bovis, were in fact S. gallolyticus. Therefore, they suggested that S. gallolyticus is more likely to be involved in human infections than S. bovis [10]. The wide range of the association rates between S. bovis/gallolyticus and colorectal cancer might be attributed to different geographical and ethnic groups studied so far [47]. In a study conducted in Hong Kong, S. bovis biotype II/2 (S. gallolyticus subspecies pasterianus), rather than biotype I (S. gallolyticus subspecies gallolyticus),

was found to be dominantly associated with colorectal tumors [48] while, in Europe and the USA, S. gallolyticus subspecies gallolyticus is dominantly associated Pictilisib clinical trial with colorectal tumors [10, 47]. Beside the characteristic adhesive traits of S. bovis/gallolyticus to the intestinal cells, it is also known that, in contrast to most α-haemolytic streptococci, S. bovis/gallolyticus is able to grow in bile [49] Therefore, unlike other bacteria, S. bovis/gallolyticus can bypass efficiently the hepatic reticulo-endothelial

system and access systemic circulation easily which might explain the route responsible for the association between selleck chemicals S. bovis/gallolyticus colonic lesions and S. bovis/gallolyticus bacteremia [50]. In this regard, an association was found between S. bovis/gallolyticus bacteraemia/endocarditis and liver disease [50]. The prevalence of chronic liver disease in Selleck LY2874455 patients with S. bovis/gallolyticus endocarditis was significantly higher than in Methamphetamine patients with endocarditis caused by another aetiology (60% vs 15.3%) [51]. The rate of simultaneous occurrence of liver disease and colon cancer in patients with S. bovis/gallolyticus endocarditis/bacteraemia was found to be 27% [4]. Therefore, it was inferred that the association of S. bovis/gallolyticus bacteraemia/endocarditis with colorectal neoplasia indicates special pathogenic traits of this bacteria rendering it capable of entering blood circulation selectively

through hepatic portal route. Accordingly, it was recommended that the liver as well as the bowel should be fully investigated in patients with S. bovis/gallolyticus endocarditis/bacteraemia [4, 50–52]. Nevertheless, this does not exclude the possibility that other intestinal bacteria might be associated with colon cancer; a rare report stated that cases of Klepsiella pneumoniae liver abscess were found to be associated with colon cancer [53, 54]. The extra colonic affection of S. bovis/gallolyticus bacteria Beside infective endocarditis, case reports suggested the possibility of infections by S. bovis/gallolyticus in various sites outside colorectum such as osteomyelitis, discitis [55] and neck abscess [56] which could be linked to colonic malignancy or malignancies in other locations. Although many studies suggested that infective endocarditis is the commonest manifestation of S.