both cultures grew S. anginosus. His physical exam was benign and there was no obvious source of infection. A TEE was done to rule out endocarditis, and was unremarkable. CT scan of the abdomen and pelvis with contrast revealed lobulated hypodense lesion in the liver and irregular thickening in the rectum s/o neoplasm. IR-guided biopsy of the liver lesion was consistent with a pyogenic abscess, and colonoscopic biopsy of the rectal lesion showed tubulovillous adenoma without any dysplasia. The patient was treated for 6 weeks with IV antibiotics, which lead to resolution of the liver abscess. The rectal adenoma showed extension into muscularis propria on EUS, and therefore, was un-resectable. Eventual biopsies showed dysplastic conversion. The patient will undergo elective LAR with loop ileostomy. Discussion:S. anginosus forms part of the normal flora of the GI tract of both adults and children. As mentioned above, they are known for their tendency to form abscesses. On the other hand, Streptococcus bovis endocarditis is strongly associated with colonic adenocarcinoma. Our case stresses the importance of considering colonic malignancy in cases with viridans streptococci bacteremia, as it might be an early manifestation of the same. Therefore, in patients like ours with S. anginosus bacteremia, if no clinically apparent signs of abscess are visible, we recommend doing radiographic investigation with CT scan and early GI screening to look for drainable collections and colonic neoplasm. Treatment involves using third generation cephalosporins or beta lactam/beta lactamase combination along with abscess drainage. Conclusion: Although further evidence is needed to warrant colonoscopic work-up of S. anginosus bacteremia, our case stresses the importance of early radiologic investigation of the abdomen with special emphasis on the colon, as it may be an early sign of colonic neoplasm.

Streptococcus bovis infection and colorectal neoplasia: a meta-analysis.

A meta-analysis was conducted to determine the risk associated with Streptococcus bovis infection and the occurrence of colorectal neoplasia (CRN). The level of risk remains unknown. We conducted a search of MEDLINE, PubMed and EMBASE up to January 2014. We used a random-effects model to analyse the data. We identified 48 studies concerning three main topics: S. bovis septicaemia, S. bovis endocarditis and S. bovis faecal carriage. The total sample sizes were 1729, 807 and 1145, respectively; the 48 studies included 9 case-control studies and 39 case series. Overall, the presence of S. bovis infection was found to be significantly associated with the presence of CRN. Streptococcus bovis endocarditis showed the strongest association in analyses of case-control studies and case series (OR 14.54, 95% CI 5.66-37.35, test for heterogeneity I2 = 43.53; event rate of 0.53, 95% CI 0.45-0.61, test for heterogeneity I2 = 53.50). Similarly, S. bovis septicaemia was also associated with a high level of concurrence with CRN (OR 7.48, 95% CI 3.10-18.06, test for heterogeneity I(2) = 43.32; event rate 0.49, 95% CI 0.42-0.56, test for heterogeneity I2 = 69.97). Patients with CRN were found to have a higher incidence of S. bovis in faeces upon stool culture (OR 2.52, 95% CI 1.14-5.58, test for heterogeneity I2 = 69.17). The meta-analysis showed a statistically significant association between the presence of S. bovis endocarditis or S. bovis septicaemia and CRN. Furthermore, there is a statistically significant increase in likelihood of finding S. bovis in the stool of individuals with CRN.

Streptococcus bovis endocarditis as a sign of colon cancer: Case report

Streptococcus bovis is labeled in the literature as a cause of bacteremia and endocarditis, which are often associated with gastrointestinal malignancy. In our paper we present a patient with endocarditis induced by Streptococcus bovis who was also, after completed cardiologic examination and treatment, diagnosed colon cancer in situ by targeted endoscopy. Owing to the timely diagnosis, and after successful cardiologic surgery with implantation of an artificial aortic valve, patient underwent surgery of the colon, and is now asymptomatic and in good health. Complete and detailed endoscopic examination of the colon must be done in patients with endocarditis caused by Streptococcus bovis, even if the patient is asymptomatic. By following these recommendations, it is possible to detect precancerosis or cancer at an early stage and save the patient's life.

Bacterial testing of platelet components: is there added benefit for our donors?

Bacterial testing of platelet components: is there added benefit for our donors?

Streptococcus bovis bacteraemia: an evaluation of the long-term effect on cardiac outcomes

Streptococcus bovis can lead to bacteraemia, septicaemia, and ultimately endocarditis. The objective of this study was to evaluate the long-term implications of S. bovis endocarditis on cardiac morbidity and mortality. A retrospective cohort study was performed between January 2000 and March 2009 to assess all patients diagnosed with S. bovis bacteraemia from the Belfast Health and Social Care Trust. The primary end-point for cardiac investigations was the presence of endocarditis. Secondary end-points included referral for cardiac surgery and overall mortality. Sixty-one positive S. bovis blood cultures from 43 patients were included. Following echocardiography, seven patients were diagnosed with infective endocarditis (16.3% of total patients); four patients (9.3%) had native valve involvement while three (7.0%) had prosthetic valve infection. Five of these seven patients had more than one positive S. bovis culture (71.4%). Three had significant valve dysfunction that warranted surgical repair/replacement, one of whom was unfit for surgery. There was a 100% recurrence rate amongst the valve replacement patients (n=2) and six patients with endocarditis had colorectal pathology. Patients with endocarditis had similar long-term survival as those with non-endocarditic bacteraemia (57.1% alive vs. 50% of non-endocarditis patients, p=0.73). Streptococcus bovis endocarditis patients tended to have pre-existing valvular heart disease and those with prosthetic heart valves had higher surgical intervention and relapse rates. These patients experienced a higher rate of co-existing colorectal pathology but currently have reasonable long-term outcomes. This may suggest that they represent a patient population that merits consideration for an early surgical strategy to maximise long-term results, however, further evaluation is warranted.

Association of Streptococcus bovis endocarditis and advanced colorectal neoplasia: A case–control study

ObjectiveTo study the association between Streptococcus bovis (S. bovis) endocarditis and advanced colorectal neoplasia.MethodsThis was a case–control study of patients with S. bovis endocarditis undergoing colonoscopic evaluation. Patients were matched 1:20 with controls by gender and age (±2 years) from a large screening colonoscopy database. The baseline, colonoscopic and clinicopathological characteristics of patients with S. bovis endocarditis were analyzed.ResultsFrom 1996 to 2010, 18 adult patients with S. bovis bacteremia were identified, of whom 10 with infective endocarditis (IE) underwent colonoscopic evaluation. Endocarditis involved a native or prosthetic valve in six and four of those patients, respectively. All 10 patients recovered without recurrence of IE (mean follow‐up duration 49.6 months). None had a concurrent or preceding history of colon disease and only one had subclinical chronic liver disease. Advanced neoplasia, defined as the presence of polyps ≥1 cm (n = 6), villous histology (n = 3), high‐grade focal dysplasia (n = 1) or cancer (n = 1), was found under colonoscopy in 6 of the 10 cases (60.0%) compared with 13/200 (6.5%) matched controls (OR 21.6, 95% CI 5.4–86.1, P < 0.0001).ConclusionsS. bovis endocarditis is strongly associated with the presence of advanced colorectal neoplasia. In the absence of any contraindication, colonoscopic examination is strongly recommended in patients with endocarditis. The exact pathophysiological mechanisms underlying this association and the predilection for S. bovis bacteremia in patients with advanced colonic neoplasia remain unclear.