[Endocarditis caused by Streptococcus bovis and colorectal neoplasms]. / Endocardite por Streptococcus bovis e neoplasias do cólon e reto.

PURPOSE: To evaluate the association of Streptococcus bovis endocarditis with large bowel neoplasms. PATIENTS AND METHOD: Twenty episodes (19 patients) of Streptococcus bovis endocarditis (5.05%) selected from 396 episodes of endocarditis followed up from 1978 to 1990. The mean age was 57.68 years, 16 (84.21%) were males. Previous heart disease was not known in nine (45%). Previous manipulation that might induce bacteremia was identified in three patients. Symptoms related to neoplasia of the digestive system were not informed. The mean time of follow up (17 cases) was 33.76 months, standard deviation 27.37 months. Sixteen patients were submitted to colonic evaluation (barium enema in 11, colonoscopy in 5 patients, and both were performed in 5 patients). RESULTS: Bowel neoplasias were diagnosed in 12 (75%) of 16 patients submitted to colonic evaluation, one colonic adenocarcinoma in one (8.33%), patient, histologic benign polyps in eight (66.6%). Two patients are waiting for colonoscopic resection. In one patient the polyp was lost after colonoscopic resection. CONCLUSION: The high incidence of large bowel neoplasia in patients with Streptococcus bovis endocarditis indicates that evaluation of the large bowel must be performed on in patients with S. bovis endocarditis in order to diagnose neoplasias, even in the absence of symptoms of bowel disease.

Endocardite por estreptococo do grupo D (S. bovis e S. faecalis) e tumor de colon. Apresentação de dois casos / Endocarditis due to group D Streptococcus (Sbovis and S faecalis) and tumor of the colon.Report of 2 cases

Sao relatados 2 casos de pacientes com endocardite infecciosa e tumor de tubo digestivo. No primeiro caso, um paciente de 50 anos, o agente etiologico foi o Steptococcus bovis e foram identificados multiplos adenomas vilosos a partir do enema opaco, realizado por ser este o agente etiologico. No outro caso, um paciente de 55 anos de idade apresentou endocardite por S. faecalis e insuficiencia cardiaca severa, necessitando de implante de bioprotese mitral e aortica.A persistencia de anemia prolongada apos a operacao levou a realizacao de enema opaco identificando-se falha de enchimento no angulo hepatico de colon, sendo o paciente submetido a hemicolectomia direita por adenocarminoma tubular, bem diferenciado. Os autores sublinham a necessidade de identificar os estreptococos ate a especie e a necessidade de investigacao do tubo digestivo no caso de identificacao de Streptococcus bovis, mesmo na ausencia de sintomas do tubo digestivo