• Alzheimer’s disease
• Mendelian randomization
• alcohol consumption
• liver hepatocellular carcinoma
• platelet count

• Humans
• Mendelian Randomization Analysis
• Liver Neoplasms/genetics
• Liver Neoplasms/epidemiology
• Liver Neoplasms/blood
• Liver Neoplasms/etiology
• Carcinoma, Hepatocellular/blood
• Carcinoma, Hepatocellular/genetics
• Carcinoma, Hepatocellular/epidemiology
• Carcinoma, Hepatocellular/etiology
• Alcohol Drinking/adverse effects
• Platelet Count
• Polymorphism, Single Nucleotide
• Genome-Wide Association Study
• Risk Factors

• Streptococcus bovis/Streptococcus equinus complex
• colorectal carcinoma
• fecal carriage
• invasive infection
• serologic evidence

• Biotipos
• Biotypes
• Colorectal cancer
• Cáncer colorrectal
• Endocarditis infecciosa
• Especies
• Infective endocarditis
• Species
• Streptococcus bovis

• IgG-Fc-receptor
• Streptococcus bovis/Streptococcus equinus complex
• bacteria-platelet interactions
• infective endocarditis
• platelet activation
• subspecies

• Streptococcus bovis
• Platelet Activation
• Platelet Aggregation
• Blood Platelets
• Immunoglobulin G

• Swedish Governmental Fund for Clinical research
• Foundation of Osterlund
• Foundation of Skane University Hospital

Streptococcus gallolyticus subspecies gallolyticus is a known pathogen that causes infective endocarditis, and most cases involve the left heart valves. We present the first reported case of prosthetic tricuspid valve endocarditis caused by this microorganism. Relevant literature is reviewed.

A 67-year-old Jewish female with a history of a prosthetic tricuspid valve replacement was admitted to the emergency department because of nonspecific complaints including effort dyspnea, fatigue, and a single episode of transient visual loss and fever. No significant physical findings were observed. Laboratory examinations revealed microangiopathic hemolytic anemia and a few nonspecific abnormalities. Transesophageal echocardiogram demonstrated a vegetation attached to the prosthetic tricuspid valve. The involved tricuspid valve was replaced by a new tissue valve, and Streptococcus gallolyticus subspecies gallolyticus was grown from its culture. Prolonged antibiotic treatment was initiated.

Based on this report and the reviewed literature, Streptococcus gallolyticus should be considered as a rare but potential causative microorganism in prosthetic right-sided valves endocarditis. The patient’s atypical presentation emphasizes the need for a high index of suspicion for the diagnosis of infective endocarditis.

• Case report
• Infective endocarditis
• Prosthetic tricuspid valve
• Streptococcus bovis
• Streptococcus gallolyticus

• Cirrhosis
• endocarditis
• enterococcus
• infective endocarditis
• staphylococcus
• streptococcus

• Anticoagulation
• Colorectal neoplasia
• Endocarditis
• Enterococci
• S. gallolyticus

• Colonoscopy
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/epidemiology
• Endocarditis/epidemiology
• Endocarditis, Bacterial/complications
• Endocarditis, Bacterial/epidemiology
• Humans
• Retrospective Studies

• Colorectal cancer
• MTT assay
• cell proliferation
• human microbiome
• secretomes

Streptococcus gallolyticus, formerly known as one of the Streptococcus bovis group, is frequently associated with endocarditis. Current guidelines recommended diagnostic work-up for endocarditis among patients with S. gallolyticus bacteremia. However, S. gallolyticus subsp. pasteurianus, was found to be associated with neonatal sepsis and liver diseases and is less commonly associated with endocarditis compared with S. gallolyticus subsp. gallolyticus. Our study aimed to identify the risk factors for S. gallolyticus subsp. pasteurianus endocarditis to help select the patients for echocardiography.

In this retrospective cohort study, medical records from all adult patients with S. gallolyticus subsp. pasteurianus isolated from blood cultures at Phramongkutklao Hospital from 2009 to 2015 were reviewed. Patients who had mixed bacteremia or missing records were excluded from the study.

During the study period, S. gallolyticus subsp. pasteurianus was isolated among 106 individuals. Mean age was 66.9±15.6 years. Most patients (61.3%) were male, with cirrhosis as the most common underlying diseases (46.2%), followed by malignancy and chronic kidney disease. Most common manifestations included primary bacteremia (44.3%), followed by spontaneous bacterial peritonitis (23.6%). Infective endocarditis was found among 9 patients. No patients with cirrhosis or single blood specimen of bacteremia had endocarditis (RR 0; p-value 0.003, and RR 1.35; p-value 0.079). The common complications associated with endocarditis were acute respiratory failure (RR 4.32; p-value 0.05), whereas acute kidney injury was a protective factor (RR 0; p-value 0.01). Among 76 patients who had records of 2-year follow-up, no new diagnosis of endocarditis or malignancy was observed.

