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Colonic Carcinoma Appearing as Streptococcus viridans- Related Endocarditis: A Case Report

Colonic Carcinoma Appearing as Streptococcus viridans- Related Endocarditis: A Case Report Case Report · Fallbericht Interdisziplinär Chir Gastroenterol 2007;23:202–204 Online publiziert: 6. Juni 2007 DOI: 10.1159/000097930 Colonic Carcinoma Appearing as Streptococcus viridans- Related Endocarditis: A Case Report Ta-Chin Lin Yi-Chieh Lin Chi-Wang Huang Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China Key Words Schlüsselwörter Streptococcus viridans ⋅ Infective endocarditis ⋅ Streptococcus viridans ⋅ Infektiöse Endokarditis ⋅ Colonic carcinoma Kolonkarzinom Summary Zusammenfassung Although the relationship between streptococcal bac- Obwohl die Beziehung zwischen einer Streptokokkenbak- teremia and colorectal malignancy is rarely reported terämie und einer kolorektalen malignen Erkrankung nur many doctors are still aware of the connection between spärlich dokumentiert ist, sind sich noch viele Ärzte der Streptococcus bovis infection and this malignancy. On Verbindung zwischen einer Infektion mit Streptococcus the other hand, there may be rare awareness of the asso- bovis und dieser Malignität bewusst. Andererseits gibt ciation between infection with other streptococcal es nur ein geringes Bewusstsein für die Beziehung zwi- species and colorectal carcinoma. We herein presented a schen einer Infektion mit anderen Streptokokkenspezies case of adenocarcinoma of the sigmoid colon presenting und kolorektalen Karzinomen. Wir präsentieren hier with Streptococcus viridans-related infective endocardi- einen Fall mit einem Adenokarzinom des sigmoiden Ko- tis. lons und gleichzeitiger durch Streptococcus viridans aus- gelöster infektiöser Endokarditis. Introduction Case Report A 62-year-old male who had progressive dyspnea and a chilling fever that There has been a great deal of documentations within the lit- had persisted for 1 week was sent to our emergency room. The patient erature about the association between streptococcal bac- also showed an advanced loss of body weight and poor appetite for nearly teremia and gastrointestinal disease, especially colonic neo- 30 days. The patient denied any systemic disease, except for hypertension plasms. Even though the specific relationship remains un- with regular medical control. On physical examinations, oral temperature known, many experts still believe that, whenever possible, was 38.7 °C, pulse rate 94/min, and respiratory rate 28/min. A low pitch diastolic murmur over the left sternal border was also noted. There were clinicians have to investigate patients with infective endo- no signs of hepatomegaly. The white blood cell count amounted to carditis caused by Streptococcus bovis, also for the presence of 18,622/mm , with 90% neutrophils, hemoglobin was 6.9 g/dl, and platelet occult colon cancer [1]. However, we should think about the count was 333,000/µl. On the other hand, biochemistry results as well as possibility of the association between the infection with other renal and hepatic function tests showed normal values. The C-reactive streptococcal species and colon cancers as well. Consequently, protein level was 8.77 mg/dl. Transthoracic echocardiography results revealed a 2.5 × 3.0 cm prolifera- we here describe the case of a patient with bacterial endo- tion adhering to the noncoronary cusp of the patient’s aortic valve. More- carditis induced by Streptococcus viridans infection and ade- over, there was also a significant aortic regurgitation, but no abnormality nocarcinoma of the sigmoid colon. of the left ventricular function with an ejection fraction of 70%. There- © 2007 S. Karger GmbH, Freiburg Dr. Ta-Chin Lin Department of Surgery, Tri-Service General Hospital Fax +49 761 4 52 07 14 Accessible online at: No 325, Sec 2, Cheng-Gung Road, Nei-Hu, Taipei, Taiwan 114 E-mail [email protected] www.karger.com/cga Tel. +886 2 8792-3311, Fax -7172 www.karger.com E-mail [email protected] fore, infective endocarditis was diagnosed. Because of the rather quick primary colon cancer or as a result of necrotizing colitis in pa- deterioration of the patient’s clinical condition, he underwent emergency tients with leukemia or with cyclic neutropenia, have a suit- operation with aortic valve replacement. During surgery, we found a