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Indian Journal of Cancer, Vol. 48, No. 3, July-September, 2011, pp. 375-376 Letter to Editor Streptococcus bovis bacteremia and colorectal carcinoma SP Maurya Department of Microbiology, Centre for Basic Sciences, Kasturba Medical College, Manipal University, Manipal, Karnataka, India Code Number: cn11102 PMID: 21921348 DOI: 10.4103/0019-509X.84924 Sir, There has been a close linkage between Streptococcus bovis bacteremia and tumors of human colon. [1],[2] However, this fecal bacterium is infrequently reported in microbiology laboratories. One of the reasons could be that the minimal test scheme followed for routine identification in most laboratories mis-identifies it as enterococci; and the pressure to send a report as soon as possible, along with high cost of automated identification systems, reduces the spectrum of more definitive identification. [3] We present here an entity that later proved to be Streptococcus bovis; and to the best of our knowledge, from India, this could be the first documented case of S. bovis bacteremia associated with colorectal carcinoma. Further, S. bovis bacteremia with such mis-identification has never been reported. This does not mean that cases of such mis-identification have not occurred previously. The finding is particularly important in a country where limitation of resources together with market competition leads laboratories to look for more common pathogens. A 59-year-old man with known history of rectal carcinoma completed adjuvant chemotherapy and radiotherapy a month back. He presented with severe intractable hiccoughs due to which he was unable to sleep the entire night. There was no history of fever, vomiting or abdominal pain. He was passing urine and stools normally. CT abdomen showed diffuse wall thickening with target appearance of the distal ileal loops with mild proximal dilatation of small-bowel loops. Features were suggestive of inflammatory wall thickening - likely to be radiation enteritis. The general physical and systemic examinations were unremarkable, not indicative of involvement of other organ systems. He was admitted and started on Piperacillin-Tazobactam, Amikacin, IV fluids, Potchlor, Rantac, Baclofen and Perinorm. His general condition improved slowly after 3 days. On discharge, the patient's condition was stable and hiccoughs decreased. The patient did not visit for follow-up. Meanwhile, blood BacT was sent for culture, which beeped positive for bacterial growth a day later. The organism was Gram-positive cocci, predominantly in pairs and short chains; catalase negative and bile esculine positive. The report was sent as enterococcus species grown in culture sensitive to ampicillin, gentamicin, doxycycline and erythromycin; and resistant to cotrimoxazole. The entire process took 3 days; and by this time, the patient had been discharged. We further evaluated our identification for the possibility of S. bovis. The result "negative growth in 6.5% NaCl nutrient broth" came 5 days later, and also the isolate hydrolyzed starch. We confirmed the isolate as Streptococcus bovis. Though not yet proven to be a causal relation, S. bovis has an active role in promoting intestinal carcinogenesis. [4] In the past, need for awareness of differences between enterococci and group D streptococci and for correct identification of isolates from patients with bacteremia and endocarditis has been emphasized. [3] However, the knowledge and importance of S. bovis in colon cancer have not been sufficiently translated into routine practice. [5] Acknowledgement I would like to thanks Dr. Vandana K.E., Department of Microbiology, Kasturba Medical College, Manipal, for her kind support in the performance of this study. References
Copyright 2011 - Indian Journal of Cancer |
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