Diseases Caused by Group A Strep

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Diseases streptococcus group aa colon cancer

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Infective endocarditis caused by Streptococcus bovis is known to be associated with colorectal malignancy.

Other less common streptococci, specifically Streptococcus sanguis, diseases streptococcus group aa colon cancer, can be similarly associated with gastrointestinal carcinoma. We present a case of disseminated colorectal carcinoma occurring after a confirmed S sanguis endocarditis, that required mitral valve surgery.

There may be a need for gastrointestinal surveillance in patients presenting with bacteraemia caused by less common streptococci. Gastrointestinal lesions may be found at an earlier stage, potentially improving prognosis. A year-old man was admitted with a 1 week history of fevers, anorexia and night sweats in May Bilateral splinter haemorrhages were noted and a pan-systolic murmur was heard at the apex.

There was no evidence of hepatosplenomegaly. Three sets of blood cultures grew S sanguis and transthoracic echocardiography demonstrated thickened mitral valve cusps with posterior leaflet prolapse and moderate mitral regurgitation.

Transoesophageal echocardiography TOE showed several small vegetations attached to, but moving independently of, the mitral leaflet fig 1. Four weeks of intravenous antibiotics benzylpenicillin, with 2 weeks of gentamicin were given with a further 2 week course of oral antibiotics.

The fever resolved and the white cell count and C reactive protein value returned to normal. Repeated blood cultures were negative. Assessment of the oral cavity revealed minor gingival inflammation with peri-apical radiolucency of a single tooth, which was removed under antibiotic cover.

It was felt this was the source of the S sanguis. Repeat TOE after completion of antibiotics showed no resolution of the vegetations and demonstrated chord rupture and severe mitral regurgitation. Transoesophageal echocardiographic view showing a highly mobile vegetation suspended from a flail segment of diseases streptococcus group aa colon cancer posterior mitral valve leaflet which prolapses back into the left atrium.

Significant mitral regurgitation was evident on both colour flow and spectral Doppler imaging. While the mitral regurgitation was asymptomatic, the patient was referred for mitral valve birth control pills reduce acne on prognostic grounds.

Preoperative coronary angiography was normal but confirmed severe mitral regurgitation on ventriculography. Surgical repair diseases streptococcus group aa colon cancer the mitral valve repair was uneventful.

No active endocarditis was seen, but ruptured chords of the P2 leaflet with mild A2 prolapse were noted to have contributed to the severe mitral regurgitation. Histological assessment confirmed signs of recent infective endocarditis, although no bacteria were grown on culture. The patient re-presented 33 months later with night sweats, weight loss, malaise and lethargy.

Acyclovir without prescription had been no change in bowel habit. He had no family history of malignancy. He was diseases streptococcus group aa colon cancer life-long non-smoker, ate a vegetarian diet, and was of normal weight.

On examination, conjunctival pallor was noted and a liver edge was palpable. No splinter haemorrhages were seen and rectal examination was normal. A microcytic anaemia was found haemoglobin 8. Blood cultures were negative. Echocardiography showed an immobile posterior mitral valve leaflet and evidence of the previous mitral valve repair, but no endocarditis.

Computed tomography of the abdomen showed a thickened hepatic diseases streptococcus group aa colon cancer with enlarged lymph nodes in the para-aortic region. Colonoscopy revealed a circumferential hepatic flexure tumour fig 2 lesion. Biopsy confirmed infiltrating adenocarcinoma. Right hemicolectomy was performed and a staging assessment demonstrated extensive disease C1 T4 N2 Mx. Adjuvant chemotherapy oxaliplatin and capecitabine was offered. Despite aggressive management, liver and lung metastases developed and the patient died of progressive malignancy 39 months diseases streptococcus group aa colon cancer the initial endocarditis.

Endocarditis is an important disease with a median incidence of 3. While the S bovis link to bowel lesions is well established, there is evidence that other forms of streptococcal infection are associated with colonic malignancy, including S viridansS sanguisS equinus and S agalactiae. It rarely causes positive blood cultures but may do so in chronic respiratory or oropharyngeal conditions.

Five previous reports suggest an association between S sanguis bacteraemia and colorectal malignancy. It is presumed that S sanguis entered the blood via ulcerated bowel lesions. The majority of cases featured elderly female patients with well differentiated adenocarcinomas in either the sigmoid or caecum.