large able port of entry for microorganisms [6]. vegetation of around 2.5 cm in diameter over the ventricular aspect of the Another bacterial species, S. bovis, which is a member of the noncoronary cusp of the aortic valve. Fortunately, the aortic valve seemed gastrointestinal tract flora of humans, became diagnostically not to be destructed severely. It was then substituted by a 21-mm mechan- ical valve. important. It has been shown that bacteremia and endocardi- As a colorectal lesion was suspected to be associated with the patient’s in- tis due to these bacteria are often associated with colorectal fection because of the presence of occult blood in the stool, colonoscopy neoplastic disease. Almost 25–80% of patients who presented was carried out on the 1st postoperative day, showing an annular tumor a S. bovis bacteremia had also a colorectal tumor. In 2004, with a diameter of approximately 6.0 cm at about 15 cm above the anal Biarc et al. [7] demonstrated that S. bovis or S. bovis wall-ex- verge. A biopsy was performed, and the pathological report revealed a moderately differentiated adenocarcinoma. Culturing of the blood sample tracted antigens were able to promote carcinogenesis. The hy- revealed colonies of S. viridans. pothesis that colonic bacteria can contribute to cancer devel- The patient underwent exploratory laparotomy with low anterior resec- opment, particularly in chronic infection/inflammation dis- tion of rectosigmoid colon 2 weeks later. Pelvic wall carcinomatosis could eases where bacterial components may interfere with cell be approved upon gross inspection, and lymph node metastases were function, was also supported by these data. [7]. found. The patient was treated with the antibiotic oxacillin administered intravenously for 1.5 months. Additionally, the patient received chemo- S. viridans bacteria, a heterogeneous group of alpha-hemolyt- therapy and radiotherapy after laparotomy. ic bacteria, are commensals of the oropharynx and the gas- The patient has been followed-up for 1 year. During this time no recur- trointestinal tract. Several species of S. viridans, including rences occurred. Streptococcus salivarius, Streptococcus mitis, Streptococcus mutans, and Streptococcus sanguis, are better known for its as- sociation with bacterial endocarditis. As for the relation to Discussion colorectal cancer, however, there are only scant anecdotal re- ports. An association between S. salivarius and colorectal can- The association between streptococcal bacteremia and gas- cer in a patient who presented with meningitis and endocardi- trointestinal disease, especially colon cancer, is well described. tis was proposed by Legier et al. [8]. An adenocarcinoma was After the patient’s blood culture revealed S. viridans infection, found in a patient with S. sanguis bacteremia [9]. In another colonoscopy was done to test for potential colorectal lesions case report [10] a patient was described who presented with S. associated with the bacterial infection. With 450,000 new cases sanguis bacteremia and was subsequently found to suffer from each year, colon cancer is the fourth most common cancer en- an adenocarcinoma of the sigmoid colon [10]. Recently, Afek tity worldwide. Each year, there are 450,000 new cases taking et al. [11] reported the case of 62-year-old white woman with place. In the USA, 105,500 new cases (49,000 male and 56,500 S. salivarius sepsis as a manifestation of adenocarcinoma of female) were diagnosed in 2003 [2]. 90% of cases were older the cecum. than 50 years. What kind of mechanism would lead to the cancer in bac- In 1995, Beebe and Koneman [3] reviewed the evidence in teremic patients? In 1995, a retrospective clinical survey in- favor of the idea that a certain bacteremia, e.g. those associat- vestigated 39 patients over a 30-month period who presented ed with Campylobacter, Listeria, and Salmonella spp., indi- with S. viridans infection associated with solid tumors of ep- cates the presence of an underlying occult or undiagnosed ithelial origin, including bronchial, pancreatic, vulvar and neoplasm. As for the colorectal region, McCoy and Mason [4] colon cancers [12]. Given the low virulence of this group of in 1951 first published a case of enterococcal endocarditis as- bacteria, impaired host immunity may be required or is even sociated with a carcinoma of the cecum. Then in 