Afebrile Multi-valve Infective Endocarditis Caused by <i>Lactococcus garvieae</i>: A Case Report and Literature Review

Abstract

Lactococcus garvieae is considered to be a rare pathogen with low virulence in humans. We herein experienced an unusual case of multi-valve infective endocarditis caused by L. garvieae in an elderly woman who had undergone bioprosthetic mitral valve replacement due to severe mitral stenosis with rheumatic etiology. The patient was successfully treated with cardiac surgery after teicoplanin antimicrobial therapy failure followed by ceftriaxone treatment. L. garvieae was confirmed as the pathogen through 16S rRNA sequencing. To the best of our knowledge, this is the first case to indicate an effective treatment for infective endocarditis caused by L. garvieae in the Republic of Korea.

Lactococcus garvieae, an unusual pathogen in infective endocarditis: case report and review of the literature

“…The ingestion of raw sea food or exposure to fish, the presence of colonic polyps and the repeated exposure to dairy products have been postulated to be risk factors for infection by L. garvieae [7]. Less than half of patients with IE caused by L. garvieae reported ingestion of fish (including raw or cooked) [7, 15, 19, 23, 24, 26–28, 30] or were diagnosed with a concomitant GI disorder [10, 13, 19–21, 24, 28–30]. Our patient reported both conditions.…”

Lactococcus garvieae Endocarditis in a Prosthetic Aortic Valve: A Case Report and Literature Review

“…Abbreviations: NAV, native aortic valve; VAN, vancomycin; NMV, native mitral valve; AMX, amoxicillin; GEN, gentamicin; GD, gastrointestinal disorder; PMV, prosthetic mitral valve; RF, raw fish; AMP, ampicillin; CTX, ceftriaxone; CLX, cloxacillin; PAV, prosthetic aortic valve; PEN, penicillin; TOB, tobramycin; Pip/Taz, piperacillin/tazobactam; RI, rifampicin; TEI, teicoplanin; PTV, prosthetic tricuspid valve; LEV, levofloxacin. 1,6,8,12,13,17,18,21,22,25-39 …”

“…Our patient was immunocompromised and had a postoperative ileus 1½ years ago and colorectal cancer, which could have facilitated the infection, together with the predisposing 1,6,8,12,13,17,18,21,22,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] factor of a biological prosthetic valve. However, he denied eating raw fish in the last couple of weeks prior to admission to the hospital.…”

Lactobacillus garvieae endocarditis presenting with leg cramps

“…Our patient did not recall eating raw fish but was known to have erosive gastritis. Among the 24 cases of L. garvieae IE reported in the literature, 18 (75%) occurred in those who were 60 years and older, and typically had prosthetic heart valves and/or gastrointestinal tract pathology [ 3 ]. As with our case, several L. garvieae IE cases have reported isolated or no fever [ 1 , 3 ].…”

“…Among the 24 cases of L. garvieae IE reported in the literature, 18 (75%) occurred in those who were 60 years and older, and typically had prosthetic heart valves and/or gastrointestinal tract pathology [ 3 ]. As with our case, several L. garvieae IE cases have reported isolated or no fever [ 1 , 3 ]. This may be attributed to the low pathogenicity of the organism or the fact that elderly patients are known to present with atypical features of infection [ 4 ].…”