Spontaneous group b streptococcal bacteremia complicating hepatic cirrhosis - Report of two cases

Two instances of Group B beta-hemolytic streptococcal sepsis accompanying hepatic cirrhosis are reported. The first patient is a 54-year-old female with postnecrotic cirrhosis (proved at autopsy), who manifested a primary bacteremia without a demonstrable septic focus; her infection was arrested with penicillin therapy, but she succumbed to the hemorrhagic complications of her underlying disease. The second patient, a chronic alcoholic female with probable Laennec's cirrhosis, entered in a hypothermic and leukopenic state with both a bacteremia and infected ascites; she quickly died of overwhelming sepsis despite specific therapy. It is emphasized that "primary" peritonitis and bacteremia accompanying hepatic cirrhosis are typically caused by coliform organisms and that these are presumed to be of enteric origin. The Group B Streptococcus, by contrast, is an uncommon and usually nonenteric species of low virulence that is implicated characteristically in neonatal sepsis and puerperal infection, and less commonly in diabetic gangrene. Its capacity to become a pathogen in the setting of hepatic cirrhosis is thus taken as further evidence for an as yet poorly understood defect of host defense mechanisms in this condition.