Updated: 1/20/2019

Streptococcus bovis/gallolyticus (Group D Streptococci)

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Snapshot
  • A 45-year-old man presents to the emergency department for generalized malaise and fatigue. His symptoms are associated with fever and chills. He denies any sick contacts or recent travel and cannot identify a possible cause for his symptoms. Medical history is unremarkable. His temperature is 101°F (38.3°C), blood pressure is 140/88 mmHg, pulse is 100/min, and respirations are 18/min. Physical examination is notable for a new heart murmur and splinter hemorrhages. A transthoracic echocardiogram demonstrates mitral valve vegetations and blood cultures grow Streptococcus gallolyticus. Preparations are made for a colonoscopy.
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    <td><strong>Snapshot</strong></td>
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    <li>A</li>
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    <td style="color: #000000; font-family: Arial, Helvetica, sans-serif; font-size: medium;" bgcolor="#F4F4F4"><strong><span style="font-size: medium">Introduction</span></strong></td>
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    <li>Classification
    <ul>
    <li>gram-positive cocci that are an important cause of bacteremia and infective endocarditis in adults</li>
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    </li>
    <li>Reservoir
    <ul>
    <li>gut</li>
    </ul>
    </li>
    <li>Associated condition
    <ul>
    <li>there is a strong associated between group D streptococci (GDS) infection and colonic neoplasms and other gastrointestinal tract lesions (<em>e.g.,</em>&nbsp;liver disease)</li>
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    <td><strong>Presentation</strong></td>
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    <li>Endocarditis
    <ul>
    <li>symptoms
    <ul>
    <li>fever</li>
    <li>chills</li>
    <li>anorexia and weight loss</li>
    </ul>
    </li>
    <li>physical exam
    <ul>
    <li>new heart murmur</li>
    <li>petechiae or splinter hemorrhages</li>
    <li>Janeway lesions</li>
    <li>Osler nodes</li>
    <li>Roth spots</li>
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    </li>
    </ul>
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    <td style="color: #000000; font-family: Arial, Helvetica, sans-serif; font-size: medium;" bgcolor="#F4F4F4"><strong><span style="font-size: medium">Studies</span></strong></td>
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    <li style="font-family: Arial, Helvetica, sans-serif;">A</li>
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Introduction
  • Classification
    • gram-positive cocci that are an important cause of bacteremia and infective endocarditis in adults
      • grows in the presence of 40% bile
      • cannot grow in 6.5% NaCl broth
      • pyrrolidonyl arylamidase negative
        • distinguishes it from enterococci
  • Reservoir
    • gut
  • Associated condition
    • a strong association between group D streptococci (GDS) infection and colonic neoplasms and other gastrointestinal tract lesions (e.g., liver disease)
Presentation
  • Endocarditis
    • symptoms
      • fever
      • chills
      • anorexia and weight loss
    • physical exam
      • new heart murmur
      • petechiae or splinter hemorrhages
      • Janeway lesions 
      • Osler nodes 
      • Roth spots 
Treatment
  • Medical
    • penicillin or ceftriaxone
      • indication
        • treatment of choice for systemic GDS infection
 

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