Streptococcus bovis bacteraemia requires rigorous exclusion of colonic neoplasia and endocarditis

Twelve patients presented to the hospitals of the Auckland Hospital Board with bacteraemia caused by Streptococcus bovis in the years 1979-84. Ten had endocarditis, affecting homograft valves in two cases and the tricuspid valve in one case. Of nine patients who underwent investigation of the large bowel, only one did not have a colorectal tumour. Three had colonic adenocarcinoma and three had colorectal villous adenoma. Two, including a patient with acute hepatic failure from alcoholic cirrhosis, had colonic adenomata. Colonoscopy provided a tissue diagnosis of colorectal neoplasia despite negative radiological studies in three patients. Bacteraemia due to S. bovis should prompt rigorous investigation to exclude both endocarditis and tumours of the large bowel.     

Infective endocarditis due to penicillin-tolerant Streptococcus bovis

Two Streptococcus bovis isolates obtained from patients with endocarditis were found to be tolerant to penicillin and other cell wall active agents. By time-kill analysis, penicillin and streptomycin acted synergistically against these strains. The existence of tolerant S. bovis strains should be considered when initially choosing antibiotics for the treatment of serious S. bovis infections.     

Isolated septic discitis associated with Streptococcus bovis bacteremia

Streptococcus bovis is a Gram-positive coccus that can be found in the intestinal flora of healthy people; it is also associated with colon cancer and infective endocarditis. We report on a 79-year-old male who initially presented with acute-onset lower back pain. Streptococcus bovis was detected in repeated blood cultures, and magnetic resonance imaging of the lumbar spine revealed septic discitis of the L2-L3 intervertebral disc. Excision and debridement of the intervertebral disc was performed and a tissue culture tested positive for S. bovis. Repeat echocardiography and colonoscopy showed no signs of vegetation or tumor lesions, respectively. We diagnosed the patient with isolated septic discitis caused by S. bovis-induced bacteremia. The patient was discharged after six weeks of antibiotic therapy.     

Bacterial complications of strongyloidiasis: Streptococcus bovis meningitis.

We report the case of a 64-year-old veteran who had Streptococcus bovis meningitis as a result of a long latent Strongyloides infection that became acute when he was treated with prednisone. We reviewed 38 reported cases of serious bacterial infections associated with strongyloidiasis. Patients most frequently had nonspecific gastrointestinal symptoms. Of these 38 patients, 21 (55%) had meningitis, and 28 (73%) had bacteremia that was polymicrobial in 3 cases (8%). Other sites of infection included lung, bone marrow, ascites, mitral valve, and lymph node. Most infections were due to enteric gram-negative bacteria. There is one previously reported case of S bovis meningitis. Thirty-four of the patients (89%) were immunosuppressed; 21 of these (55%) were taking pharmacologic doses of adrenal corticosteroids. Thirty-three of the 38 (87%) patients died. Patients with enteric bacterial infection without an obvious cause should be tested for the presence of strongyloidiasis.     

In vitro susceptibility of Streptococcus bovis to six antibiotics

A recent report of two isolates of Streptococcus bovis resistant to killing by low levels of penicillin G prompted this study of the in vitro susceptibility of 100 clinical isolates of S bovis to six antibiotics. Using a microdilution method, we found the minimum bactericidal concentrations for 99% of the isolates to be as follows: penicillin G, 0.5 microgram/ml; methicillin, 16 micrograms/ml; ampicillin, 0.5 microgram/ml; cephalothin, 2 micrograms/ml; clindamycin, 2 micrograms/ml; and vancomycin, 2 micrograms/ml. The high-level resistance of S bovis to penicillin G previously described was not seen. This study suggests that penicillin G can still prove effective in treating most infections caused by S bovis, including infective endocarditis, and that cephalothin and vancomycin are useful alternative agents.     

