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This study was designed to evaluate a spray-dried multivalent polyclonal antibody preparation (PAP) against lactate-producing bacteria as an alternative to monensin (MON) to control ruminal acidification. Holstein cows (677 ± 98 kg) fitted with ruminal cannulas were allocated in an incomplete Latin square design with two 20 days period. Cows were randomly assigned to control (CTL), PAP, or MON treatments. For each period, cows were fed a forage diet in the first 5 days (d-5 to d-1), composed of sugarcane, urea and a mineral supplement, followed by a 74% concentrate diet for 15 days (d 0 to d 14). There were no treatment main effects (P > 0.05) on dry matter intake (DMI) and microbial protein synthesis. However, there was a large peak (P < 0.01) of intake on d 0 (18.29 kg), followed by a large decline on d 1 (3.67 kg). From d2, DMI showed an increasing pattern (8.34 kg) and stabilized around d 8 (12.96 kg). Higher mean pH was measured (P < 0.01) in cattle-fed MON (6.06 vs. PAP = 5.89 and CTL = 5.91). The ruminal NH3-N concentration of CTL-fed cows was lower (P < 0.01) compared to those fed MON or PAP. The molar concentration of acetate and lactate was not affected (P > 0.23) by treatments, but feeding MON increased (P = 0.01) propionate during the first 4 days after the challenge. Feeding MON and PAP reduced (P = 0.01) the molar proportion of butyrate. MON was effective in controlling pH and improved ruminal fermentation of acidosis-induced cows. However, PAP was not effective in controlling acidosis. The acidosis induced by the challenge was caused by the accumulation of SCFAs. Therefore, the real conditions for evaluation of this feed additive were not reached in this experiment, since this PAP was proposed to work against lactate-producing bacteria.

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Introduction: Streptococcus gallolyticus belongs to theStreptococcus bovis complex, and it is a common bacterium colonizing the gastrointestinal tract. Its presence in the blood may suggest an underlying pathology such as a colonic neoplasm. We report herein a case of S. bovis bacteremia in an apheresis platelet donor, review similar cases in the literature, and suggest a flowchart for the management of similar cases in other blood donation centers. Case Presentation: A 61-year-old subject presented to a Hemotherapy Service to make an apheresis platelet donation. On quality control testing, S. gallolyticus was identified in hemoculture, and the donor was called back for follow-up. At first, a new hemoculture was requested, and the patient was referred to the outpatient department of infectious diseases to further investigate pathologies associated with S. gallolyticus. A subsequent colonoscopy investigation evidenced a polypoid structure in the ascending colon. Pathology reported the resected specimen as a low-grade tubular adenoma. Conclusion: Isolation of S. bovis in blood products requires further investigation and should be managed with precision by Hemotherapy Services. A standard protocol for the management of asymptomatic patients with S. bovis positive hemoculture, with the requests of a new blood culture, a colonoscopy, and an echocardiogram is crucial, as it may ensure early diagnosis and reduce morbidity and mortality. (AU)

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Streptococcus bovis bacteremia (currently called S. gallolyticus) represents an infrequent condition, but associated with a high rate of morbidity and mortality Amado et al. (2015). The clinical presentation is characterized by symptoms associated with disseminated infection and with a higher frequency of endocarditis and gastrointestinal neoplasms, often occult Amado et al. (2015), Olmos et al. (2016). Probable sources of infection and zoonotic transmission have not been explored in the literature. We present a case of disseminated infection after ingestion of a marine mammal.

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Dada la importancia de la correcta validación clínica de los aislamientos de Streptococcus bovis, nos planteamos la revisión de su presencia en muestras de orina con el objetivo de conocer su frecuencia relativa y su patrón de sensibilidad antibiótica. Se revisó retrospectivamente la sensibilidad a los antibióticos de 91 aislados de S. bovis recuperados de muestras de orina durante un período de 4 años (2012-2015). La media de la edad de los pacientes fue de 55 años y en su mayoría fueron mujeres (81%). El 37,4% eran pacientes hospitalizados con enfermedades urológicas (61%). La sensibilidad a penicilina, vancomicina y teicoplanina fue del 97,8%. Aunque S. bovis puede ser poco común en los aislamientos de orina, su presencia en sujetos con enfermedades de base justifica la realización de estudios de patogenicidad que demuestren la verdadera capacidad de producir enfermedad de este grupo de bacterias.

