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Septic shock caused by Streptococcus bovis in a haemodialysis patient
Shock séptico por Streptococcus bovis en paciente en Hemodiálisis
Pilar Galindoa, Almudena Péreza, Carla Ferreiraa, Elena Zarcoa, Elena Vaqueroa
a Servicio Nefrología, H.U. Virgen de las Nieves, Granada, Granada, España,
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    "textoCompleto" => "<p class="elsevierStylePara">Dear Editor&#58;</p><p class="elsevierStylePara">In patients with chronic renal failure in substitutive treatment&#44; cardiovascular pathology is assumed to be the primary cause of morbi-mortality&#44; followed by infection&#46;<span class="elsevierStyleSup">1</span> Hypoalbuminaemia&#44; catheter holders and other factors predispose these patients to infections which are much more serious than in the general population&#46;<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup"></span>Streptococcus bovis is a Lancefield group D streptococcus which has properties in common with enterococcus and some streptococci of the Viridans group&#44; although it differs from these in habitat and clinical significance&#46; It is usually found in bovine livestock intestine and can contaminate through faeces&#44; water and food of animal origin&#46;<span class="elsevierStyleSup">3</span> As a human pathogen&#44; it gives rise to bacteremia and endocarditis&#44; particularly in elderly patients with chronic disease&#46; It is associated with adenoma&#44; colorectal carcinoma and liver disease&#59; it therefore appears to be related to the habitual point of entry for bacteria&#58; the gastrointestinal system&#46;<span class="elsevierStyleSup">4</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup"></span>Streptococcal peritonitis has been described in patients in substitutive treatment with peritoneal dialysis&#59; however&#44; the Viridans group is more common&#46;<span class="elsevierStyleSup">5</span></p><p class="elsevierStylePara"><span class="elsevierStyleSup"></span>We describe the case of a 77 year old patient suffering from terminal chronic renal failure as a result of probable nephrosclerosis&#44; who had started periodical haemodialysis four years earlier&#44; with significant associated comorbidity&#58; myocardial ischaemia&#44; aneurysm of the abdominal aorta subject to intervention ten years previously and HCV-positive antibodies&#46; Splenectomised for thrombocytopenic purpura since the age of 60&#46; Three months prior to admission the patient presented with gastroenteritis with fever after ingesting shellfish &#40;oysters&#41; which required hydration and was treated with ciprofloxacin&#46;</p><p class="elsevierStylePara">Having previously been well and having eaten out twice that day&#44; the patient attended at dawn&#44; presenting with elevated fever and general ill health&#46; After taking blood cultures and a basic laboratory test&#44; empirical treatment with cefotaxime and gentamicin was started&#46; Pancytopenia was detected&#44; which had not been present four days previously at the monthly checkup&#46; A session of haemodialysis was required for hyperpotassaemia&#46; Hypotension persisted despite vasoactive drugs&#44; and the patient died within hours&#46;</p><p class="elsevierStylePara">Streptococcus bovis was later isolated in the blood culture&#46;</p><p class="elsevierStylePara">We were struck by the speed of the condition&#191;s progress in a patient who had been in a good clinical situation beforehand&#46;</p><p class="elsevierStylePara">The HCV-positive serology and the previous gastroenteritis were possible predisposing factors in the appearance of streptococcus-induced bacteremia&#46; Given that no autopsy was performed&#44; we cannot know if valvular lesions &#40;endocarditis&#41; or lesions on the prosthetic aorta were present&#44; or if organic intestinal pathology existed&#46;</p><p class="elsevierStylePara">Faced with bacteremia in patients with renal failure which also presents liver or intestinal disease&#44; we should consider the possibility of Streptococcus bovis and begin early treatment with penicillin or vancomycin&#46; A speedy introduction of specific antibiotic therapy is fundamental in avoiding the onset of septic shock&#44; which in our case had a fatal outcome in a few hours&#46;<br></br></p>"
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