1971, Hill et essential for S. viridans sepsis to develop. As demonstrated by al. [5] showed that the intestinal microflora is involved in the Takada et al. [13], supernatant concentrates of representative pathogenesis of colon cancer. After that, a connection be- strains of S. viridans (two S. mitis and two S. oralis), when in- tween bacterial infection and colonic neoplasms has been con- jected intravenously, induced serum TNF-α, IL-6, and INF-γ. firmed by several other case reports, reviews of case series, The authors found that the extracellular proteins of S. viridans and one case-control study. For example, Kornbluth et al. [6] which are capable to induce various cytokines – like other bio- demonstrated in 1989 that Clostridium septicum bacteremia logical response modifiers of bacterial origin – may have both and myonecrosis are associated with a high incidence of occult beneficial and harmful effects on the host. Just like S. bovis, S. colon cancer; of the 162 cases with C. septicum infection, 81% viridans is part of the normal flora in of the human gastroin- also had a malignant disease, with 34% having colon carcino- testinal system. Normally, cytokines may serve as useful im- ma and 40% having hematological diseases. At the time of munomodulators. However, these cytokines also might trigger their infection with C. septicum, these malignancies were un- pathological processes that culminate in the manifestation of revealed in 37% of patients. The simultaneous occurrence of clinical signs in some diseases, or even might promote carcino- C. septicum infection and malignant disease may be due to the genesis in immunocompromised hosts [13]. fact that patients with colonic mucosal disease, whether from Except for the cytokine hypothesis, there is another theory, Chir Gastroenterol 2007;23:202–204 Colonic Carcinoma Appearing as 203 Streptococcus viridans-Related Endocarditis advocated by Deitch and Berg [14] in 1987, that translocation the normal gut flora were found, also resulting in an invasion of bacteria from the gut to the blood stream by several mecha- of the muscularis mucosae. In other reports [15, 16], infection nisms might be responsible for the association between S. viri- was associated various organisms and noninvasive lesions such dans sepsis and colon cancer. Bacterial translocation from the as villous adenoma. gastrointestinal tract normally does not happen in the healthy host owing to the presence of an indigenous gastrointestinal microflora preventing bacterial overgrowth, an intact intesti- Conclusion nal epithelial barrier, and normal host immune defenses. However, a thermal injury, as well as other stressors, can result S. viridans infection does not seem to be a result of a single in the disruption or impairment of any of these protective special defect in either humoral or cell-medicated immunity. It mechanisms and thus to bacterial translocation, potentially could be found more frequently in patients having an endo- leading to lethal systemic infections with bacteria colonizing carditis. S. viridans infection is similar to that with S. bovis. the gut [14]. Meanwhile, it is well established that S. bovis bacteremia is as- In summary, the above mentioned studies suggest that Strepto- sociated with gastrointestinal disease, particularly colorectal coccus spp. are able to impair the human intestinal environ- neoplasia. The same is possibly true for S. viridans bacteremia. ment if the patient’s immune system is compromised by one Patients in whom an infection with S. viridans was diagnosed or more metabolic, physiologic, or immunologic factors so far should therefore be examined for the manifestation of malig- not definitely known. In our study, impaired host defenses, nant neoplasms of the colon as soon as possible after acute physical damage to the intestinal mucosa, and alternation of therapy. References 1Gold JS, Bayar S, Salem RR: Association of Strep- 6Kornbluth AA, Danzig JB, Bernstein LH: Clostrid- 12 Sriskandan S, Soto A, Evans TJ, et al: Viridans tococcus bovis bacteremia with colonic neoplasia ium septicum infection and associated malignancy. streptococcal bacteraemia: a clinical survey. QJM and extracolonic malignancy. Arch Surg 2004;139: Report of 2 cases and review of the literature. Med- 1995;88(6):415–20. 760–5. icine (Baltimore). 1989;68(1):30–7. 