Given the relevance of proper clinical validation of Streptococcus bovis, we here consider revising its presence in urine samples in order to determine its relative frequency and the pattern of antibiotic susceptibility. The susceptibility to antibiotics of 91 isolates of S. bovis from urine samples was retrospectively reviewed over a period of 4 years (2012-2015). The mean age of patients was 55 years, 81% of whom were women and 37.4% were hospitalized patients suffering from urological diseases (61%). Susceptibility to penicillin, vancomycin and teicoplanin was 97.8%. Due to the fact that S. bovis can be infrequent in urine isolates and given its presence in patients suffering from urological diseases, further pathogenic studies, showing the true ability of this group of bacteria to produce disease, are required.

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Given the relevance of proper clinical validation of Streptococcus bovis, we here consider revising its presence in urine samples in order to determine its relative frequency and the pattern of antibiotic susceptibility. The susceptibility to antibiotics of 91 isolates of S. bovis from urine samples was retrospectively reviewed over a period of 4 years (2012-2015). The mean age of patients was 55 years, 81% of whom were women and 37.4% were hospitalized patients suffering from urological diseases (61%). Susceptibility to penicillin, vancomycin and teicoplanin was 97.8%. Due to the fact that S. bovis can be infrequent in urine isolates and given its presence in patients suffering from urological diseases, further pathogenic studies, showing the true ability of this group of bacteria to produce disease, are required.

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Background: Bacteremia due to Streptococcus bovis (now S. gallolyticus) has been traditionally associated to colon or hepatobiliar disease and endocarditis but there is no information on this matter in Chile. Aims: To describe clinical features of adult patients suffering bacteremia by S. bovis/S. gallolyticus, identify the source of the bacteremia and the frequency of endocarditis. Methods: Retrospective-descriptive study using laboratory records. Results: Between January 2003 and August 2014, 23 S. bovis/S. gallolyticus bacteremic events were identified among 22 patients. Mean age was 72.7 years (range 46-96). Co-morbidities were frequent (9.1 to 47.6%). The primary source of bacteremia was intestinal in 52.2%; hepatobiliar in 17.4% and in 34.8% it was not elucidated. Six patients had infective endocarditis (26.1%) and one patient had espondylodiscitis (4.3%). S. bovis represented 39.1% of isolates (all until 2008), S. gallolyticus subsp pasteurianus 39.1% and, S. gallolyticus subsp infantarius and S. gallolyticus subsp gallolyticus 8.7% each one, respectively. Association studies between the bacteremic source or endocarditis with specific S. gallolyticus subspecies were limited by the small number of isolates. Seven patients (30.4%) underwent surgical interventions. In-hospital mortality reached 21.7% (n = 5). Conclusions: Although infrequent, bacteremic events by S. gallolyticus/S. bovis have increased in-hospital mortality, require surgical intervention and affect older patients with co-morbidities. Near two-thirds suffer from colonic or hepatobiliary disease that act as the primary source of bacteremia. In addition, near one fourth is affected by infective endocarditis. Detection of S. gallolyticus/S. bovis in blood cultures prompts a thorough clinical evaluation in order to clarify the source of the bloodstream infection and the presence of complications.

