The association of Streptococcus bovis bacteremia with colon tumors has been known since the late 1970s (3). Later, it was established that this association corresponded to biotype I (6). The association of S. bovis biotype II is less known. A few studies have related biliary tract infections and cirrhotic bacteremia (1, 5, 6, 8).
Extensive taxonomic changes have occurred in this group, and strains formerly known as human S. bovis isolates are now designated different species (2, 7). Thus, in human pathology today, there are two species of principal interest: Streptococcus gallolyticus, with the subspecies gallolyticus (formerly S. bovis I) and pasteurianus (formerly S. bovis II/2), and Streptococcus infantarius (formerly S. bovis II/1), with the subspecies coli and infantarius.
We have studied all the S. bovis bacteremias prospectively over 20 years (1988 to 2007). The identification was determined by the API 20 strep method (bioMérieux, Marcy- l′Etoile, France), and since 2005, we have used, in addition, the GP card of the VITEK 2 system (bioMérieux, Marcy-l′Etoile, France). Over this period, we have found 133 bacteremias, 90 caused by S. gallolyticus subsp. gallolyticus, 15 by S. gallolyticus subsp. pasteurianus, and 28 by S. infantarius.
The association of colon tumors with S. gallolyticus was 48.5% (51 of 105) versus 11% (3 of 28) for S. infantarius (P < 0.0003). Nevertheless, for noncolonic cancer the association was 6% (6 of 105) for S. gallolyticus versus 57% (16 of 28) for S. infantarius (P < 0.0001). Of these 16 noncolonic cancers associated with S. infantarius, 12 (75%) were of the digestive tract (fundamentally pancreas and biliary tract), 9 of them appearing as cholangitis.
In an extensive review of the literature carried out by Klein et al. (4), no association between S. bovis and noncolonic digestive cancers was found, although at that time, the biotypes of the strains were not considered. New studies are needed to confirm our findings, in which we observe a strong association of S. infantarius with noncolonic digestive cancers.
Footnotes
Published ahead of print on 6 February 2008.
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