Among patients with S. gallolyticus subsp. pasteurianus bacteremia, echocardiography might not be needed among patients with cirrhosis and without sustained bacteremia.

• Streptococcus gallolyticus subspecies pasteurianus
• bacteremia
• cirrhosis
• endocarditis

Streptococcus gallolyticus is an important cause of bacteremia and infective endocarditis in adults. Studies from other parts of the world have shown a strong association between S. gallolyticus bacteremia and colonic neoplasia. The profile of S. gallolyticus bacteremia is understudied in Indian population.

We retrospectively analyzed the data of 16 patients with S. gallolyticus bacteremia obtained from microbiology registry. BacT/ALERT positive samples were inoculated into blood agar, chocolate agar, and MacConkey agar. Organisms were identified by the VITEK 2 microbial identification system, and susceptibility was done by the microbroth dilution method as per Clinical and Laboratory Standards Institute (CLSI) M100 guidelines. Clinical details were obtained from electronic medical records.

Majority of our isolates were S. gallolyticus subspecies pasteurianus. Total 16 patients had S. gallolyticus isolated from blood over a 1 year period. The median age was 58 years (IQR: 46.5–66). Eleven were males; type II diabetes mellitus and chronic liver disease were the common comorbidities observed in our patients. None of our patients had underlying infective endocarditis or colonic malignancy. Penicillin sensitivity was 81.2% while all the isolates were susceptible to ceftriaxone. Ampicillin resistance was seen in only one of the isolates. In-hospital mortality was 12.5%.

Streptococcus gallolyticus subsp. pasteurianus is the commonest subspecies of S. gallolyticus isolated in our population. Unlike previous studies, colonic neoplasia and infective endocarditis were rare in our patients. Type II diabetes mellitus and chronic liver disease were the commonest risk factors identified in patients with S. gallolyticus bacteremia.

Niyas VKM, Arjun R, Sasidharan A, Palakunnath GA. Streptococcus gallolyticus Bacteremia: An Experience from a Tertiary Center in South India. Indian J Crit Care Med 2020;24(10):943–945.

• Bacteremia
• Endocarditis
• Streptococcus bovis
• Streptococcus gallolyticus

• cirrhosis
• gastroenterology
• infectious diseases
• malignant disease and immunosuppression

• HCC
• ascitic fluid

Patients with liver cirrhosis are susceptible to infections due to various mechanisms, including abnormalities of humoral and cell-mediated immunity and occurrence of bacterial translocation from the intestine. Bacterial infections are common and represent a reason for progression to liver failure and increased mortality. Fungal infections, mainly caused by Candida spp., are often associated to delayed diagnosis and high mortality rates. High level of suspicion along with prompt diagnosis and treatment of infections are warranted. Bacterial and fungal infections negatively affect the outcomes of liver transplant candidates and recipients, causing disease progression among patients on the waiting list and increasing mortality, especially in the early post-transplant period. Abdominal, biliary tract, and bloodstream infections caused by Gram-negative bacteria [e.g., Enterobacteriaceae and Pseudomonas aeruginosa (P. aeruginosa)] and Staphylococcus spp. are commonly encountered in liver transplant recipients. Due to frequent exposure to broad-spectrum antibiotics, invasive procedures, and prolonged hospitalizations, these patients are especially at risk of developing infections caused by multidrug resistant bacteria. The increase in antimicrobial resistance hampers the choice of an adequate empiric therapy and warrants the knowledge of the local microbial epidemiology and the implementation of infection control measures. The main characteristics and the management of bacterial and fungal infections in patients with liver cirrhosis and liver transplant recipients are presented.