Antecedentes: Los cuadros de bacteriemia por Streptococcus bovis (actualmente S. gallolyticus) han sido tradicionalmente asociados a patología colónica o hepatobiliar y endocarditis pero no se conoce de estudios en Chile que hayan abordado este tema. Objetivos: Describir aspectos clínicos de pacientes adultos afectados por bacteriemias por S. bovis/S. gallolyticus, identificar la fuente de la bacteriemia y la frecuencia de endocarditis. Métodos: Diseño de tipo retrospectivo, descriptivo, con el registro de casos bacteriemia. Resultados: Entre enero de 2003 y agosto de 2014 se identificaron 23 eventos de bacteriemia por S. bovis/S. gallolyticus en 22 pacientes. La edad promedio fue de 72,7 años (rango 46-96). La prevalencia de diferentes co-morbilidades fue elevada (9,1 a 47,6%). El foco primario de la bacteriemia fue intestinal en 52,2%, hepatobiliar en 17,4% y, en 34,8% no se aclaró el foco. Seis pacientes presentaron endocarditis infecciosa (26,1%) y uno espondilodiscitis (4,3%). S. bovis representó 39,1% de los aislados (todos hasta el 2008), S. gallolyticus subsp pasteurianus 39,1%, S. gallolyticus subsp infantarius y S. gallolyticus subsp gallolyticus 8,7%, respectivamente. Los estudios de asociación estuvieron limitados por el bajo número de aislados. Siete pacientes (30,4%) debieron ser intervenidos quirúrgicamente. La mortalidad hospitalaria fue de 21,7% (n: 5). Conclusiones: Aunque infrecuentes, los eventos de bacteriemia por S. gallolyticus/S. bovis tienen una elevada mortalidad hospitalaria, requieren con frecuencia procedimientos quirúrgicos y afectan a pacientes mayores con co-morbilidades. Cerca de dos tercios padecen de una patología colónica o hepatobiliar que actúa como foco primario y cerca de un cuarto presenta endocarditis infecciosa. La detección de este grupo bacteriano en los hemocultivos requiere una evaluación para establecer el origen de la bacteriemia y la presencia de complicaciones.

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BACKGROUND: Streptococcus bovis is a classical etiology of endocarditis and is associated with colonic lesions. No series of cases from Brazil has been described. OBJECTIVES: To describe aspects of S. bovis endocarditis. METHODS: This is a case series of patients admitted to a cardiac surgery referral center, during the years 2005-2014. Clinical, laboratory, echochardiographic, colonoscopic, treatment, surgical and outcome variables were studied. RESULTS: Nine patients with S. bovis endocarditis were included; all cases fulfilled the modified Duke criteria. Incidence was 8/220 (4%) in years 2006-2014. There were seven male and two female patients; mean age was 56.7 years, standard deviation 13.4. All patients had native aortic valve involvement. Presentation was subacute in 7/9 (71%). Fever was present in 7/9 (77.7%), embolic lesions to solid organs occurred in three, and perivalvular abscess in two patients. All echocardiograms showed moderate to severe valvular regurgitation and vegetations. Microcytic anemia was seen in 7/7 patients. Colonoscopy showed abnormal findings in 7/9 (77.7%). Surgery was indicated for 6/9 patients due to acute aortic regurgitation and left ventricular failure. All patients were discharged home. CONCLUSIONS: S. bovis most frequently affected the aortic valve of male patients. Colon disease was frequent. Surgery was indicated frequently due to hemodynamic compromise.

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Uno de los agentes bacterianos que ha sido regularmente asociado con el cáncer colorectal es el Streptococcus bovis. Del 25 al 80 % de los pacientes con bacteremia por Streptococcus bovis tienen tumores colorrectales y la incidencia de asociación de neoplasia de colon con endocarditis por S. bovis ha sido mostrada del 18 al 62 %. Por tales razones se decidió la presentación del caso de un paciente de 57 años, de procedencia urbana, con antecedentes de alcoholismo y diabetes mellitus tipo I, desde hacía seis años, que ingresó en el Hospital de Cienfuegos con sangrado digestivo alto y fiebre de 39 a 40 o C. En hemocultivo se aisló Streptococcus bovis. El paciente falleció a las 72 hora de ingresado. Los resultados de la necropsia mostraron adenocarcinoma de colon derecho, moderadamente diferenciado.

