eMedicine Specialties > Infectious Diseases > Bacterial Infections

Streptococcus Group D Infections: Follow-up

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

Follow-up

Further Inpatient Care

  • Approximately 72 hours after beginning antibiotics, run two series of blood cultures. If the results are positive, repeat every 3-4 days until the results are negative.
  • Monitor serum creatinine levels closely in patients receiving gentamicin and vancomycin.

Further Outpatient Care

  • Patients who are stable and infected with a penicillin-sensitive strain of S bovis and whose conditions have improved with antibiotic therapy can be discharged to complete their intravenous treatment on an outpatient basis.

Complications

  • Complications of S bovis infection are similar to those of S viridans endocarditis.
  • S bovis subacute bacterial endocarditis can involve the heart, kidneys, CNS, spleen, lungs, and eyes. Mycotic aneurysms are potential complications.
    • Heart: Destruction of the valve leaflets and rupture of the chordae tendineae, papillary muscles, or interventricular septum may cause intractable heart failure. Other rare complications of SBE include myocarditis, pericarditis, and myocardial infarction. Ring abscesses (mainly with prosthetic valve endocarditis) could extend to the septum and cause atrioventricular blockade.
    • Kidneys: Embolization could cause kidney infarction or abscesses. Immune complexes are responsible for glomerulonephritis.
    • CNS: Cerebral emboli can cause cerebral infarction, arteritis, mycotic aneurysms, hemorrhage, cerebritis, and meningitis.
    • Spleen: Splenic infarction or abscesses may occur.
    • Lungs: With right-sided endocarditis, pulmonary emboli are common and may cause infarction or septic emboli.
    • Eyes: Endogenous endophthalmitis may occur.
    • Mycotic aneurysms: Found most commonly in the CNS, they also occur in the abdominal aorta; the sinus of Valsalva; and splenic, coronary, pulmonary, and mesenteric arteries.

Prognosis

  • See Mortality/Morbidity.
  • S bovis endocarditis is an aggressive disease with significant mortality.
    • Heart failure is a frequent complication and an indication for valve replacement.
    • In a study by Kupferwasser et al, 73% of patients with S bovis endocarditis underwent surgical treatment, but only 34%, 34%, and 41% of patients with endocarditis caused by other streptococci, staphylococci, or other bacteria underwent surgery, respectively.6

Miscellaneous

Medicolegal Pitfalls

  • Failure to investigate the gastrointestinal tract for possible diseases, either neoplastic or nonneoplastic, in patients with S bovis bacteremia or endocarditis
 


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
[ CLOSE WINDOW ]

References

  1. Tripodi MF, Adinolfi LE, Ragone E, et al. Streptococcus bovis endocarditis and its association with chronic liver disease: an underestimated risk factor. Clin Infect Dis. May 15 2004;38(10):1394-400. [Medline].

  2. Montalto M, Izzi D, La Regina M, Nucera G, Manna R, Gasbarrini G. Non-life-threatening sepsis: report of two cases. Am J Med Sci. May 2004;327(5):275-7. [Medline].

  3. Biedenbach DJ, Moet GJ, Jones RN. Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997-2002). Diagn Microbiol Infect Dis. Sep 2004;50(1):59-69. [Medline].

  4. Pfaller MA, Jones RN, Marshall SA, et al. Nosocomial streptococcal blood stream infections in the SCOPE Program: species occurrence and antimicrobial resistance. The SCOPE Hospital Study Group. Diagn Microbiol Infect Dis. Dec 1997;29(4):259-63. [Medline].

  5. Hoen B, Chirouze C, Cabell CH, Selton-Suty C, Duchêne F, Olaison L, et al. Emergence of endocarditis due to group D streptococci: findings derived from the merged database of the International Collaboration on Endocarditis. Eur J Clin Microbiol Infect Dis. Jan 2005;24(1):12-6. [Medline].

