This study aimed to describe the incidence of Streptococcus bovis/Streptococcus equinus complex (SBSEC) bacteremia, distribution of the SBSEC subspecies, and their respective association with colorectal cancer (CRC). A population-based retrospective cohort study of all episodes of SBSEC-bacteremia from 2003 to 2018 in Skåne Region, Sweden. Subspecies was determined by whole-genome sequencing. Medical charts were reviewed. The association between subspecies and CRC were analysed using logistic regression. In total 266 episodes of SBSEC-bacteremia were identified and the average annual incidence was 2.0 per 100 000 inhabitants. Of the 236 isolates available for typing, the most common subspecies was S. gallolyticus subsp. pasteurianus 88/236 (37%) followed by S. gallolyticus subsp. gallolyticus 58/236 (25%). In order to determine the risk of cancer following bacteremia, an incidence cohort of 174 episodes without a prior diagnosis of CRC or metastasised cancer was followed for 560 person-years. CRC was found in 13/174 (7%), of which 9 (69%) had S. gallolyticus subsp. gallolyticus-bacteremia. In contrast to other European studies, S. gallolyticus subsp. pasteurianus was the most common cause of SBSEC-bacteremia. CRC diagnosis after bacteremia was strongly associated with S. gallolyticus subsp. gallolyticus-bacteremia. Identification of SBSEC subspecies can guide clinical decision-making regarding CRC work-up following bacteremia.

The influence of a diet of either pasture or hay on the development of lactic acidosis in sheep was investigated using a grain challenge approach. Twenty-four Merino wethers with a mean live weight of 36·7 (s.e.3·6) kg were used; 12 were adapted to grass pasture and 12 to hay (lucerne and oaten hay, 60: 40) for 4 weeks before being given 1 kg of crushed barley via stomach tube. Six sheep in each group were also given virginiamycin (VM; 50 mg/kg barley) with the grain to test the efficacy of this antibiotic in controlling the bacteria responsible for the development of acidosis. Changes in volatile fatty acid (VFA), pH, lactate and bacterial count in the rumen and faecal pH and dry matter (DM) were measured for a 24-h period following administration of the barley. Daily intakes of hay were measured for a 10-day period following grain engorgement. Total ruminal VFA increased (P < 0·01) over time and tended (P = 0·08) to be higher in sheep adapted to hay than in those adapted to pasture (67·5 v. 59·8 mmol/l). The molar proportions of VFA changed (P < 0·01) over time in favour of propionate in both groups. Ruminal pH was higher (P < 0·001) in pasture-adapted sheep, but declined (P < 0·001) in both groups over time following the introduction of barley. This decline in pH was associated with increases in ruminal concentration of VFA in pasture-adapted sheep and VFA and lactate in hay-adapted sheep. The addition of VM resulted in a higher (P < 0·001) proportion of propionate and a trend towards higher (P = 0·24) faecal pH and DM content. Faecal pH and DM content declined (P < 0·001) over time and was lower for the pasture-adapted sheep. The introduction of either barley alone or barley with VM from both hay and pasture diets increased (P < 0·05) the viable counts of total bacteria, Streptococcus bovis and lactic acid bacteria. Bacterial isolates were purified and identified by complete sequencing of the 16S rRNA gene to determine the predominant bacteria during the overfeeding of grain. Isolates from medium selective for S. bovis were all identified as this species when VM was not given. VM had no effect on counts of viable bacteria, but inhibited the growth of S. bovis.

This study has shown that sheep given hay are more susceptible to lactic acidosis, the signs of which can be reduced by VM.

Bacteraemia or endocarditis caused by Streptococcus bovis, a non-enterococcal group D streptococcus, is a very common finding in patients suffering from intestinal tumours or other colon diseases. A case of a patient with a lateral neck abscess caused by S. bovis is reported. During the treatment the patient was found to have colonic malignant lesions. The problems in the appropriate diagnosis and the possible correlation between these two clinical entities are presented and discussed.