One of the bacterial agents commonly associated with colorectal cancer is Streptococcus bovis. Twenty five to 80 % of patients with Streptococcus bovis bacteremia develop colorectal tumors and the incidence of colonic neoplasia associated with S. bovis endocarditis has been shown to be 18 to 62 %. Hence, it was decided to present the case of a 57-year-old patient from an urban area with a 6-year history of diabetes mellitus type I and alcoholism, who was admitted to the hospital in Cienfuegos because of significant gastrointestinal bleeding and fever (39-40 o C). Streptococcus bovis was isolated from the blood culture. The patient died 72 hours after his admission. Autopsy results showed a moderately differentiated adenocarcinoma of the right colon.

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Uno de los agentes bacterianos que ha sido regularmente asociado con el cáncer colorectal es el Streptococcus bovis. Del 25 al 80 por ciento de los pacientes con bacteremia por Streptococcus bovis tienen tumores colorrectales y la incidencia de asociación de neoplasia de colon con endocarditis por S. bovis ha sido mostrada del 18 al 62 por ciento. Por tales razones se decidió la presentación del caso de un paciente de 57 años, de procedencia urbana, con antecedentes de alcoholismo y diabetes mellitus tipo I, desde hacía seis años, que ingresó en el Hospital de Cienfuegos con sangrado digestivo alto y fiebre de 39 a 40 o C. En hemocultivo se aisló Streptococcus bovis. El paciente falleció a las 72 hora de ingresado. Los resultados de la necropsia mostraron adenocarcinoma de colon derecho, moderadamente diferenciado(AU)

One of the bacterial agents commonly associated with colorectal cancer is Streptococcus bovis. Twenty five to 80 percent of patients with Streptococcus bovis bacteremia develop colorectal tumors and the incidence of colonic neoplasia associated with S. bovis endocarditis has been shown to be 18 to 62 percent. Hence, it was decided to present the case of a 57-year-old patient from an urban area with a 6-year history of diabetes mellitus type I and alcoholism, who was admitted to the hospital in Cienfuegos because of significant gastrointestinal bleeding and fever (39-40 o C). Streptococcus bovis was isolated from the blood culture. The patient died 72 hours after his admission. Autopsy results showed a moderately differentiated adenocarcinoma of the right colon

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Streptococcus gallolyticus subsp. pasteurianus is known to cause bacterial meningitis in adults, and most of the few pediatric cases observed occurred in neonates. We report the case of a 9-month old boy with a history of repeated hospitalizations due to respiratory diseases, who presented meningitis and bacteremia by Streptococcus gallolyticus subsp. pasterianus. To our knowledge, this is the first reported case in Santa Fe to this date.

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La endocarditis por Streptococcus bovis representa el 10% de los casos de endocarditis bacteriana, siendo frecuente su asociación con enfermedades intestinales y hepáticas. Se presenta el caso de una mujer de 36 años con antecedentes de fiebre reumática en la niñez, quien hace un año comenzó con sintomatología digestiva, para la cual fue sometida a estudios clínicos invasivos como endoscopia y colonoscopia, desarrollando posteriormente una endocarditis con aislamiento microbiológico de Streptococcus bovis. Se detalla la fisiopatología, clínica, diagnóstico y los aspectos terapéuticos de esta entidad. Además se discuten las posibles relaciones de las enfermedades intestinales, las instrumentaciones del tubo digestivo y las hepatopatías con la bacteriemia por Streptococcus bovis biotipoI. Esta asociación sugiere un posible mecanismo de adherencia biotipo-específica que aún no ha sido fehacientemente demostrado. Por último se resalta la conveniencia de someter a exploración digestiva y ecocardiografía a todo paciente con hemocultivos positivos a este tipo de germen..

