IE and procedure indicated

Q: For patients who develop infective endocarditis (IE) due to group D streptococci and E. faecalis, which non-cardiac procedure should be performed? 



Answer: colonoscopy

Patients who get identified as IE due to group D streptococci ((Streptococcus bovis/Streptococcus equinus complex) and E. faecalis, a colonoscopy should be performed. Colon cancer is found to be highly associated with these patients. 

It is not fully clear why these bugs are highly associated with colon cancer but at least in case of group D streptococci, it is suggested that proteins presented in S. bovis biotype I bind to overexpressed ligands in colonic neoplasms. Simultaneously, S. bovis biotype I can form biofilms on collagen-rich surfaces of valve endothelium. 

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References: 

1. Boleij A, Muytjens CM, Bukhari SI, et al. Novel clues on the specific association of Streptococcus gallolyticus subsp gallolyticus with colorectal cancer. J Infect Dis 2011; 203:1101. 

2. Pericàs JM, Corredoira J, Moreno A, et al. Relationship Between Enterococcus faecalis Infective Endocarditis and Colorectal Neoplasm: Preliminary Results From a Cohort of 154 Patients. Rev Esp Cardiol (Engl Ed) 2017; 70:451. 

3. Escolà-Vergé L, Peghin M, Givone F, et al. Prevalence of colorectal disease in Enterococcus faecalis infective endocarditis: results of an observational multicenter study. Rev Esp Cardiol (Engl Ed) 2019.