13 H Takada, Y Kawabata, M Tamura, et al: Cytokine 2Niederhuber JE, Cole CE, Grochow L, et al: Colon 7 Biarc J, Nguyen IS, Pini A, et al: Carcinogenic induction by extracellular products of oral viridans cancer; in Abeloff MD et al (eds): Clinical Oncolo- properties of proteins with pro-inflammatory activ- group streptococci. Infect Immun 1993;61(12): gy, 3rd ed. Philadelphia, Elsevier Churchill Living- ity from Streptococcus infantarius (formerly S. 5252–60. stone, 2004, chapter 80, p 1877. bovis). Carcinogenesis 2004;25(8):1477–84. 14 Deitch EA, Berg R: Bacterial translocation from 3Beebe JL, Koneman EW: Recovery of uncommon 8 Legier JF: Streptococcus salivarius meningitis and the gut: a mechanism of infection. J Burn Care Re- bacteria from blood: association with neoplastic colonic carcinoma. South Med J 1991;84(8):1058–9. habil 1987;8:475–82. disease. Clin Microbiol Rev. 1995;8(3):336–56. 9Fass R, Alim A, Kaunitz JD: Adenocarcinoma of 15 Ben-Haim A, Nechmad M, Edoute Y, et al: Colonic 4McCoy WC, Mason JM 3rd: Enterococcal endo- the colon presenting as Streptococcus sanguis bac- villous adenoma, polyp and leiomyoma presenting carditis associated with carcinoma of the sigmoid; teremia. Am J Gastroenterol. 1995;90(8):1343–5. with Streptococcus bovis endocarditis. Am Heart J report of a case. J Med Assoc State Ala 1951;21 10 Siegert CE, Overbosch D: Carcinoma of the colon 1988;115(1 pt 1):192–5. (6):162–6. presenting as Streptococcus sanguis bacteremia. 16 Harley WE, Gibbs JC, Horton JM: Streptococcus 5Hill MJ, Drasar BS, Hawksworth G, et al: Bacteria Am J Gastroenterol. 1995;90(9):1528–9. bovis meningitis associated with a colonic villous and aetiology of cancer of large bowel. Lancet. 11 Afek S, Sperber AD, Almog Y: Carcinoma of the adenoma (letter). Clin Infect Dis 1992;14:979–80. 1971;i(7690):95–100. colon presenting as Streptococcus salivarius sepsis. J Clin Gastroenterol. 2004;38(1):86–7. Chir Gastroenterol 2007;23:202–204 204 Lin/Lin/Huang http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Visceral Medicine Karger

Colonic Carcinoma Appearing as Streptococcus viridans- Related Endocarditis: A Case Report

Lin, Ta-Chin; Lin, Yi-Chieh; Huang, Chi-Wang
Visceral Medicine , Volume 23 (2): 3 – Jun 1, 2007
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Karger
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© 2007 S. Karger AG, Basel
ISSN
2297-4725
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2297-475X
DOI
10.1159/000097930
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Abstract

Case Report · Fallbericht Interdisziplinär Chir Gastroenterol 2007;23:202–204 Online publiziert: 6. Juni 2007 DOI: 10.1159/000097930 Colonic Carcinoma Appearing as Streptococcus viridans- Related Endocarditis: A Case Report Ta-Chin Lin Yi-Chieh Lin Chi-Wang Huang Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China Key Words Schlüsselwörter Streptococcus viridans ⋅ Infective endocarditis ⋅ Streptococcus viridans ⋅ Infektiöse Endokarditis ⋅ Colonic carcinoma Kolonkarzinom Summary Zusammenfassung Although the relationship between streptococcal bac- Obwohl die Beziehung zwischen einer Streptokokkenbak- teremia and colorectal malignancy is rarely reported terämie und einer kolorektalen malignen Erkrankung nur many doctors are still aware of the connection between spärlich dokumentiert ist, sind sich noch viele Ärzte der Streptococcus bovis infection and this malignancy. On Verbindung zwischen einer Infektion mit Streptococcus the other hand, there may be rare awareness of the asso- bovis und dieser Malignität bewusst. Andererseits gibt ciation between infection with other streptococcal es nur ein geringes Bewusstsein für die Beziehung zwi- species and colorectal carcinoma. We herein presented a schen einer Infektion mit anderen Streptokokkenspezies case of adenocarcinoma of the sigmoid colon presenting und kolorektalen Karzinomen. Wir präsentieren hier with Streptococcus viridans-related infective endocardi- einen Fall mit einem Adenokarzinom des sigmoiden Ko- tis. lons und gleichzeitiger durch Streptococcus viridans aus- gelöster infektiöser Endokarditis. Introduction Case Report A 62-year-old male who had progressive dyspnea and a chilling fever that There has been a great deal of documentations within the lit- had persisted for 1 week was sent to our emergency room. The patient erature about the association between streptococcal