• Liver cirrhosis
• Liver transplant recipients
• Bacterial infections
• Fungal infections
• Multidrug resistant organisms
• Management

• Anti-Bacterial Agents/adverse effects
• Anti-Bacterial Agents/therapeutic use
• Antifungal Agents/adverse effects
• Antifungal Agents/therapeutic use
• Bacterial Infections/drug therapy
• Bacterial Infections/immunology
• Bacterial Infections/microbiology
• Bacterial Infections/mortality
• Candida/isolation & purification
• Candida/pathogenicity
• Disease Progression
• Drug Resistance, Multiple, Bacterial/drug effects
• End Stage Liver Disease/complications
• End Stage Liver Disease/immunology
• End Stage Liver Disease/mortality
• End Stage Liver Disease/therapy
• Gram-Negative Bacteria/isolation & purification
• Gram-Negative Bacteria/pathogenicity
• Humans
• Infection Control/methods
• Liver Transplantation
• Microbial Sensitivity Tests
• Mycoses/drug therapy
• Mycoses/immunology
• Mycoses/microbiology
• Mycoses/mortality
• Staphylococcus/isolation & purification
• Staphylococcus/pathogenicity
• Waiting Lists/mortality

The Streptococcus bovis/Streptococcus equinus complex (SBSEC) comprises several species inhabiting the animal and human gastrointestinal tract (GIT). They match the pathobiont description, are potential zoonotic agents and technological organisms in fermented foods. SBSEC members are associated with multiple diseases in humans and animals including ruminal acidosis, infective endocarditis (IE) and colorectal cancer (CRC). Therefore, this review aims to re-evaluate adhesion and colonization abilities of SBSEC members of animal, human and food origin paired with genomic and functional host-microbe interaction data on their road from colonization to infection. SBSEC seem to be a marginal population during GIT symbiosis that can proliferate as opportunistic pathogens. Risk factors for human colonization are considered living in rural areas and animal-feces contact. Niche adaptation plays a pivotal role where Streptococcus gallolyticus subsp. gallolyticus (SGG) retained the ability to proliferate in various environments. Other SBSEC members have undergone genome reduction and niche-specific gene gain to yield important commensal, pathobiont and technological species. Selective colonization of CRC tissue is suggested for SGG, possibly related to increased adhesion to cancerous cell types featuring enhanced collagen IV accessibility. SGG can colonize, proliferate and may shape the tumor microenvironment to their benefit by tumor promotion upon initial neoplasia development. Bacteria cell surface structures including lipotheichoic acids, capsular polysaccharides and pilus loci (pil1, pil2, and pil3) govern adhesion. Only human blood-derived SGG contain complete pilus loci and other disease-associated surface proteins. Rumen or feces-derived SGG and other SBSEC members lack or harbor mutated pili. Pili also contribute to binding to fibrinogen upon invasion and translocation of cells from the GIT into the blood system, subsequent immune evasion, human contact system activation and collagen-I-binding on damaged heart valves. Only SGG carrying complete pilus loci seem to have highest IE potential in humans with significant links between SGG bacteremia/IE and underlying diseases including CRC. Other SBSEC host-microbe combinations might rely on currently unknown mechanisms. Comparative genome data of blood, commensal and food isolates are limited but required to elucidate the role of pili and other virulence factors, understand pathogenicity mechanisms, host specificity and estimate health risks for animals, humans and food alike.

• Streptococcus gallolyticus
• Streptococcus infantarius
• Streptococcus lutetiensis
• colorectal cancer
• infective endocarditis
• microbiota
• pilus
• virulence

• Bacteraemia
• Clostridium septicum
• Colorectal neoplasia
• Streptococcus bovis
• Streptococcus gallolyticus

• Aged
• Aged, 80 and over
• Bacteremia/complications
• Clostridium septicum/isolation & purification
• Colonoscopy
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/microbiology
• Female
• Humans
• Male
• Middle Aged
• Neutropenia/complications
• Occult Blood
• Spain
• Streptococcus gallolyticus subspecies gallolyticus/isolation & purification

• Cattle
• Streptococcus bovis
• group D streptococcus
• injection
• septicemia

• Adult
• Aged
• Cohort Studies
• Colorectal Neoplasms/epidemiology
• Colorectal Neoplasms/etiology
• Endocarditis/complications
• Female
• Humans
• Male
• Middle Aged
• Neoplasms/epidemiology
• Neoplasms/etiology
• Regression Analysis
• Retrospective Studies
• Risk Factors
• Taiwan

• Arthritis, Infectious
• Colorectal neoplasms
• Osteomyelitis
• Spondylitis
• Streptococcus bovis

