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S. gallolyticus-based assays needed in colorectal cancer screening programs
Boleij A. Clin Infect Dis. 2011;53:870-878.
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Streptococcus bovis should no longer be regarded as a single species in clinical practice because S. bovis biotype I, or S. gallolyticus infection, has an explicit association with colorectal cancer, according to researchers from the Netherlands.
“Our data show that S. gallolyticus infection has a significant association with colonic adenomas and carcinomas,” Harold Tjalsma, PhD, of the Radboud University Center for Oncology in the Netherlands, told Infectious Disease News. “This association is surprisingly lower for the closely related bacterium S. infantarius. As both species were often classified as S. bovis, one can imagine that the overall association between S. bovis and colorectal cancer has systematically been underestimated. With this study, we want to emphasize that proper and consistent microbial classification is crucial to understand the full impact of these bacterial infections in colorectal cancer patients.”
Tjalsma and colleagues conducted a systematic review of all studies that assessed the association between S. bovis, infective endocarditis and colorectal cancer. A search of the PubMed database revealed 52 case reports and 31 case series; 11 of which were used for meta-analysis on the association between S. bovis biotype, infective endocarditis and adenomas or carcinomas.
Of the S. bovis-infected patients who underwent colonic evaluation, 60% of patients (interquartile range [IQR], 22%) had concomitant adenomas or carcinomas. “This significantly exceeds the disease rate reported in the general asymptomatic population,” the researchers wrote.
Compared with S. bovis biotype II-infected patients, those with S. bovis biotype I had a significantly increased risk for colorectal cancer (OR=7.26; 95% CI, 3.94-13.36) and infective endocarditis (OR=16.61; 95% CI, 8.85-31.16). Colorectal cancer was more common among those with S. bovis infective endocarditis vs. those with S. bovis-infection elsewhere (OR=3.72; 95% CI, 2.03-6.81).
“Our study advocates full bowel examination in all patients who are diagnosed with S. gallolyticus infection, and clinicians should be aware of this new nomenclature,” Tjalsma said. “Furthermore, we hope that our study stimulates clinical microbiology labs to perform additional subtyping when a S. bovis strain has been found. To fully exploit the presence of S. gallolyticus as intestinal biosensor for colorectal cancer, molecular tools need to be established to accurately monitor these subclinical infections. Novel S. gallolyticus-based assays may be implemented in colorectal cancer screening programs and eventually aid in early detection, which is crucial in the battle against this disease.” – by Ashley DeNyse
Disclosure: This work was supported by the Dutch Cancer Society (KWF; project KUN 2006-3591 to A. B.).
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