A 44 year old man, was operated on 3 years ago for PVR of the mitral valve (rheumatic stenosis). After 1.5 years he presented an atrial fibrillation, treated with Amiodarone, and after he developed a hyperthyroid state (resolved at present).
Also, in the moment of hyperthyroid state, this patient was treated for an infection of upper airways (= amoxicillin + clavulanic acid 625 mg x 3 times per day – 2 days; but fever was still present; than = cefuroxime axetil 500 mg 1 tab x 2 times per day – 5 days; than = Ceftriaxone 2 gr per day i/v -7 days).
After one month the fever is back. The recommended treatment was with Moxifloxacin 400 mg intravenous- 3 days + 4 days PO; fever disappeared again. The patient continued to take prednisolone ( for cordarone hyperthyreosis). After another month, fever appeared again, with a non-significant sore throat.
At this moment it was performed blood culture (suspect ion for endocarditis.
At echo of heart no signs of endocarditis. In blood: Streptococcus gallolyticus multi sensible. Body scan was performed to determine the origin of this bacteria: all clean.
To treat this bacteremia a treatment with antibiotic was started:
Cefuroxime axetil 500 mg x 2 times per day – 7 days
Ciprofloxacin 500 mg x 2 times per day – 10 days
Moxifloxacin 400 mg IV – 5 days + 12 days PO.
After each scheme of treatment with antibiotics in blood culture was find Streptococcus gallolyticus with the same sensitivity. Clinically patient presents only fever, which disappear during antibiotherapy and is back after stop of this therapy.
It was suspected colon carcinoma (origin of persistent Str. gallolyticus described in the literature), but it was excluded after colonoscopy.
Did you have same situation in your practice: persistent bacteremia with Streptococcus gallolyticus without response to antibiotic treatment?
What you think about the origin of persistent bacteremia?
What an unfortunate patient. I had a group B streptococcal sepsis infant with recurrence of the infection 3 weeks after completing a 3 weeks course. Our ID expert told me there are occasions that GBS has recurrent infection. Group D step has some similarity to GBS and it is possible that the germ is colonized in his bowel.
Dear colleague, origins of recurrent of Streptococcus gallolyticus bacteremia in your patient would be an endovascular infection (endocarditis or micro-abscess intra vasculaire). I think a fistula digestive-vascular should be explored, it could be a cause of recurrent bacteremia. The Pet-TDM may help you to find some case of endocarditis that can't be done by echocardiography.
Other case of immunodeficiency such as asplenia, solid cancer or hypogammaglobulinemia were a risk factor of recurrent bacteremia.
Your sincerely,
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