Advertisement

Gemella morbillorum bacteremia associated with adenocarcinoma of the cecum

      To the Editor
      The association between bacteremia and gastrointestinal neoplasms is well known. Since the first association between Streptococcus bovis bacteremia and colonic neoplasms was reported in 1977 (
      • Klein R.S.
      • Recco R.A.
      • Catalano M.T.
      • et al.
      Association of Streptococcus bacteremia, and underlying gastrointestinal disease.
      ), other streptococcal species and bacteria associated with underlying colonic malignancy include S. sanguis, S. salivarius, S. equinus, S. milleri, S. agalactiae, group G streptococci, and Clostridium septicum(
      • Marinella M.A.
      Streptococcus sanguis bacteremia associated with cecal carcinoma case report and review of the literature.
      ,
      • Legier J.F.
      Streptococcus salivarius meningitis and colonic carcinoma.
      ,
      • Gilon D.
      • Moses A.
      Carcinoma of the colon presenting as Streptococcus equinus bacteremia.
      ,
      • Rich M.W.
      • Radwany S.M.
      Streptococcus milleri septicemia in a patient with colorectal carcinoma.
      ,
      • Wiseman A.
      • Rene P.
      • Crelinsten G.L.
      Streptococcus agalactiae endocarditis an association with villous adenomas of the large intestine.
      ,
      • Kornbluth A.A.
      • Danzig J.B.
      • Bernstein L.H.
      Clostridium septicum infection and associated malignancy. Report of 2 cases and review of the literature.
      ). We report an association between Gemella morbillorum and colon cancer.
      An 89-year-old woman came to the emergency room because of generalized body weakness and a nonproductive cough of 3 weeks’ duration. She reported vague, lower abdominal pains, as well as significant weight loss over the past few months. She reported no hematemesis, vomiting, jaundice, melena, hematochezia, or change in stool habits. Her medications included aspirin and nonsteroidal anti-inflammatory agents. There was no family history of malignancies. On admission, her vital signs were normal except for an oral temperature of 39.4°C. Examination of her heart and lungs was unremarkable. Her abdomen was slightly distended, and no masses were palpable. A rectal examination revealed no masses and heme-negative stools.
      Laboratory data included a white blood cell count of 19,100 ×103 cells per μL with 85% neutrophils, hemoglobin of 10.4 with mean corpuscular volume of 82 fL, and normal platelets. Liver function tests were normal. Radiographs of the chest and abdomen were unremarkable. A sonogram of the liver, gallbladder, and pancreas revealed a normal-size liver with no gallstones and a normal pancreas. Results of urine cultures were negative. Blood cultures later revealed growth of G. (Streptococcus) morbillorum. A subsequent colonoscopy revealed a fungating mass in the cecum. Biopsy specimens showed a well-differentiated adenocarcinoma. A transesophageal echocardiogram showed a calcified mitral annulus, no vegetations, and normal left ventricular function. The patient improved greatly after a 2-week course of intravenous penicillin and gentamycin therapy, and results of repeat blood cultures were negative. She refused to undergo surgery or chemotherapy for the colon cancer.
      How neoplasms of the colon predispose to bacteremia is not understood. The normal intestinal barrier may be disrupted in neoplastic tissues, permitting bacterial translocation into the blood stream (
      • Diethch E.A.
      • Berg R.
      Bacterial translocation from the gut a mechanism of infection.
      ). Gemella morbillorum is a commensal organism in the gastrointestinal, respiratory, and genitourinary tracts in humans. Human infections are rare, but the spectrum of disease is very similar to that caused by S. viridans. Isolated cases of endocarditis, septic shock, arthritis, and meningitis have been reported (
      • Debast S.B.
      • Koot R.
      • Mas J.F.
      Infections caused by Gemella morbillorum.
      ,
      • Omran Q.
      • Wood C.A.
      Endovascular infection and septic arthritis caused by Gemella morbillorum.
      ). Treatment consists of intravenous penicillin and gentamycin. Gemella morbillorum is now on the list of bacteria that should lead to a search for an underlying colonic neoplasm.

      References

        • Klein R.S.
        • Recco R.A.
        • Catalano M.T.
        • et al.
        Association of Streptococcus bacteremia, and underlying gastrointestinal disease.
        Arch Intern Med. 1977; 297: 800-802
        • Marinella M.A.
        Streptococcus sanguis bacteremia associated with cecal carcinoma.
        Am J Gastroenterol. 1997; 92: 1541-1542
        • Legier J.F.
        Streptococcus salivarius meningitis and colonic carcinoma.
        South Med J. 1991; 84: 1058-1059
        • Gilon D.
        • Moses A.
        Carcinoma of the colon presenting as Streptococcus equinus bacteremia.
        Am J Med. 1989; 86: 135-136
        • Rich M.W.
        • Radwany S.M.
        Streptococcus milleri septicemia in a patient with colorectal carcinoma.
        Eur J Clin Microbiol Infect Dis. 1993; 12: 225
        • Wiseman A.
        • Rene P.
        • Crelinsten G.L.
        Streptococcus agalactiae endocarditis.
        Ann Intern Med. 1985; 103: 893-894
        • Kornbluth A.A.
        • Danzig J.B.
        • Bernstein L.H.
        Clostridium septicum infection and associated malignancy. Report of 2 cases and review of the literature.
        Medicine (Baltimore). 1989; 68: 30-37
        • Diethch E.A.
        • Berg R.
        Bacterial translocation from the gut.
        J Burn Care Rehab. 1987; 8: 475-482
        • Debast S.B.
        • Koot R.
        • Mas J.F.
        Infections caused by Gemella morbillorum.
        Lancet. 1993; 342: 560
        • Omran Q.
        • Wood C.A.
        Endovascular infection and septic arthritis caused by Gemella morbillorum.
        i. 1993; 16: 131-134