RE: Group B streptococcal endocarditis following elective surgical abortion

I read with great interest the case report by Billick and Gold, entitled “Group B streptococcal endocarditis following elective surgical abortion” [1]. I would like to contribute some important and relevant points to this report, which are based on my experience.
I encountered a similar case of Group B streptococcal (Streptococcus agalactiae) infective endocarditis (IE) that occurred 2 years after transcatheter aortic valve implantation (TAVI). The patient was an elderly woman who presented to our department with a 3-day history of high fever and a 1-week history of general malaise and diarrhea. Since severe bacterial sepsis of unknown focus was suspected, a broad-spectrum antibiotic was started, with a favorable response to the treatment. The patient had frequent episodes of watery diarrhea after hospitalization, but the diarrhea and her general condition improved within a few days. Gram-positive cocci from 2 blood cultures suggested IE. Transesophageal echocardiography revealed vegetation on the implanted valve, which confirmed the diagnosis. The patient underwent emergency aortic valve replacement and was discharged without complications.
IE caused by S. agalactiae is rare and progresses rapidly, leading to a severe, life-threatening condition. [2] Early cardiac surgery is generally required. Since S. agalactiae is an indigenous bacterium mainly colonizing the vagina and colon, it can behave as a pathogen after gynecological surgery, as seen in the case reported by Billick and Gold. Hence, clinicians should be aware that S. agalactiae can cause sepsis in a patient with a prior episode of lower gastrointestinal symptoms such as diarrhea and hematochezia.

Written informed consent was obtained from the patient for publication of this case.