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JOURNAL OF CLINICAL MICROBIOLOGY, Feb. 2009, p. 516 0095-1137/09/$08.00 0 doi:10.1128/JCM.01755-08

Vol. 47, No. 2

Association between Streptococcus bovis and Colon Cancer
We read with greatinterest the article by Marcella Beck and colleagues (1). We fully support their recommendation that proper distinction between the “Streptococcus bovis” strains belonging to Streptococcus gallolyticusand Streptococcus infantarius (previously biotypes I and II/2, respectively) should be made in future studies to obtain a clear picture of the disease associations of these opportunistic pathogens;above all, because proper bacterial classification and subsequent recognition of their association with colon cancer can be a life-saving event for S. bovis-infected individuals with undiagnosed coloncancer (4, 5, 8). We were therefore somewhat puzzled by the authors’ conclusion that the association between S. bovis bacteremia and colon cancer (7%) may not be as strong as previously thought. Beckand colleagues based their conclusion on the finding that 3 out of 46 individuals with S. bovis bacteremia presented with a coincidental colon carcinoma. The authors recognize, however, that only 15 ofthese 46 patients underwent full bowel examination and that in the other patients asymptomatic colon tumors could be missed. In two cited papers, Ruoff et al. (6) and Corredoira et al. (2) reportrespective associations of 100% and 57% for the association of S. bovis biotype I and colon cancer in patients that underwent colonoscopy. Importantly, these associations also took into account thepresence of premalignant adenomas that are generally regarded as (earlystage) precursors of carcinomas. In fact, Corredoira et al. (3) recently reported that upon examination by colonoscopy, 4 carcinomas and25 adenomas were detected in 46 S. bovis type I-infected patients (together, 63%). This confirms the notion that S. bovis can also associate with (pre)malignant colonic lesions, which in general do...