• Adenoma/complications
• Adenoma/diagnosis
• Adult
• Aged
• Aged, 80 and over
• Anti-Bacterial Agents/therapeutic use
• Arthritis, Infectious/complications
• Arthritis, Infectious/microbiology
• Arthritis, Infectious/therapy
• Carcinoma/complications
• Carcinoma/diagnosis
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/diagnosis
• Discitis/complications
• Discitis/microbiology
• Discitis/therapy
• Drainage
• Endocarditis, Bacterial/complications
• Female
• Humans
• Male
• Middle Aged
• Osteomyelitis/complications
• Osteomyelitis/microbiology
• Osteomyelitis/therapy
• Streptococcal Infections/complications
• Streptococcal Infections/microbiology
• Streptococcal Infections/therapy
• Streptococcus bovis
• Streptococcus gallolyticus subspecies gallolyticus

Since the 1950s, medical communities have been facing with emerging and reemerging infectious diseases, and emerging pathogens are now considered to be a major microbiologic public health threat. In this review, we focus on bacterial emerging diseases and explore factors involved in their emergence as well as future challenges. We identified 26 major emerging and reemerging infectious diseases of bacterial origin; most of them originated either from an animal and are considered to be zoonoses or from water sources. Major contributing factors in the emergence of these bacterial infections are: (1) development of new diagnostic tools, such as improvements in culture methods, development of molecular techniques and implementation of mass spectrometry in microbiology; (2) increase in human exposure to bacterial pathogens as a result of sociodemographic and environmental changes; and (3) emergence of more virulent bacterial strains and opportunistic infections, especially affecting immunocompromised populations. A precise definition of their implications in human disease is challenging and requires the comprehensive integration of microbiological, clinical and epidemiologic aspects as well as the use of experimental models. It is now urgent to allocate financial resources to gather international data to provide a better understanding of the clinical relevance of these waterborne and zoonotic emerging diseases.

• Disease causation
• Koch postulates
• emerging bacteria
• emerging infectious diseases
• intracellular bacteria
• zoonoses

To assess the prevalence of gastrointestinal neoplasia in patients with Streptococcus bovis infectious endocarditis we performed a retrospective cohort analysis of all episodes of S. bovis infectious endocarditis treated at our institution between January 2000 through December 2014. Twenty-five patients were identified for this purpose. 12/25 patients received colonoscopy and 1/25 of the patients was assessed with CT colonography. Of the 13 who underwent colonic assessment, 11 were diagnosed with colonic neoplasms at different stages of development. In the absence of any strong contraindication, gastroenteroscopic evaluation in all patients diagnosed with S. bovis infectious endocarditis should be pursued.

• Colonic neoplasia
• Infectious endocarditis
• Streptococcus bovis

• Bacteraemia
• Biotypes
• Colonoscopy
• Colorectal neoplasm
• Endocarditis
• Malignancies
• Mortality
• Streptococcus bovis

Streptococcus bovis is a classical etiology of endocarditis and is associated with colonic lesions. No series of cases from Brazil has been described.

To describe aspects of S. bovis endocarditis.

This is a case series of patients admitted to a cardiac surgery referral center, during the years 2005–2014. Clinical, laboratory, echochardiographic, colonoscopic, treatment, surgical and outcome variables were studied.

Nine patients with S. bovis endocarditis were included; all cases fulfilled the modified Duke criteria. Incidence was 8/220 (4%) in years 2006–2014. There were seven male and two female patients; mean age was 56.7 years, standard deviation 13.4. All patients had native aortic valve involvement. Presentation was subacute in 7/9 (71%). Fever was present in 7/9 (77.7%), embolic lesions to solid organs occurred in three, and perivalvular abscess in two patients. All echocardiograms showed moderate to severe valvular regurgitation and vegetations. Microcytic anemia was seen in 7/7 patients. Colonoscopy showed abnormal findings in 7/9 (77.7%). Surgery was indicated for 6/9 patients due to acute aortic regurgitation and left ventricular failure. All patients were discharged home.

S. bovis most frequently affected the aortic valve of male patients. Colon disease was frequent. Surgery was indicated frequently due to hemodynamic compromise.

• Cardiac surgery
• Colonic lesions
• Infective endocarditis
• Streptococcus bovis group

• Colorectal cancer
• Streptococcus bovis
• colon cancer
• meta-analysis
• rectal cancer
• risk factor

Embolic events are a major cause of morbidity and mortality in patients with infective endocarditis. We analyzed the database of the prospective cohort study SEI in order to identify factors associated with the occurrence of embolic events and to develop a scoring system for the assessment of the risk of embolism.