Endocarditis caused by Streptococcus bovis represents 10% of the cases of bacterial endocarditis and is frequently associated with intestinal and liver diseases. We present the case of a 36-year old female patient with a history of rheumatic fever in childhood. The gastrointestinal symptomatology began one year before the bacterial endocarditis. Several invasive clinical investigations as endoscopy and colonoscopy, were performed and subsequently she developed endocarditis. Streptococcus bovis was isolated in microbiological studies. Pathophysiology, clinical manifestations, diagnosis, and treatment are detailed. The association between bacteremia from Streptococcus bovis biotype I and intestinal diseases, instrumentation of the digestive tract, and hepatopathy is reviewed. This association suggests a possible mechanism of bacteremia and endocarditis associated with biotype I but this has not been definitely confirmed. We have highlighted the importance of performing echocardiography in all patients with blood cultures positive for Streptococcus bovis who have had invasive studies of the gastrointestinal tract..

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A monoartrite continua sendo diagnóstico desafiador para reumatologistas e ortopedistas. O autor descreve um caso de artrite séptica por Streptococcus bovis após vários episódios de derrame articular tratado com ácido hialurônico (hilano G-F 20) e acetato de metilprednisolona em paciente de 69 anos de idade portador de cirrose hepática devido ao vírus da hepatite C, sem presença de adenoma de cólon ou endocardite. Discutem-se as possibilidades diagnósticas para este caso de monoartrite, bem como as patologias associadas às infecções causadas por esse microrganismo de interesse para o reumatologista, e a possível implicação da reação da articulação ao ácido hialurônico como possível fator predisponente do derrame articular.

Monoarthritis remains a diagnostic challenge in Rheumatology and Orthopedics. The author reports a case of septic arthritis due to Streptococcus bovis after several episodes of joint effusion treated with hyaluronic acid (Hylan G-F 20) and methylprednisolone acetate in a 69-year-old patient with liver cirrhosis due to hepatitis C virus. Neither adenoma of the colon nor endocarditis was present. The diagnostic possibilities for this case of monoarthritis, the pathologies related to the microorganism of interest to the rheumatologist, and the possible involvement of joint reaction to hyaluronic acid as a predisposing factor to joint effusion are discussed.

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Descrevemos o caso de uma paciente de 66 anos de idade, com endocardite infecciosa por Streptococcus bovis e adenocarcinoma colônico, que desenvolveu insuficiência aórtica grave aguda. Foi submetida à cirurgia de troca valvar aórtica e posteriormente à ressecção tumoral (hemicolectomia direita). É importante ressaltar a necessidade de complementação do estudo do cólon, mesmo em indivíduos assintomáticos, quando diagnosticamos endocardite infecciosa por S. bovis.

We report the case of a 66 year-old female patient with infectious endocarditis due to Streptococcus bovis and adenocarcinoma of the colon that developed acute aortic insufficiency. She was submitted to aortic valve replacement surgery and later to tumor resection (right hemicolectomy). It is important to emphasize the need for complementing the study of the colon, even in asymptomatic individuals, when infectious endocarditis due to S. bovis is diagnosed.

Describimos el caso de una paciente de 66 años de edad, con endocarditis infecciosa por streptococcus bovis y adenocarcinoma colónico, que desarrolló insuficiencia aórtica grave aguda. Fue sometida a cirugía de reemplazo valvular aórtico y posteriormente a resección tumoral (hemicolectomía derecha). Es importante destacar la necesidad de complementación del estudio del colon, aun en individuos asintomáticos, cuando diagnosticamos endocarditis infecciosa por S. bovis.

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Spontaneous bacterial peritonitis (SBP) is a frequent and severe complication that occurs in patient with cirrhosis and ascites. It occurs in 10 percent to 30 percent of patients admitted to hospital. The organisms that cause SBP are predominantly enteric. Escherichia coli is the most frequent recovered pathogen, and Gram-positive bacteria, mainly Staphylococcus spp., are being considered an emerging causative agent of SBP. Streptococcus bovis that may be found as part of the commensal bowel flora in about 10 percent of healthy adults constitute an uncommon cause of peritonitis that was first reported in 1994. We describe the first case of SBP at the University Hospital of Santa Maria (HUSM) caused by S. bovis, resistant to the antibiotics erythromycin and clindamycin (inducible clindamycin resistance detected by disk diffusion test using the D-zone test).

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