bac- also showed an advanced loss of body weight and poor appetite for nearly teremia and gastrointestinal disease, especially colonic neo- 30 days. The patient denied any systemic disease, except for hypertension plasms. Even though the specific relationship remains un- with regular medical control. On physical examinations, oral temperature known, many experts still believe that, whenever possible, was 38.7 °C, pulse rate 94/min, and respiratory rate 28/min. A low pitch diastolic murmur over the left sternal border was also noted. There were clinicians have to investigate patients with infective endo- no signs of hepatomegaly. The white blood cell count amounted to carditis caused by Streptococcus bovis, also for the presence of 18,622/mm , with 90% neutrophils, hemoglobin was 6.9 g/dl, and platelet occult colon cancer [1]. However, we should think about the count was 333,000/µl. On the other hand, biochemistry results as well as possibility of the association between the infection with other renal and hepatic function tests showed normal values. The C-reactive streptococcal species and colon cancers as well. Consequently, protein level was 8.77 mg/dl. Transthoracic echocardiography results revealed a 2.5 × 3.0 cm prolifera- we here describe the case of a patient with bacterial endo- tion adhering to the noncoronary cusp of the patient’s aortic valve. More- carditis induced by Streptococcus viridans infection and ade- over, there was also a significant aortic regurgitation, but no abnormality nocarcinoma of the sigmoid colon. of the left ventricular function with an ejection fraction of 70%. There- © 2007 S. Karger GmbH, Freiburg Dr. Ta-Chin Lin Department of Surgery, Tri-Service General Hospital Fax +49 761 4 52 07 14 Accessible online at: No 325, Sec 2, Cheng-Gung Road, Nei-Hu, Taipei, Taiwan 114 E-mail [email protected] www.karger.com/cga Tel. +886 2 8792-3311, Fax -7172 www.karger.com E-mail [email protected] fore, infective endocarditis was diagnosed. Because of the rather quick primary colon cancer or as a result of necrotizing colitis in pa- deterioration of the patient’s clinical condition, he underwent emergency tients with leukemia or with cyclic neutropenia, have a suit- operation with aortic valve replacement. During surgery, we found a large able port of entry for microorganisms [6]. vegetation of around 2.5 cm in diameter over the ventricular aspect of the Another bacterial species, S. bovis, which is a member of the noncoronary cusp of the aortic valve. Fortunately, the aortic valve seemed gastrointestinal tract flora of humans, became diagnostically not to be destructed severely. It was then substituted by a 21-mm mechan- ical valve. important. It has been shown that bacteremia and endocardi- As a colorectal lesion was suspected to be associated with the patient’s in- tis due to these bacteria are often associated with colorectal fection because of the presence of occult blood in the stool, colonoscopy neoplastic disease. Almost 25–80% of patients who presented was carried out on the 1st postoperative day, showing an annular tumor a S. bovis bacteremia had also a colorectal tumor. In 2004, with a diameter of approximately 6.0 cm at about 15 cm above the anal Biarc et al. [7] demonstrated that S. bovis or S. bovis wall-ex- verge. A biopsy was performed, and the pathological report revealed a moderately differentiated adenocarcinoma. Culturing of the blood sample tracted antigens were able to promote carcinogenesis. The hy- revealed colonies of S. viridans. pothesis that colonic bacteria can contribute to cancer devel- The patient underwent exploratory laparotomy with low anterior resec- opment, particularly in chronic infection/inflammation dis- tion of rectosigmoid colon 2 weeks later. Pelvic wall carcinomatosis could eases where bacterial components may interfere with cell be approved upon gross inspection, and lymph node metastases were function, was also supported by these data. [7]. found. The patient was treated with the antibiotic oxacillin administered intravenously for 1.5 months. Additionally, the patient received chemo- S. viridans bacteria, a heterogeneous group of alpha-hemolyt- therapy and radiotherapy after laparotomy. ic bacteria, are commensals of the oropharynx and the gas- The patient has been followed-up for 1 year. During this time no recur- trointestinal tract. Several