Based on previous reports, the time interval between bacteraemia and discovery of the colonic neoplasm ranged from days 7 to 28 months 12 following S bovis endocarditis. The bacteraemia represents a marker of the occult malignancy; the streptococci are low grade pathogens and bacteraemia suggests an opportunistic change from their usual state. An ulcerating colonic malignancy may allow the bacteria to penetrate the bloodstream with subsequent endocarditis.

Intact local polyps with metaplasia may allow bacterial translocation across a weakened protective wall. Animal work in rat models has suggested extracted antigens from S bovis may cause carcinoma, 13 raising the possibility of an aetiological role for the bacteria. It remains possible that the colonic lesion in our patient is a coincidental event. The patient was found to have mild gingival inflammation, potentially being the portal for the endocarditis with coincidental later malignancy.

However, diseases streptococcus group aa colon cancer, given the previously reported cases, some with long intervals between infection and malignancy, it is equally possible there is a true association between the two events.

Together with the previous descriptions, this report suggests that patients with confirmed streptococcal endocarditis, particularly caused by unusual subspecies, should undergo colonic assessment. However, it remains unclear how long surveillance should continue for, given that colonic malignancy may develop at a later period. While there is no formal guidance, a strong clinical suspicion of occult malignancy is recommended for both S bovis and S sanguis endocarditis.

National Center for Biotechnology InformationU. Published online Feb Sukhjinder Nijjer and Simon William Dubrey. Correspondence to Sukhjinder Nijjer, ku. This article has been cited by other articles in PMC. Abstract Infective endocarditis caused by Streptococcus bovis is known to be associated with colorectal malignancy. Background Infective endocarditis caused by Streptococcus bovis is known to be associated with colorectal malignancy. Case presentation A year-old man was admitted with a 1 week history of fevers, diseases streptococcus group aa colon cancer, anorexia and night sweats in May Open in a separate window.

Endoscopy image showing a circumferential tumour at the hepatic flexure. Discussion Endocarditis is an important disease with a median incidence of 3.

Learning points Several case reports have suggested different streptococcal bacteraemia can be associated with gastrointestinal malignancy. While S bovis is commonly considered, S sanguis has also been implicated.

S sanguis bacteraemia may be a consequence of an ulcerated gastrointestinal lesion and this may present later as a malignancy. Investigation of the gastrointestinal tract should be considered in cases of S sanguis bacteraemia. Enterococcal endocarditis associated with carcinoma of the sigmoid.

J Med Assoc State Ala ; Streptococcus sanguis bacteremia associated with cecal carcinoma: Am J Gastroenterol ; The changing face of infective endocarditis. Mylonakis E, Calderwood SB. Infective Endocarditis in Adults. N Engl J Med ; Infectious endocarditis from Streptococcus bovis associated with colonic carcinoma: Arq Gastroenterol ; Association of Streptococcus bovis bacteremia with colonic neoplasia and extracolonic malignancy.

Arch Surg ; Infective endocarditis from Streptococcus viridans associated with colonic carcinoma: J Card Surg ; Streptococcus sanguis bacteremia and colorectal cancer. South Med J ; Adenocarcinoma of the colon presenting as Streptococcus sanguis bacteremia, diseases streptococcus group aa colon cancer. Streptococcus sanguis bacteremia and colorectal cancer: Med Pediatr Oncol ; Siegert CE, Overbosch D.

Robbins N, Klein RS. Carcinoma of the colon 2 years after endocarditis due to Streptococcus bovis. Carcinogenic properties of proteins with pro-inflammatory activity from Streptococcus infantariusc formerly S.

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Diseases streptococcus group aa colon cancer

Keyword Keyword children 27 surgical treatment 8 bronchopulmonary dysplasia 3 connective tissue dysplasia 3 diagnosis 3 diagnostic criteria 3 thyroid 3 abdominal pain 2 adolescents 2 angiogenesis 2 angiology 2 apnea 2 autoimmune diseases 2 cardiorespiratory monitoring 2 chemotherapy 2. Publication Date Publication Date 23 11 31 25 23 Publication Date Publication Date. User Username Password Remember me Forgot password? Keywords Marfan syndrome adolescents children connective tissue dysplasia diagnosis diagnostic criteria diagnostics metabolic syndrome morbidity newborn newborns obesity pancreas pregnancy prevention quality of life risk factors surgical treatment therapy treatment urolithiasis. Issue Title Vol 7, No 2 Neoplasms, as one of the causes of the syndrome of palpable abdominal tumor in children Abstract Rus similar documents Kostylev A. Syndrome of palpable abdominal tumor in children is a difficult diagnostic problem