History

Meningitis, peritonitis, septic arthritis, urinary tract infections, and neonatal sepsis due to group D streptococci have clinical features referable to the site of infection. When due to group D streptococcal infection, the clinical features do not differ from other bacterial causes of these infections.

The following are findings associated with group D streptococcal endocarditis:

Subacute endocarditis with persistent fever lasting days or weeks
Associated with nonspecific symptoms, including anorexia, weight loss, fatigue, night sweats, and weakness

The following are findings associated with group D streptococcal bacteremia:

Fever
Only possible to distinguish from endocarditis with patient history and echocardiography

Physical

Group D streptococcal bacteremia manifests as fever without localizing signs.

The following are the physical findings of group D streptococcal endocarditis:

A minority of patients with group D streptococcal endocarditis have heart murmurs at presentation. Murmurs usually develop with time.
Classic peripheral signs occasionally observed include splinter hemorrhages, conjunctival petechiae, Osler nodules, Janeway lesions, and Roth spots. At least one of these manifestations occurs in approximately 50% of cases.
Embolic phenomena may include neurologic manifestations, septic infarctions, or vascular occlusion.
Renal failure may be present and may be caused by an immune-complex glomerulonephritis.
If cerebral hemorrhage is observed, it is a consequence of a ruptured mycotic aneurism.

Causes

Group D streptococci, along with other catalase-negative, gram-positive cocci, belong to the family Streptococcaceae. Group D strepotococci are gram positive cocci that are in pairs or chains and have nonhemoltyic colonies on blood agar^[10]. Group D streptococci may also be referenced as the S bovis–Streptococcus equinus complex.^[11]S bovis has recently been reclassified as Streptococcus gallolyticus, but references to S bovis remain prevalent in the clinical literature. S equinus is almost never isolated from human specimens.

Group D streptococci share many features with enterococci. In the mid 1980s, Streptococcus faecalis, Streptococcus faecium, and others were reclassified under the newly created genus Enterococcus.

Similar to enterococci, S bovis possesses the group D lipoteichoic acid antigen in its cell wall. It also shares the ability to hydrolyze esculin in the presence of bile. Unlike enterococci, S bovis fails to grow in broth containing a concentration of 6.5% sodium chloride and is negative for the pyrrolidonyl arylamidase reaction.

S bovis was traditionally differentiated into two biotypes, termed S bovis or S bovis I (now termed S gallolyticus subspecies gallolyticus) and S bovis variant or S bovis II. S bovis II was further differentiated into 2 sub-biotypes, S bovis II/1 (now termed Streptococcus infantarius) and S bovis II/2 (now termed S gallolyticus subspecies pasteurianus or Streptococcus pasteurianus).

In a study of patients with S bovis bacteremia, Ruoff et al demonstrated the following:^[12]

S bovis I is most often associated with endocarditis and/or malignant or premalignant colonic lesions.
S bovis II (mainly sub-biotype II/1) is most often associated with a bacteremia of hepatobiliary origin.

Differential Diagnoses

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Author

Shirin A Mazumder, MD, FIDSA Associate Professor of Medicine, Director of Infectious Disease Fellowship Program, Division of Infectious Diseases, Department of Internal Medicine, University of Tennessee Health Science Center College of Medicine, University of Tennessee Methodist Physicians

Shirin A Mazumder, MD, FIDSA is a member of the following medical societies: American Academy of HIV Medicine, American College of Physicians, American Medical Association, HIV Medicine Association, Infectious Diseases Society of America, Memphis Medical Society, Society for Healthcare Epidemiology of America, Tennessee Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John L Brusch, MD, FACP Corresponding Faculty Member, Harvard Medical School

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Christian P Sinave, MD Associate Professor, Department of Medical Microbiology and Infectious Diseases, University of Sherbrooke Faculty of Medicine, Canada

Christian P Sinave, MD is a member of the following medical societies: American Society for Microbiology, Association of Medical Microbiology and Infectious Disease Canada

Disclosure: Nothing to disclose.

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

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, Infectious Diseases Society of America, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

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.