Research Article Open Access

Relationship between Streptococcus gallolyticus Infective Endocarditis and Pre-Neoplastic Colorectal Lesions

Pau Vilardell1, Sergio Moral1, Josep Maria Frigola1, Manel Morales1, Esther Ballesteros2, Xavier Salgado1, Antoni Castro1, Antoni Rubió2, Marc Abulí1 and Ramon Brugada3
  • 1 Hospital Universitari Doctor Josep Trueta, Spain
  • 2 Dirección Territorial de Radiologia i Medicina Nuclear de Girona, Spain
  • 3 Centro Investigación Biomédica en Red, Spain


Colorectal cancer is associated with Infective Endocarditis (IE) due to specific gut pathogens, such as Streptococcus gallolyticus subspecies, that use tumor presence as a point of blood entry. However, the association between Streptococcus gallolyticus related IE and pre-cancerous colorectal lesions like dysplastic adenomas is unclear. Seventy-one patients diagnosed with IE who underwent colonoscopy in the extension study during admission were included in a clinical, microbiological and imaging follow-up, between January 2008 and December 2020. Pre-cancerous lesions were divided as high and low-grade dysplasia based on World Health Organization criteria. Colorectal cancer was defined as the presence of malignant cell beyond the muscularis mucosa. Twenty-two IE patients (31%) presented colorectal lesions: 8 (36%) colorectal cancer and 14 (64%) pre-cancerous lesions [14% high degree (n = 2); 86% low degree (n = 12)]. Both, colorectal cancer (25% Vs 2%; p = 0.007) and pre-neoplastic lesions (50% Vs 2%; p<0.001) were related with higher prevalence of IE caused by Streptococcus gallolyticus. Additionally, the subgroup of low grade pre-cancerous lesions also showed this association (50% Vs 2%; p<0.001). Pre-cancerous colorectal lesions are associated with Streptococcus gallolyticus IE. These results suggest that high and low degree colorectal lesions may also act as a gateway for gut pathogens.

American Journal of Infectious Diseases
Volume 17 No. 3, 2021, 88-96


Submitted On: 15 April 2021 Published On: 28 May 2021

How to Cite: Vilardell, P., Moral, S., Frigola, J. M., Morales, M., Ballesteros, E., Salgado, X., Castro, A., Rubió, A., Abulí, M. & Brugada, R. (2021). Relationship between Streptococcus gallolyticus Infective Endocarditis and Pre-Neoplastic Colorectal Lesions. American Journal of Infectious Diseases, 17(3), 88-96.

  • 2 Citations



  • Infective Endocarditis
  • Colorectal Cancer
  • Streptococcus gallolyticus
  • Gut Pathogens