Group B streptococcal bacteremia associated with adenocarcinoma of the stomach

Streptococcus Mitis Endocarditis Associated with Early Gastric Carcinoma

We report a case of Streptococcus mitis endocarditis associated with early gastric carcinoma. A 71-year-old man who had been diagnosed with aortic regurgitation (AR) two years previously was referred for valve surgery and evaluation of elevated inflammatory markers. Four months previously, atrophic gastritis, early gastric adenocarcinoma, and colon polyp had been identified in the patient during endoscopy. However, Helicobacter pylori testing was negative. On admission, he had no dental diseases or recent oral procedures. Echocardiography demonstrated severe AR and mobile vegetation on the aortic valve. Magnetic resonance imaging revealed cerebral embolism and spondylodiscitis. Blood cultures grew Streptococcus mitis. At surgery, destruction of the left cusp with vegetation and a perforation of the non-coronary cusp were found; in addition, aortic valve replacement was performed. Although the association between Streptococcus bovis bacteremia and colon neoplasm is well recognized, the association between Streptococcus mitis endocarditis and gastrointestinal carcinoma should also be kept in mind.

Infections associated with solid malignancies

Although solid tumors comprise the vast majority of cancers, the incidence of serious infectious complications in this population is much less than in patients with hematologic malignancies. Most infections involving patients with solid tumors comprise two groups. First, patients acquire infections as a result of the cancer itself, due to either mass effect that interrupts normal function or destruction of the normal barriers to infection. Second, patients acquire infections as a complication of the treatments they receive, such as chemotherapy, radiation, surgery, or medical devices. Advances in the management of cancer have resulted in a gradual stepwise improvement in survival for patients with most types of solid tumors. Much of this improvement has been attributed to advances in cancer screening, diagnosis, and therapeutic modalities. In addition, improvements in the prevention, diagnosis, and treatment of infections have likely contributed to this prolonged survival. This review highlights select articles in the medical literature that shed light on the epidemiology and pathophysiology of infections in patients with solid tumors. In addition, this review focuses upon the diagnosis and treatment of these infections and their recent advances.

Espondilodiscitis y sacroileítis por Streptococcus agalactiae en adultos: caso clínico y revisión de la literatura

INTRODUCTION

Streptococcus agalactiae is a well-known pathogen related with infection in newborns, and in women during pregnancy and the puerperium. In recent years it has been described as a causal agent in invasive disease in immunodepressed adults and those with other severe underlying pathologies.

METHODS

We describe a case of S. agalactiae spondylodiscitis and concomitant bilateral sacroiliitis in an adult with no known underlying diseases. A systematic review of the related literature was performed (MEDLINE and EMBASE, up to December 2003).

RESULTS

The literature search retrieved only 33 cases of spondylodiscitis (predominance in men, 55-70 years old) and 13 cases of sacroiliitis (higher frequency in women, 30-40 years old) due to S. agalactiae. Simultaneous involvement of both locations of the axial skeleton is unusual.

CONCLUSION

Spondylodiscitis and sacroiliitis due to S. agalactiae is uncommon. S. agalactiae is an emerging pathogen in adults outside of the gestational and perinatal period. This micro-organism produces spondylodiscitis in the adult population over 50 years old. In contrast, sacroiliac involvement is described mainly in women in the reproductive age.

Group B streptococcal spondylodiscitis in adults: 2 case reports

Streptococcus agalactiae, or group B streptococcus (GBS), has been traditionally considered an infrequent etiologic agent of disease in adults except for urinary tract infection in pregnant women. Attention has recently been drawn to other adult infections caused by GBS such as skin and soft tissue infections, bacteriemias, pneumonia, meningitis, endocarditis, peritonitis, and bone and joint infections. We present two adult patients with GBS spondylodiscitis and review 30 cases of GBS spinal infection previously reported in the literature. This series clearly illustrates that GBS has recently been recognized as an emerging cause of vertebral infections in adults, particularly in those with chronic underlying diseases, although it can also affect immunocompetent patients without debilitating conditions. Although uncommon, GBS should be considered in the differential diagnosis of infective spondylodiscitis in nonpregnant adults, whatever the patient's immunological status.

Vertebral osteomyelitis caused by Streptococcus agalactiae

Streptococcus agalactiae is a rare cause of vertebral osteomyelitis. We present four cases of spondylitis caused by this micro-organism and a review of 20 cases previously described in the literature. Only seven patients (29%) were under 50 years of age. Diabetes mellitus and neoplasms were the most frequent underlying conditions, although 37.5% of the patients did not have any predisposition. Neck or back pain was the most common symptom. Diagnosis depended mainly on magnetic resonance imaging. Blood cultures were positive in 50% of the patients. The duration of antibiotic therapy was 6 weeks for most patients. The outcome was favourable, with none of the patients suffering serious sequelae.