From the Guidelines
There is a significant association between Group G streptococcal (GGS) endocarditis and gastrointestinal (GI) malignancy, and patients diagnosed with GGS endocarditis should undergo comprehensive GI cancer screening. This association is highlighted in the most recent guidelines, which emphasize the importance of colonoscopy and other imaging studies to detect potential malignancies or mucosal lesions in patients with GGS endocarditis 1. The connection between GGS endocarditis and GI malignancy is thought to be related to the ability of these streptococci to enter the bloodstream through compromised intestinal mucosa in patients with colorectal cancer or other GI tumors.
Key Considerations
- Patients with GGS endocarditis should be treated with intravenous penicillin G (4 million units every 4 hours) or ceftriaxone (2g daily) for 4-6 weeks, often combined with gentamicin (1mg/kg every 8 hours) for the first 2 weeks 1.
- For penicillin-allergic patients, vancomycin (15-20mg/kg every 12 hours) is recommended 1.
- Comprehensive GI cancer screening, including colonoscopy and appropriate imaging studies, is essential for patients diagnosed with GGS endocarditis, even without obvious GI symptoms 1.
- Treatment should address both the endocarditis and the underlying malignancy, with close monitoring for complications such as heart failure, embolic events, or metastatic infection.
Evidence-Based Recommendations
The most recent guidelines from the American Heart Association emphasize the importance of prompt treatment and comprehensive GI cancer screening for patients with GGS endocarditis 1. These recommendations are based on the evolving taxonomy of viridans group streptococci and the biological characteristics that may complicate diagnosis and therapy. The guidelines also highlight the need for individualized treatment approaches, taking into account the specific characteristics of the infecting organism and the patient's underlying health status.
Clinical Implications
The association between GGS endocarditis and GI malignancy has significant implications for clinical practice. Patients diagnosed with GGS endocarditis should be managed by a multidisciplinary team, including cardiologists, infectious disease specialists, and oncologists. Close monitoring for complications and regular follow-up appointments are essential to ensure optimal outcomes for these patients. By prioritizing comprehensive GI cancer screening and individualized treatment approaches, clinicians can improve morbidity, mortality, and quality of life for patients with GGS endocarditis.
From the Research
Association between Group G Streptococcal Endocarditis and Gastrointestinal Malignancy
- There is evidence to suggest an association between Group G streptococcal (GGS) endocarditis and gastrointestinal (GI) malignancy, as reported in a case study where a 72-year-old male presented with severe sepsis, iron deficiency anemia, and newly diagnosed cardiac murmur, which was later confirmed to be group G streptococcus bacteremia, infective endocarditis, and newly diagnosed carcinoma of the colon 2.
- This association is also observed in other types of streptococcal infections, such as Group D Streptococcus bovis, which is commonly reported in association with carcinoma of the colon 2.
- However, not all studies have investigated the specific association between GGS endocarditis and GI malignancy, with some focusing on the clinical characteristics and treatment of GGS endocarditis 3, 4, 5.
- A study on penicillin-resistant viridans group streptococci, which includes Group G streptococci, reported on the characteristics of patients with infective endocarditis caused by these bacteria, but did not specifically investigate the association with GI malignancy 6.