species of S. viridans, including rences occurred. Streptococcus salivarius, Streptococcus mitis, Streptococcus mutans, and Streptococcus sanguis, are better known for its as- sociation with bacterial endocarditis. As for the relation to Discussion colorectal cancer, however, there are only scant anecdotal re- ports. An association between S. salivarius and colorectal can- The association between streptococcal bacteremia and gas- cer in a patient who presented with meningitis and endocardi- trointestinal disease, especially colon cancer, is well described. tis was proposed by Legier et al. [8]. An adenocarcinoma was After the patient’s blood culture revealed S. viridans infection, found in a patient with S. sanguis bacteremia [9]. In another colonoscopy was done to test for potential colorectal lesions case report [10] a patient was described who presented with S. associated with the bacterial infection. With 450,000 new cases sanguis bacteremia and was subsequently found to suffer from each year, colon cancer is the fourth most common cancer en- an adenocarcinoma of the sigmoid colon [10]. Recently, Afek tity worldwide. Each year, there are 450,000 new cases taking et al. [11] reported the case of 62-year-old white woman with place. In the USA, 105,500 new cases (49,000 male and 56,500 S. salivarius sepsis as a manifestation of adenocarcinoma of female) were diagnosed in 2003 [2]. 90% of cases were older the cecum. than 50 years. What kind of mechanism would lead to the cancer in bac- In 1995, Beebe and Koneman [3] reviewed the evidence in teremic patients? In 1995, a retrospective clinical survey in- favor of the idea that a certain bacteremia, e.g. those associat- vestigated 39 patients over a 30-month period who presented ed with Campylobacter, Listeria, and Salmonella spp., indi- with S. viridans infection associated with solid tumors of ep- cates the presence of an underlying occult or undiagnosed ithelial origin, including bronchial, pancreatic, vulvar and neoplasm. As for the colorectal region, McCoy and Mason [4] colon cancers [12]. Given the low virulence of this group of in 1951 first published a case of enterococcal endocarditis as- bacteria, impaired host immunity may be required or is even sociated with a carcinoma of the cecum. Then in 1971, Hill et essential for S. viridans sepsis to develop. As demonstrated by al. [5] showed that the intestinal microflora is involved in the Takada et al. [13], supernatant concentrates of representative pathogenesis of colon cancer. After that, a connection be- strains of S. viridans (two S. mitis and two S. oralis), when in- tween bacterial infection and colonic neoplasms has been con- jected intravenously, induced serum TNF-α, IL-6, and INF-γ. firmed by several other case reports, reviews of case series, The authors found that the extracellular proteins of S. viridans and one case-control study. For example, Kornbluth et al. [6] which are capable to induce various cytokines – like other bio- demonstrated in 1989 that Clostridium septicum bacteremia logical response modifiers of bacterial origin – may have both and myonecrosis are associated with a high incidence of occult beneficial and harmful effects on the host. Just like S. bovis, S. colon cancer; of the 162 cases with C. septicum infection, 81% viridans is part of the normal flora in of the human gastroin- also had a malignant disease, with 34% having colon carcino- testinal system. Normally, cytokines may serve as useful im- ma and 40% having hematological diseases. At the time of munomodulators. However, these cytokines also might trigger their infection with C. septicum, these malignancies were un- pathological processes that culminate in the manifestation of revealed in 37% of patients. The simultaneous occurrence of clinical signs in some diseases, or even might promote carcino- C. septicum infection and malignant disease may be due to the genesis in immunocompromised hosts [13]. fact that patients with colonic mucosal disease, whether from Except for the cytokine hypothesis, there is another theory, Chir Gastroenterol 2007;23:202–204 Colonic Carcinoma Appearing as 203 Streptococcus viridans-Related Endocarditis advocated by Deitch and Berg [14] in 1987, that translocation the normal gut flora were found, also resulting in an invasion of bacteria from the gut to the blood stream by several mecha- of