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.

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.

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. See the following:

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]

Questions

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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.