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Colorectal neoplasia associated with Streptococcus gallolyticus subspecies pasteurianus

2014; Elsevier BV; Volume: 14; Issue: 4 Linguagem: Inglês

10.1016/s1473-3099(14)70031-3

1474-4457

Juan Corredoira Sánchez, Fernando Garcı́a-Garrote, Amparo Coira, Hugo López-Agreda, Marı́a Pilar Alonso,

Bacterial Identification and Susceptibility Testing

The association of colorectal neoplasia with bacteraemia caused by Streptococcus bovis is well known. Findings from a systematic review1Boleij A van Gelder MM Swinkels DW Tjalsma H Clinical impotance of Streptococcus gallolyticus infection among colorectal cancer patients: systematic review and meta-analysis.Clin Infect Dis. 2011; 53: 70-78Crossref Scopus (228) Google Scholar showed that 69% of patients infected with S bovis had concomitant colorectal neoplasia, but there were differences among the S bovis subspecies and their association with underlying colorectal neoplasia; patients with S gallolyticus subspecies gallolyticus (biotype I) had a higher risk of colorectal neoplasia than did patients infected by other S bovis subspecies. We read with interest the Personal View by Annemarie Boleij and Harold Tjalsma (August, p 719),2Boleij A Tjalsma H The itinerary of Streptococcus bovis infection in patients with colonic malignant disease.Lancet Infect Dis. 2013; 13: 719-723Summary Full Text Full Text PDF PubMed Scopus (93) Google Scholar in which they affirm that a major drawback of most studies is the lack of discrimination between S bovis biotype II subspecies. S gallolyticus gallolyticus bacteraemia is an indication to search for colorectal neoplasia,3Corredoira J García-Garrote F Rabuñal R et al.Association between bacteremia due to Streptococcus gallolyticus subsp. gallolyticus (S. bovis I) and colorectal neoplasia: a case-control study.Clin Infect Dis. 2012; 55: 491-496Crossref PubMed Scopus (87) Google Scholar but more detailed analysis of the other subspecies is needed to rule out or confirm their association with colorectal neoplasia. Facklan4Facklan R What happened to the streptococci: overview of taxonomic changes in the streptococci.Clin Microbial Rev. 2002; 15: 613-630Crossref PubMed Scopus (722) Google Scholar suggested that S gallolyticus gallolyticus and S gallolyticus subspecies pasteurianus (formerly known as S bovis biotype II/2) are isolated from haemocultures of patients with colorectal neoplasia more often than is S infantarius (biotype II/1). We have noted significant differences between S gallolyticus gallolyticus and S infantarius in their association with colorectal neoplasia, both in the percentage (63·3% vs 10·3%, p<0·001) and with the stage of the illness.5Corredoira J Coira A Iñiguez I Pita J Varela J Alonso MP Advanced bowel cancer associated with Streptococcus infantarius (former S. bovis II / 1) sepsis.Int J Clin Pract. 2013; 67: 1358-1359Crossref PubMed Scopus (10) Google Scholar However, few studies have compared the frequency of colorectal neoplasia in patients with bacteraemia caused by S gallolyticus pasteurianus and S gallolyticus gallolyticus; in a recent report,6Romero B Morosini M Loza E et al.Reidentification of Streptococcus bovis isolates causing bacteremia according to the new taxonomy criteria: still an issue?.J Clin Microbiol. 2011; 49: 3228-3233Crossref PubMed Scopus (66) Google Scholar no differences were noted. We prospectively followed up all episodes of bacteraemia caused by S bovis group bacteria during 1988–2012. The isolates were identified as previously described.3Corredoira J García-Garrote F Rabuñal R et al.Association between bacteremia due to Streptococcus gallolyticus subsp. gallolyticus (S. bovis I) and colorectal neoplasia: a case-control study.Clin Infect Dis. 2012; 55: 491-496Crossref PubMed Scopus (87) Google Scholar We recorded 119 cases of S gallolyticus gallolyticus and 29 cases of S gallolyticus pasteurianus. Colonoscopy was done in 108 patients with S gallolyticus gallolyticus bacteraemia (mean age 66 years, 89% male) and 22 patients with S gallolyticus pasteurianus bacteraemia (mean age 70 years, 55% male). Colorectal neoplasia was detected in 77 patients (71%) with S gallolyticus gallolyticus bacteraemia and five patients (23%) with S gallolyticus pasteurianus bacteraemia (p=0·001). Rates of non-advanced adenoma, advanced adenoma, and carcinoma were increased in the S gallolyticus gallolyticus group (19% vs 9%; 40% vs 14% [p<0·02]; and 12% vs 0%, respectively). The rates of colorectal neoplasia in patients with S gallolyticus pasteurianus bacteraemia were similar to those reported in studies of screening for colorectal neoplasia in the general population. Our data suggest that colonoscopy should not be done in all patients with S gallolyticus pasteurianus bacteraemia. However, further studies with more patients are needed to support our findings. We declare that we have no competing interests. The itinerary of Streptococcus gallolyticus infection in patients with colonic malignant diseaseBacteria constitute about 90% of all cells in the human body. The densest and most complex bacterial community is in the large intestine. This population is quite stable in healthy intestines, but intestinal disease distorts the ecological balance and induces dysbiosis. Results of studies have indicated that the epithelial and metabolic changes that occur with colorectal cancer provide a competitive advantage to a subset of intestinal bacteria. Strikingly, however, Streptococcus gallolyticus gallolyticus (previously known as Streptococcus bovis biotype I) is one of the very few opportunistic pathogens that has been clinically linked to colonic malignant diseases. Full-Text PDF