  6. Kupferwasser I, Darius H, Muller AM, et al. Clinical and morphological characteristics in Streptococcus bovis endocarditis: a comparison with other causative microorganisms in 177 cases. Heart. Sep 1998;80(3):276-80. [Medline].

  7. Giannitsioti E, Chirouze C, Bouvet A, Béguinot I, Delahaye F, Mainardi JL, et al. Characteristics and regional variations of group D streptococcal endocarditis in France. Clin Microbiol Infect. Aug 2007;13(8):770-6. [Medline].

  8. Corredoira J, Alonso MP, Coira A, Casariego E, Arias C, Alonso D, et al. Characteristics of Streptococcus bovis endocarditis and its differences with Streptococcus viridans endocarditis. Eur J Clin Microbiol Infect Dis. Apr 2008;27(4):285-91. [Medline].

  9. Karchmer AW. Infective endocarditis. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Saunders; 2007:1713.

  10. van't Wout JW, Bijlmer HA. Bacteremia due to Streptococcus gallolyticus, or the perils of revised nomenclature in bacteriology. Clin Infect Dis. Apr 1 2005;40(7):1070-1. [Medline].

  11. Ruoff KL, Miller SI, Garner CV, et al. Bacteremia with Streptococcus bovis and Streptococcus salivarius: clinical correlates of more accurate identification of isolates. J Clin Microbiol. Feb 1989;27(2):305-8. [Medline].

  12. Mouton JW, Endtz HP, den Hollander JG, et al. In-vitro activity of quinupristin/dalfopristin compared with other widely used antibiotics against strains isolated from patients with endocarditis. J Antimicrob Chemother. May 1997;39 Suppl A:75-80. [Medline].

  13. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. Jun 14 2005;111(23):e394-434. [Medline].

  14. Bayer AS, Scheld WM. Endocarditis and intravascular infections. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. Vol 1. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2000:857-902.

  15. Burns CA, McCaughey R, Lauter CB. The association of Streptococcus bovis fecal carriage and colon neoplasia: possible relationship with polyps and their premalignant potential. Am J Gastroenterol. Jan 1985;80(1):42-6. [Medline].

  16. Corredoira J, Alonso MP, Coira A, Varela J. Association between Streptococcus infantarius (formerly S. bovis II/1) bacteremia and noncolonic cancer. J Clin Microbiol. Apr 2008;46(4):1570. [Medline].

  17. Cunha BA. Antibiotic Essentials. 7th ed. Royal Oak, Mich: Physicians Press; 2008.

  18. Cunha BA. Antimicrobial therapy of multidrug-resistant Streptococcus pneumoniae, vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus. Med Clin North Am. Nov 2006;90(6):1165-82. [Medline].

  19. Cunha BA. New uses for older antibiotics: nitrofurantoin, amikacin, colistin, polymyxin B, doxycycline, and minocycline revisited. Med Clin North Am. Nov 2006;90(6):1089-107. [Medline].

  20. Cunha BA. Oral antibiotic therapy of serious systemic infections. Med Clin North Am. Nov 2006;90(6):1197-222. [Medline].

  21. Diekema DJ, Pfaller MA, Jones RN, et al. Trends in antimicrobial susceptibility of bacterial pathogens isolated from patients with bloodstream infections in the USA, Canada and Latin America. SENTRY Participants Group. Int J Antimicrob Agents. Feb 2000;13(4):257-71. [Medline].

  22. Diekema DJ, Pfaller MA, Jones RN; SENTRY Participants Group. Age-related trends in pathogen frequency and antimicrobial susceptibility of bloodstream isolates in North America: SENTRY Antimicrobial Surveillance Program, 1997-2000. Int J Antimicrob Agents. Dec 2002;20(6):412-8. [Medline].

  23. García-Porrúa C, González-Gay MA, Monterroso JR, Sánchez-Andrade A, González-Ramirez A. Septic arthritis due to Streptococcus bovis as presenting sign of 'silent' colon carcinoma. Rheumatology (Oxford). Mar 2000;39(3):338-9. [Medline].

