title: Streptococcus bovis septic arthritis and osteomyelitis: A report of 21 cases and a literature review.
abstract: The Streptococcus bovis group (SBG) is a well-known cause of endocarditis, but its role in osteoarticular infections (OAIs) has not been well described.
  
  
  
  We analyzed all patients with OAIs by SBG diagnosed in our hospital (1988-2014). We selected those cases with septic arthritis and osteomyelitis, as defined according to clinical, microbiological, and imaging studies. Identification of the strains was performed by using the API 20 Strep and the GP card of the Vitek 2 system, and confirmed the identification by molecular methods. In addition, we reviewed the literature to select all cases of OAI by SBG during the period 1980-2015.
  
  
  
  From the 83 cases of OAI included in the analysis (21 from our center and 62 from the literature review), 59 were osteomyelitis (57 of them spondylodiscitis) and 24 were arthritis (2 with associated spondylodiscitis). The mean age was 66.9 years, and 79.2% of the patients were men. Endocarditis (IE) was associated with 59% of the cases and this association was greater for osteomyelitis than for arthritis (78.9% vs. 13.6%; P = 0.001). OAI was a presenting symptom in 63% of the cases of IE. Colonoscopy was performed in 64 cases, which detected colorectal neoplasm (CRN) in 46 patients (71.8%), almost all asymptomatic. Some 69.5% of these neoplasm were carcinomas or advanced adenomas. The blood cultures were positive in 78.3% cases. In 45 cases, the S. bovis species was identified; in 82.2% of the cases the cause was Streptococcus gallolyticus subsp. gallolyticus. The mortality was 7.2%, which in no case was attributable to the OAI.
  
  
  
  OAIs are frequently the initial manifestation of IE caused by SBG. S. gallolyticus causes most of these infections. Echocardiogram and colonoscopy are therefore mandatory, given the species' close association with IE and CRN.
authors.affiliation: Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: García-País
authors.affiliation: Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain. Electronic address: ramon.rabunal.rey@sergas.es.
authors.forename: Ramón
authors.initials: R
authors.lastname: Rabuñal
authors.affiliation: Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Armesto
authors.affiliation: Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: López-Reboiro
authors.affiliation: Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: García-Garrote
authors.affiliation: Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Amparo
authors.initials: A
authors.lastname: Coira
authors.affiliation: Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Pita
authors.affiliation: Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Ana Isabel Bd
authors.initials: AI
authors.lastname: Rodríguez-Macías
authors.affiliation: Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: López-Álvarez
authors.affiliation: Department of Radiology, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Alonso
authors.affiliation: Infectious Disease Unit, Hospital Universitario Lucus Augusti, Lugo, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Corredoira
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D002277:Carcinoma / Q000150:complications* / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis; D015299:Discitis / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D004322:Drainage; D004697:Endocarditis, Bacterial / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D013290:Streptococcal Infections / Q000150:complications* / Q000382:microbiology / Q000628:therapy; D016985:Streptococcus bovis; D000070197:Streptococcus gallolyticus subspecies gallolyticus
chemical_list: D000900:Anti-Bacterial Agents
keywords: Arthritis, Infectious; Colorectal neoplasms; Osteomyelitis; Spondylitis; Streptococcus bovis