Streptococcus bovis Endocarditis and Its Association with Chronic Liver Disease: An Underestimated Risk Factor

Abstract

Clinical and epidemiological characteristics of Streptococcus bovis endocarditis were prospectively studied among 199 patients with definite endocarditis. Thirty patients (15.1%) had S. bovis endocarditis. Compared with patients with non-S. bovis endocarditis, these 30 patients were older (mean age, 58.6+/-12.4 years vs. 46.0+/-17.0 years; P<.001) and had higher rates of bivalvular involvement (43.3% vs. 7.7%; P<.001), embolism (73.3% vs. 40.2%; P=.002), and diskitis (23.3% vs. 0.6% P<.001). In patients with S. bovis biotype I (S. bovis I) endocarditis, advanced liver disease was present in 56.7%, compared with 15.3% of patients with non-S. bovis endocarditis (P<.001), and colonic adenoma was present in 46.7%. The in-hospital mortality rate (16.7%) was correlated with delayed diagnosis and advanced liver diseases. In our city, S. bovis I endocarditis is frequently correlated with liver diseases; diskitis may be the first sign of the disease.

Infectious endocarditis in patients with cirrhosis of the liver: a model of infection in the frail patient

“…Anecdotal case reports of endocarditis associated with invasive procedures -TIPS, upper endoscopy, sclerotherapy of esophageal varices or liver biopsy -, and caused by unusual pathogens comprise the majority of the articles [3][4][5][6][7]. However, to the best of our knowledge, studies have not analyzed the impact of liver cirrhosis, a common morbid condition, on the outcome of patients with endocarditis and thus, some important clinical and prognostic factors of endocarditis in patients with cirrhosis are still poorly known.…”

An uncommon manifestation of Streptococcus gallolyticus infective endocarditis with cerebral septic emboli

“…It reported an incidence of S. gallolyticus as follows: 2% (9/597) in North America, 7% (17/254) in South America, 10% (116/1,213) in Europe, and 3% (23/717) in Africa, Middle East and Asia combined. [8] Risk factors associated with early embolization has often been an interest of study, in order to better anticipate and diagnose embolic diseases early. S. bovis I infection was found to be associated with advanced age, with more frequent involvement of native valves, and a higher rate of multiple embolic events.…”

“…S. bovis I infection was found to be associated with advanced age, with more frequent involvement of native valves, and a higher rate of multiple embolic events. [8,9] The association of S. gallolyticus IE and colonic lesions has long been established. Recent studies have also found the association of S. gallolyticus IE with inflammatory bowel disease and chronic liver disease.…”

“…Recent studies have also found the association of S. gallolyticus IE with inflammatory bowel disease and chronic liver disease. [8] It was found that 25% to 80% of patients with S. gallolyticus bacteremia and 18% to 62% of patients with S. gallolyticus endocarditis have underlying colorectal tumors. [10][11][12][13][14][15][16][17] In view of our patient's history of loss of weight and incomplete colonoscopy, it was possible that he had an underlying undiagnosed colonic tumor.…”

Sepsis, the Liver and the Gut

“…Tripodi et al prospectively studied 199 patients with infective endocarditis and found that 30 of these were attributable to S. bovis biotype I (S. gallolyticus). [93] 56.7% of these patients had advanced liver disease, compared with only 15.3% of patients with non-S.bovis endocarditis, while colonic adenomas were present in 46.7% of cirrhotics. Alazmi and his team [94] retrospectively analysed microbiology data from 46 patients (38 adult and 8 paediatric) with proven S.gallolyticus bacteraemia and found that 19% had end-stage liver disease while colonic neoplasia was found in 6 of 10 adult patients in whom colonoscopy was performed.…”