Streptococcus bovis Bacteraemia Requires Rigorous Exclusion of Colonic Neoplasia and Endocarditis

Twelve patients presented to the hospitals of the Auckland HospitalBoard with bacteraemia caused by Streptococcus bovis in theyears 1979–84. Ten had endocarditis, affecting homo-graftvalves in two cases and the tricuspid valve in one case. Ofnine patients who underwent investigation of the large bowel,only one did not have a colorectal tumour. Three had colonicadenocarcinoma and three had colorectal villous adenoma. Two,including a patient with acute hepatic failure from alcoholiccirrhosis, had colonic adenomata. Colonoscopy provided a tissuediagnosis of colorectal neoplasia despite negative radiologicalstudies in three patients. Bacteraemia due to S. bovis shouldprompt rigorous investigation to exclude both endocarditis andtumours of the large bo     

Genetic basis of antibiotic resistance in clinical isolates of Streptococcus gallolyticus (Streptococcus bovis)

Among 128 Streptococcus gallolyticus (Streptococcus bovis) isolates, 77.7% were resistant to tetracyclines and contained tet(M) and/or tet(L) and/or tet(O). A total of 59.4% had macrolide resistance and contained erm(B) and, rarely, mef(A). Among the one-third of isolates highly resistant to kanamycin and streptomycin, most harbored aphA3 and aad-6 genes.     

Antibiotic Susceptibility of Streptococcus bovis and Other Group D Streptococci Causing Endocarditis

Seventy-four strains of Streptococcus bovis and 35 strains of enterococci (Streptococcus faecalis and its varieties, Streptococcus faecium and Streptococcus durans), most of which were isolated from patients with endocarditis, were tested for their susceptibility to penicillin, ampicillin, erythromycin, cephalothin, vancomycin, methicillin, tetracycline, chloramphenicol, kanamycin, streptomycin, and gentamicin. Minimal inhibitory concentrations (MIC) and minimal bactericidal concentrations (MBC) were determined by a microtiter broth dilution technique. All of these organisms are group D streptococci, but the S. bovis strains are not enterococci. On the basis of both MIC and MBC, the S. bovis strains were much more susceptibile in general to antibiotics then were the enterococcal strains. For the S. bovis strains, the lowest MICs were obtained with penicillin, ampicillin, and erythromycin, and the lowest MBCs with penicillin and ampicillin. Although these antibiotics were also the most active against the enterococci, the MICs and MBCs were much higher than obtained with the S. bovis strains. Gentamicin was the most active aminoglycoside. On the basis of in vitro susceptibility results, the S. bovis strains resemble the viridans streptococci rather than enterococci.     

Benign neoplasia and pseudoneoplasia of the small bowel in children

Fourteen cases of benign tumorous conditions in children are reported. Each new growth described represents a true neoplasm, one simulating a true neoplasm, or one simulating a true tumor, clinically and/or radiographically.The series contains 10 female and 4 male patients. Most patients were under 1 year of age when manifestations-most often, gastrointestinal hemorrhage or bowel obstruction — of the condition became evident. Nine patients had roentgenographic findings which indicated the presence of an abnormality, but the specificity of the findings was low. Some patients had cutaneous or other somatic clinical stigmata found in known syndromes also containing gastrointestinal pathology. These stigmata and the awareness of the clinical and roentgenographic manifestations of small bowel tumors in children should lead to an early diagnosis and hopefully to the usually successful surgical therapy.     

Antimicrobial susceptibilities of Streptococcus species that cause septicemia in neutropenic patients.

Sixty-three consecutive streptococcal blood isolates from neutropenic patients, represented mainly by viridans group streptococci, were evaluated in vitro for antibiotic susceptibility. Of these isolates, 79.3% were highly susceptible to penicillin (MIC, less than or equal to 0.12 microgram/ml). Overall, imipenem was the most active agent, followed by teicoplanin and vancomycin. All other agents showed decreased activity against streptococcal isolates that were not highly susceptible to penicillin.     

Screening for large bowel cancer

Is there a need for yet another screening process to be applied in general practice with all the consequent costs in terms of materials, doctors' time and patient anxieties? What is the evidence for and against screening for colorectal cancer?     

MR imaging of the large bowel

MR colonography (MRC) is an accurate diagnostic tool for the detection of colorectal masses and inflammatory diseases. This article describes the underlying techniques of MRC that concern data acquisition and image interpretation. Indications for MRC are discussed, and technical developments are explained.