  24. Gavin PJ, Thomson RB Jr, Horng SJ, Yogev R. Neonatal sepsis caused by Streptococcus bovis variant (biotype II/2): report of a case and review. J Clin Microbiol. Jul 2003;41(7):3433-5. [Medline].

  25. Gonzlez-Quintela A, Martinez-Rey C, Castroagudín JF, et al. Prevalence of liver disease in patients with Streptococcus bovis bacteraemia. J Infect. Feb 2001;42(2):116-9. [Medline].

  26. Grant RJ, Whitehead TR, Orr JE. Streptococcus bovis meningitis in an infant. J Clin Microbiol. Jan 2000;38(1):462-3. [Medline].

  27. Hechmann Wittrup I, Chenoufi Schaadt ML, Arpi M, Danneskiold-Samsoe B. Bacteremia complicated by vertebral osteomyelitis due to Streptococcus bovis. Eur J Clin Microbiol Infect Dis. May 1999;18(5):365-7. [Medline].

  28. Klein RS, Catalano MT, Edberg SC, et al. Streptococcus bovis septicemia and carcinoma of the colon. Ann Intern Med. Oct 1979;91(4):560-2. [Medline].

  29. Klein RS, Recco RA, Catalano MT, et al. Association of Streptococcus bovis with carcinoma of the colon. N Engl J Med. Oct 13 1977;297(15):800-2. [Medline].

  30. Moellering RC Jr. Enterococcus species, Streptococcus bovis, and Leuconostoc species. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Disease. 6th ed. Philadelphia, Pa: Churchill Livingstone; 2005.

  31. Moellering RC Jr, Watson BK, Kunz LJ. Endocarditis due to group D streptococci. Comparison of disease caused by streptococcus bovis with that produced by the enterococci. Am J Med. Aug 1974;57(2):239-50. [Medline].

  32. Murray HW, Roberts RB. Streptococcus bovis bacteremia and underlying gastrointestinal disease. Arch Intern Med. Jul 1978;138(7):1097-9. [Medline].

  33. Pfaller MA, Jones RN, Doern GV, et al. Survey of blood stream infections attributable to gram-positive cocci: frequency of occurrence and antimicrobial susceptibility of isolates collected in 1997 in the United States, Canada, and Latin America from the SENTRY Antimicrobial Surveillance Progr. Diagn Microbiol Infect Dis. Apr 1999;33(4):283-97. [Medline].

  34. Rehm SJ. Outpatient intravenous antibiotic therapy for endocarditis. Infect Dis Clin North Am. Dec 1998;12(4):879-901, vi. [Medline].

  35. Reynolds JG, Silva E, McCormack WM. Association of Streptococcus bovis bacteremia with bowel disease. J Clin Microbiol. Apr 1983;17(4):696-7. [Medline].

  36. Selton-Suty C, Hoen B, Grentzinger A, et al. Clinical and bacteriological characteristics of infective endocarditis in the elderly. Heart. Mar 1997;77(3):260-3. [Medline].

  37. Siegman-Igra Y, Schwartz D. Streptococcus bovis revisited: a clinical review of 81 bacteremic episodes paying special attention to emerging antibiotic resistance. Scand J Infect Dis. 2003;35(2):90-3. [Medline].

  38. Terpenning MS, Buggy BP, Kauffman CA. Infective endocarditis: clinical features in young and elderly patients. Am J Med. Oct 1987;83(4):626-34. [Medline].

  39. Vilaichone RK, Mahachai V, Kullavanijaya P, Nunthapisud P. Spontaneous bacterial peritonitis caused by Streptococcus bovis: case series and review of the literature. Am J Gastroenterol. Jun 2002;97(6):1476-9. [Medline].

  40. Wilson WR, Karchmer AW, Dajani AS, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA. Dec 6 1995;274(21):1706-13. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.