Group D Streptococcus (GDS) Infections (Streptococcus bovis/Streptococcus gallolyticus) Clinical Presentation

Updated: Mar 02, 2021
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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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


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.


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.