We retrospectively analyzed 1456 episodes of infective endocarditis from the multicenter study SEI. Predictors of embolism were identified. Risk factors identified at multivariate analysis as predictive of embolism in left-sided endocarditis, were used for the development of a risk score: 1 point was assigned to each risk factor (total risk score range: minimum 0 points; maximum 2 points). Three categories were defined by the score: low (0 points), intermediate (1 point), or high risk (2 points); the probability of embolic events per risk category was calculated for each day on treatment (day 0 through day 30).

There were 499 episodes of infective endocarditis (34%) that were complicated by ≥ 1 embolic event. Most embolic events occurred early in the clinical course (first week of therapy: 15.5 episodes per 1000 patient days; second week: 3.7 episodes per 1000 patient days). In the total cohort, the factors associated with the occurrence of embolism at multivariate analysis were prosthetic valve localization (odds ratio, 1.84), right-sided endocarditis (odds ratio, 3.93), Staphylococcus aureus etiology (odds ratio, 2.23) and vegetation size ≥ 13 mm (odds ratio, 1.86). In left-sided endocarditis, Staphylococcus aureus etiology (odds ratio, 2.1) and vegetation size ≥ 13 mm (odds ratio, 2.1) were independently associated with embolic events; the 30-day cumulative incidence of embolism varied with risk score category (low risk, 12%; intermediate risk, 25%; high risk, 38%; p < 0.001).

Staphylococcus aureus etiology and vegetation size are associated with an increased risk of embolism. In left-sided endocarditis, a simple scoring system, which combines etiology and vegetation size with time on antimicrobials, might contribute to a better assessment of the risk of embolism, and to a more individualized analysis of indications and contraindications for early surgery.

• Bacterial infection
• Cirrhosis
• Fungal infections
• Infections

Streptococcus gallolyticus infections in humans are often associated with bacteremia, infective endocarditis and colon cancers. The disease manifestations are different depending on the subspecies of S. gallolyticus causing the infection. Here, we present the complete genomes of S. gallolyticus ATCC 43143 (biotype I) and S. pasteurianus ATCC 43144 (biotype II.2). The genomic differences between the two biotypes were characterized with comparative genomic analyses. The chromosome of ATCC 43143 and ATCC 43144 are 2,36 and 2,10 Mb in length and encode 2246 and 1869 CDS respectively. The organization and genomic contents of both genomes were most similar to the recently published S. gallolyticus UCN34, where 2073 (92%) and 1607 (86%) of the ATCC 43143 and ATCC 43144 CDS were conserved in UCN34 respectively. There are around 600 CDS conserved in all Streptococcus genomes, indicating the Streptococcus genus has a small core-genome (constitute around 30% of total CDS) and substantial evolutionary plasticity. We identified eight and five regions of genome plasticity in ATCC 43143 and ATCC 43144 respectively. Within these regions, several proteins were recognized to contribute to the fitness and virulence of each of the two subspecies. We have also predicted putative cell-surface associated proteins that could play a role in adherence to host tissues, leading to persistent infections causing sub-acute and chronic diseases in humans. This study showed evidence that the S. gallolyticus still possesses genes making it suitable in a rumen environment, whereas the ability for S. pasteurianus to live in rumen is reduced. The genome heterogeneity and genetic diversity among the two biotypes, especially membrane and lipoproteins, most likely contribute to the differences in the pathogenesis of the two S. gallolyticus biotypes and the type of disease an infected patient eventually develops.

• Adaptation, Physiological/genetics
• Amino Acid Sequence
• Animals
• Bacterial Proteins/genetics
• Base Sequence
• Chromosomes, Bacterial/genetics
• DNA, Bacterial/chemistry
• DNA, Bacterial/genetics
• DNA, Circular/chemistry
• DNA, Circular/genetics
• Genetic Variation
• Genome, Bacterial/genetics
• Genomics/methods
• Humans
• Molecular Sequence Data
• Open Reading Frames/genetics
• Phylogeny
• Sequence Analysis, DNA
• Species Specificity
• Streptococcal Infections/microbiology
• Streptococcus/classification
• Streptococcus/genetics
• Streptococcus/pathogenicity
• Virulence/genetics

• Adenoma/diagnosis
• Adenoma/etiology
• Adenoma/microbiology
• Animals
• Bacteremia/complications
• Bacteremia/microbiology
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/etiology
• Colorectal Neoplasms/microbiology
• Endocarditis/complications
• Endocarditis/microbiology
• Gastrointestinal Tract/microbiology
• Humans
• Inflammation/complications
• Intestinal Mucosa/microbiology
• Precancerous Conditions/etiology
• Precancerous Conditions/microbiology
• Streptococcal Infections/complications
• Streptococcus bovis/classification