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Int J Med Microbiol. 2014 May;304(3-4):262-8. doi: 10.1016/j.ijmm.2013.10.004. Epub 2013 Oct 20.

Viridans and bovis group streptococci that cause infective endocarditis in two regions with contrasting epidemiology.

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Department of Microbiology, PG Institute of Basic Medical Sciences, University of Madras, Chennai 600113, Tamil Nadu, India.
German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, D-52074 Aachen, Germany.
Department of Medical Microbiology, Helmholtz Centre for Infection Research, D-38124 Braunschweig, Germany. Electronic address:


Viridans group (VGS) or bovis group streptococci (BGS) are the major causes for streptococcal infective endocarditis (IE). However, the causative isolates are not sufficiently characterized. Using multilocus sequence analysis we have examined VGS and BGS (VGS/BGS) isolates that caused IE in southern India and Germany, two distant geographic regions with a contrasting IE epidemiology. Other than in Germany, the majority of patients (68%) in Chennai, southern India had an underlying rheumatic heart disease (RHD). In accord with the high prevalence of RHD in the younger population and with the expansive age structure of India, the median age (24 years) of the VGS/BGS endocarditis patients was lower than in Germany (63 years), where RHD is rare and the age structure is contractive. Both in Germany and in southern India, the majority of cases were caused by mitis group streptococci, however, with considerable differences in the spectra of causative (sub)species. BGS endocarditis was more frequent in Germany. The spectrum of VGS/BGS that cause IE differs considerably between distant geographic regions in which different predisposing conditions prevail. Therefore, improved microbiological diagnosis in IE may facilitate determination of the optimal therapy.


MLSA; Non-beta hemolytic; Rheumatic fever; Rheumatic heart disease; Streptococcus

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