Journal List > Korean J Lab Med > v.30(2) > 1011622

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Kim, Joo, Yi, and Kim: A Case of Streptococcus gallolyticus subsp. gallolyticus Infective Endocarditis with Colon Cancer: Identification by 16S Ribosomal DNA Sequencing
Case Report

Korean J Leg Med 2010;30(2):160-165.

Published online: 14 January 2010

DOI: https://doi.org/10.3343/kjlm.2010.30.2.160

A Case of Streptococcus gallolyticus subsp. gallolyticus Infective Endocarditis with Colon Cancer: Identification by 16S Ribosomal DNA Sequencing

Seon Young Kim, M.D., Sei-Ick Joo, M.T., Jongyoun Yi, M.D., Eui-Chong Kim, M.D.

Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea

Corresponding author: Eui-Chong Kim, M.D. Department of Laboratory Medicine, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea Tel: +82-2-2072-3500 Fax: +82-2-764-6542 E-mail: euichong@snu.ac.kr

      Revised 23 November 200914 January 2010       Accepted 19 February 2010

Copyright © 2010 Korean Society for Legal Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Although the association between Streptococcus bovis endocarditis and colon carcinoma is well known, very few cases of S. bovis infection associated with underlying malignancies have been reported in Korea. The S. bovis group has been recently reclassified and renamed as Streptococcus gallolyticus and Streptococcus infantarius subspecies under a new nomenclature system. We report a case of infective endocarditis with colon cancer caused by S. gallolyticus subsp. gallolyticus (previously named S. bovis biotype I). A 59-yr-old woman presented with a 1-month history of fever. Initial blood cultures were positive for gram-positive cocci, and echocardiography showed vegetation on mitral and aortic valves. Antibiotic treatment for infective endocarditis was started. The infecting strain was a catalase-negative and bile-esculin-positive alpha-hemolytic Streptococcus susceptible to penicillin and vancomycin. The strain was identified as S. gallolyticus subsp. gallolyticus with the use of the Vitek 2 GPI and API 20 Strep systems (bioMérieux, USA). The 16S rDNA sequences of the blood culture isolates showed 100% homology with those of S. gallolyticus subsp. gallolyticus reported in GenBank. The identification of the infecting organism, and the subsequent communication among clinical microbiologists and physicians about the changed nomenclature, led to the detection of colon cancer. The patient recovered after treatment with antibiotics, valve surgery, and operation for colon cancer. This is the first report of biochemical and genetic identification of S. gallolyticus subsp. gallolyticus causing infective endocarditis associated with underlying colon cancer in a Korean patient.

Keywords: Streptococcus gallolyticus, Endocarditis, Colon cancer, rDNA sequencing

REFERENCES

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Table 1.
Characteristics of the blood culture isolates of this case in comparison with the subspecies of Streptococcus gallolyticus and Streptococcus infantarius
Characteristics Isolates of this case S. gallolyticus and S. infantarius subspecies∗
Vitek 2 GP API 20 Strep S. gallolyticus subsp. gallolyticus S. gallolyticus ubsp. pasteurianus S. gallolyticus subsp. macedonicus S. infantarius subsp. infantarius S. infantarius subsp. coli
Hydrolysis of:              
Esculin NT + + + - v +
Production of:              
b-Glucosidase NT + + + - v +
b-Glucuronidase - - - + - - -
a-Galactosidase + - + v v + +
b-Galactosidase - - - + v - -
Acidification of:              
Starch NT + + - + + v
Glycogen NT + + - - + -
Inulin NT - + - - - -
Lactose + + + + + + +
Mannitol + + + - - - -
Methyl-b-D-glucopyranoside + NT + + - - +
Raffinose + + + v - + -
Trehalose + + + + - - -

∗ The biochemical profiles of the subspecies of S. gallolyticus and S. infantarius were obtained from a report by Schlegel et al. [4].

Abbreviations: NT, not tested; +, ≥80% of strains positive; -, ≤20% of strains positive; v, 21-79% activity compared to the positive control reaction.

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