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Infective Endocarditis — SCE Infectious Diseases MCQ

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ModerateBone & Joint InfectionInfective EndocarditisSCE Infectious Diseases

A 60-year-old woman with a prosthetic mitral valve develops Streptococcus gallolyticus (formerly S. bovis biotype I) endocarditis confirmed by TOE and blood cultures. What additional investigation should be performed as a priority?

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Correct answer: C — Colonoscopy to exclude colorectal neoplasia

S. gallolyticus (S. bovis biotype I) bacteraemia and endocarditis have a strong association with colorectal neoplasia (adenoma or carcinoma). Current guidelines recommend colonoscopy in all patients with S. gallolyticus bloodstream infection, even in the absence of gastrointestinal symptoms. This association is distinct from other viridans group streptococci. CT head for mycotic aneurysm is reasonable in endocarditis but is not the priority unique to this organism.

Reference: ESC 2023 – Endocarditis guidelines; BSG 2020 – Colorectal cancer screening