Group D Streptococcus (GDS) Infections (Streptococcus bovis/Streptococcus gallolyticus) Follow-up

Updated: Aug 10, 2017
  • Author: Shirin A Mazumder, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Follow-up

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.

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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.

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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.
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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]

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