Streptococcus bovis infection in young infants

Background: Sporadic cases of invasive Streptococcus bovis disease have been reported in young infants. However, little is known about the clinical manifestations or the conditions that predispose to S. bovis infection in this population. Objective: The objective of this case series and review of the literature was to describe cases of S. bovis infection treated at 2 children's hospitals and compare patients evaluated at our institutions with those reported in the literature. Results: Seven infants with S. bovis infection were treated at our institutions: 4 of the patients had S. bovis meningitis and 3 of these also had S. bovis bacteremia. Five of the patients had signs of gastrointestinal disturbance at presentation. None of the 7 patients died. Twenty-three patients with S. bovis infection reported in the literature had meningitis with concurrent bacteremia (n = 9), bacteremia alone (n = 9), meningitis alone (n = 4), and pneumonia with overwhelming sepsis (n = 1). Six (26%) of the patients reported in the literature died as a consequence of S. bovis infection. The difference in median age between our patients (14 days; range, 1-43 days) and those reported in the literature (3 days; range, 1-60 days) was not statistically significant (P = 0.49). Abdominal distention was more commonly noted among patients in our series (71%) than among patients reported in the literature (10%; odds ratio = 21.3; 95% confidence interval = 1.7-319.0). Conclusions: Bacteremia and meningitis were the most common manifestations. Gastrointestinal disturbance was common among patients in our series. The mortality rate from S. bovis infection appears to be lower than suggested by previous reports.