Sections

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

Sections Group D Streptococcus (GDS) Infections (Streptococcus bovis/Streptococcus gallolyticus)
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
References

Workup

Laboratory Studies

Basic laboratory studies to evaluate for Streptococcus group D infections should include CBC count, electrolyte evaluation, creatinine level, and LFTs.

Blood cultures

Blood cultures are the most important tests.

Blood culture results are usually positive during the first 24-48 hours. In cases of endocarditis and sustained bacteremia, blood culture results are positive.

Gram stain from the blood culture bottles demonstrates gram-positive cocci in pairs or chains. S bovis cannot be differentiated from other streptococci using Gram staining.

Differentiating S bovis from Streptococcus salivarius is sometimes very difficult because S salivarius yields a positive reaction on the bile-esculin test. This happens with approximately 20% of the isolates.

Sensitivity testing is recommended, although most S bovis strains are exquisitely sensitive to penicillin. In a study by Mouton et al on 19 strains of S bovis, the minimal inhibitory concentrations (MICs) 50 and 90 were, respectively, 0.06 mg/L (susceptible) and 1 mg/L (intermediate susceptibility). The highest MIC was 2 mg/L (resistant).^[13]

Echocardiography

Transthoracic or transesophageal (more sensitive) echocardiography frequently permits visualization of vegetations. Echocardiography should be performed in all patients with S bovis bacteremia. Vegetations associated with Group D streptococcal infections tend to be larger and can cause signficant valvular destruction^[14].

An absence of vegetation does not rule out infective endocarditis. For more information on echocardiography findings, see Infective Endocarditis.

Colonoscopy

This test is used to detect malignant lesions of the colon.

Colonoscopy should be performed in all patients with S. bovis bacteremia or endocarditis as there is an association with colonic neoplasia. There appears to be a increased association with malignancy with S. bovis biotype I than with S. bovis biotype II^[15].

Regular-interval follow-up colonoscopy should be performed in patients in whom no lesion is found on initial investigation.

Esophagogastroduodenoscopy

Esophagogastroduodenoscopy (EGD) is used to detect malignant lesions of the esophagus, stomach, and duodenum.

EGD should be performed in patients with S bovis bacteremia or endocarditis who have no evidence of colonic malignancy.

Liver ultrasonography and CT scanning

Both of these studies should be performed in cases of associated hepatobiliary disease.

Usually, liver ultrasonography is performed first, followed by CT scanning.

Other Tests

Consider referral of the organism for formal MIC testing if the response to antibiotic therapy is unfavorable.

Treatment & Management

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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.

Sections Group D Streptococcus (GDS) Infections (Streptococcus bovis/Streptococcus gallolyticus)
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Follow-up
Questions & Answers
References

Group D Streptococcus (GDS) Infections (Streptococcus bovis/Streptococcus gallolyticus) Workup

Laboratory Studies

Blood cultures

Imaging Studies

Echocardiography

Colonoscopy

Esophagogastroduodenoscopy

Liver ultrasonography and CT scanning

Other Tests

Group D Streptococcus (GDS) Infections (Streptococcus bovis/Streptococcus gallolyticus) Workup

Laboratory Studies

Blood cultures

Imaging Studies

Echocardiography

Colonoscopy

Esophagogastroduodenoscopy

Liver ultrasonography and CT scanning

Other Tests

References

Tables

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