the muscularis mucosae. In other reports [15, 16], infection nisms might be responsible for the association between S. viri- was associated various organisms and noninvasive lesions such dans sepsis and colon cancer. Bacterial translocation from the as villous adenoma. gastrointestinal tract normally does not happen in the healthy host owing to the presence of an indigenous gastrointestinal microflora preventing bacterial overgrowth, an intact intesti- Conclusion nal epithelial barrier, and normal host immune defenses. However, a thermal injury, as well as other stressors, can result S. viridans infection does not seem to be a result of a single in the disruption or impairment of any of these protective special defect in either humoral or cell-medicated immunity. It mechanisms and thus to bacterial translocation, potentially could be found more frequently in patients having an endo- leading to lethal systemic infections with bacteria colonizing carditis. S. viridans infection is similar to that with S. bovis. the gut [14]. Meanwhile, it is well established that S. bovis bacteremia is as- In summary, the above mentioned studies suggest that Strepto- sociated with gastrointestinal disease, particularly colorectal coccus spp. are able to impair the human intestinal environ- neoplasia. The same is possibly true for S. viridans bacteremia. ment if the patient’s immune system is compromised by one Patients in whom an infection with S. viridans was diagnosed or more metabolic, physiologic, or immunologic factors so far should therefore be examined for the manifestation of malig- not definitely known. In our study, impaired host defenses, nant neoplasms of the colon as soon as possible after acute physical damage to the intestinal mucosa, and alternation of therapy. References 1Gold JS, Bayar S, Salem RR: Association of Strep- 6Kornbluth AA, Danzig JB, Bernstein LH: Clostrid- 12 Sriskandan S, Soto A, Evans TJ, et al: Viridans tococcus bovis bacteremia with colonic neoplasia ium septicum infection and associated malignancy. streptococcal bacteraemia: a clinical survey. QJM and extracolonic malignancy. Arch Surg 2004;139: Report of 2 cases and review of the literature. Med- 1995;88(6):415–20. 760–5. icine (Baltimore). 1989;68(1):30–7. 13 H Takada, Y Kawabata, M Tamura, et al: Cytokine 2Niederhuber JE, Cole CE, Grochow L, et al: Colon 7 Biarc J, Nguyen IS, Pini A, et al: Carcinogenic induction by extracellular products of oral viridans cancer; in Abeloff MD et al (eds): Clinical Oncolo- properties of proteins with pro-inflammatory activ- group streptococci. Infect Immun 1993;61(12): gy, 3rd ed. Philadelphia, Elsevier Churchill Living- ity from Streptococcus infantarius (formerly S. 5252–60. stone, 2004, chapter 80, p 1877. bovis). Carcinogenesis 2004;25(8):1477–84. 14 Deitch EA, Berg R: Bacterial translocation from 3Beebe JL, Koneman EW: Recovery of uncommon 8 Legier JF: Streptococcus salivarius meningitis and the gut: a mechanism of infection. J Burn Care Re- bacteria from blood: association with neoplastic colonic carcinoma. South Med J 1991;84(8):1058–9. habil 1987;8:475–82. disease. Clin Microbiol Rev. 1995;8(3):336–56. 9Fass R, Alim A, Kaunitz JD: Adenocarcinoma of 15 Ben-Haim A, Nechmad M, Edoute Y, et al: Colonic 4McCoy WC, Mason JM 3rd: Enterococcal endo- the colon presenting as Streptococcus sanguis bac- villous adenoma, polyp and leiomyoma presenting carditis associated with carcinoma of the sigmoid; teremia. Am J Gastroenterol. 1995;90(8):1343–5. with Streptococcus bovis endocarditis. Am Heart J report of a case. J Med Assoc State Ala 1951;21 10 Siegert CE, Overbosch D: Carcinoma of the colon 1988;115(1 pt 1):192–5. (6):162–6. presenting as Streptococcus sanguis bacteremia. 16 Harley WE, Gibbs JC, Horton JM: Streptococcus 5Hill MJ, Drasar BS, Hawksworth G, et al: Bacteria Am J Gastroenterol. 1995;90(9):1528–9. bovis meningitis associated with a colonic villous and aetiology of cancer of large bowel. Lancet. 11 Afek S, Sperber AD, Almog Y: Carcinoma of the adenoma (letter). Clin Infect Dis 1992;14:979–80. 1971;i(7690):95–100. colon presenting as Streptococcus salivarius sepsis. J Clin Gastroenterol. 2004;38(1):86–7. Chir Gastroenterol 2007;23:202–204 204 Lin/Lin/Huang

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Visceral Medicine – Karger

Published: Jun 1, 2007

There are no references for this article.