Clinical

Liver disease often present in patients with Streptococcus bovis endocarditis

Last Updated: 2004-05-13 16:30:08 -0400 (Reuters Health)

NEW YORK (Reuters Health) - In patients with Streptococcus bovis endocarditis, bivalvular involvement is common and the incidence of embolisms, severe liver disease, and diskitis seems to be higher than for other causes of endocardial inflammation, according to a new study.

S. bovis has been linked to an increasing proportion of endocarditis cases in southern Europe, Dr. Marie-Francoise Tripodi and associates note in the May 15th issue of Clinical Infectious Diseases. Predisposing conditions for this infection are not known, and the relative severity of the disease has been unclear.

The team at Second University of Naples Medical School in Italy therefore prospectively followed 199 patients with definite endocarditis diagnosed since 1990.

Thirty cases (15%) were due to S. bovis, including 23 diagnosed since 2000. Thus, the proportion increased from 7% during the first decade to 25.3% since then, comprising the second most common pathogen during the latter period.

S. bovis infection was more likely to involve two valves (43.3% versus 7.8%), liver disease (56.7% versus 15.4%) and embolism (73.3% versus 40%). In the seven S. bovis cases with spine involvement, the symptoms of diskitis were the initial symptoms. In contrast, only one patient with other infections had diskitis.

Moreover, 14 of 27 patients with S. bovis had colonic adenomas.

The interval between onset of fever and diagnosis averaged 73.7 days among those who recovered with medical therapy alone and 118.3 days for those who required surgery.

Dr. Tripodi's group advises liver function tests in patients with endocarditis. "The onset of the disease may be atypical," they conclude, "with unusual complications such as diskitis that may delay the diagnosis and worsen the prognosis."

Clin Infect Dis 2004;38:1394-1400.