eMedicine Specialties > Infectious Diseases > Bacterial Infections

Streptococcus Group D Infections: Differential Diagnoses & Workup

Author: John W Downs, MD, Resident Physician, Department of Medicine, Tripler Army Medical Center
Coauthor(s): Christian P Sinave, MD, Associate Professor, Department of Medical Microbiology and Infectious Diseases, University of Sherbrooke, Canada; Tomas Michael Ferguson, MD, Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Tripler Army Medical Center
Contributor Information and Disclosures

Updated: Jan 23, 2009

Differential Diagnoses

Infective Endocarditis
Meningitis
Pneumococcal Infections
Sepsis, Bacterial
Streptococcus Group A Infections
Streptococcus Group B Infections

Workup

Laboratory Studies

  • Basic laboratory studies to evaluate for Streptococcus group D infections should include CBC count, electrolyte evaluation, creatinine level, and LFTs.
  • Blood cultures are the most important tests.
    • Blood culture results are usually positive during the first 24-48 hours. In cases of endocarditis and sustained bacteremia, blood culture results are positive.
    • Gram stain from the blood culture bottles demonstrates gram-positive cocci in pairs or chains. S bovis cannot be differentiated from other streptococci using Gram staining.
    • Differentiating S bovis from Streptococcus salivarius is sometimes very difficult because S salivarius yields a positive reaction on the bile-esculin test. This happens with approximately 20% of the isolates.
    • Sensitivity testing is recommended, although most S bovis strains are exquisitely sensitive to penicillin. In a study by Mouton et al on 19 strains of S bovis, the minimal inhibitory concentrations (MICs) 50 and 90 were, respectively, 0.06 mg/L (susceptible) and 1 mg/L (intermediate susceptibility). The highest MIC was 2 mg/L (resistant).12

Imaging Studies

  • Echocardiography
    • Transthoracic or transesophageal (more sensitive) echocardiography frequently permits visualization of vegetations. Echocardiography should be performed in all patients with S bovis bacteremia.
    • An absence of vegetation does not rule out infective endocarditis. For more information on echocardiography findings, see Infective Endocarditis.
  • Colonoscopy
    • This test is used to detect malignant lesions of the colon.
    • Colonoscopy should be performed in all patients with S bovis bacteremia or endocarditis.
    • Regular-interval follow-up colonoscopy should be performed in patients in whom no lesion is found on initial investigation.
  • Esophagogastroduodenoscopy
    • Esophagogastroduodenoscopy (EGD) is used to detect malignant lesions of the esophagus, stomach, and duodenum.
    • EGD should be performed in patients with S bovis bacteremia or endocarditis who have no evidence of colonic malignancy.
  • Liver ultrasonography and CT scanning
    • Both of these studies should be performed in cases of associated hepatobiliary disease.
    • Usually, liver ultrasonography is performed first, followed by CT scanning.

Other Tests

  • Consider referral of the organism for formal MIC testing if the response to antibiotic therapy is unfavorable.

More on Streptococcus Group D Infections

Overview: Streptococcus Group D Infections
Differential Diagnoses & Workup: Streptococcus Group D Infections
Treatment & Medication: Streptococcus Group D Infections
Follow-up: Streptococcus Group D Infections
References
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References

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Further Reading

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Keywords

Streptococcus group D infections, streptococcal group D infections, group D Streptococcus, group D streptococci, Streptococcus bovis–Streptococcus equinus complex, Streptococcus bovis, Streptococcus gallolyticus, Streptococcus infantarius, Streptococcus pasteurianus, S bovis–S equinus complex, S bovis, S gallolyticus, S infantarius, S pasteurianus, infective endocarditis, infectious endocarditis, bacterial endocarditis, endocarditis, neonatal sepsis, streptococcal bloodstream infections, S bovis bacteremia, S bovis endocarditis

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Contributor Information and Disclosures

Author

John W Downs, MD, Resident Physician, Department of Medicine, Tripler Army Medical Center
John W Downs, MD is a member of the following medical societies: Alpha Omega Alpha and American College of Physicians
Disclosure: Nothing to disclose.

Coauthor(s)

Christian P Sinave, MD, Associate Professor, Department of Medical Microbiology and Infectious Diseases, University of Sherbrooke, Canada
Christian P Sinave, MD is a member of the following medical societies: American Society for Microbiology and Canadian Infectious Disease Society
Disclosure: Nothing to disclose.

Tomas Michael Ferguson, MD, Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Tripler Army Medical Center
Tomas Michael Ferguson, MD is a member of the following medical societies: American College of Physicians, Armed Forces Infectious Diseases Society, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Pranatharthi Haran Chandrasekar, MD, Director of Infectious Disease Fellowship, Professor, Department of Internal Medicine, Harper Hospital, Wayne State University School of Medicine
Pranatharthi Haran Chandrasekar, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

John L Brusch, MD, FACP, Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance
John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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