Lactococcus garvieae endocarditis in a native valve identified by MALDI-TOF MS and PCR-based 16s rRNA in Spain: A case report

Abstract

Lactococcus garvieae is a Gram-positive, catalase negative coccus arranged in pairs or short chains, well-known as a fish pathogen. We report a case of Infective Endocarditis (IE) by L. garvieae in a native valve from a 68-year-old male with unknown history of contact with raw fish and an extensive history of heart disease. This case highlights the reliability of MALDI-TOF MS compared to conventional methods in the identification of rare microorganisms like this.

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

“…Previous reports speculated that L. garvieae infections might result from ingestion of contaminated food, especially raw fish, in patients with modified gastrointestinal tracts (13,17,18,21,23). Our case was also exposed to raw fish and had underlying gastritis.…”

“…This organism is well known in aquaculture as a fish pathogen, however, there are few reports in the literature of infections caused by L. garvieae in both immunocompromised and immunocompetent humans, including patients with infective endocarditis (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), osteomyelitis (19)(20)(21), liver abscess (22), cholecystitis (23), and peritonitis (24). Based on its low virulence in humans, L. garvieae has generally been considered to be an opportunistic pathogen in immunocompromised hosts.…”

Endocarditis por Lactococcus garvieae en un paciente sometido a hemodialisis crónica. Primer caso reportado en Chile y revisión de la literatura

“…De éstos 42% provienen de Europa, 35% de Asia y 23% de América. Según el tipo de infección, hubo 20 endocarditis infecciosas, (11 de válvulas mitrales nativas [4][5][6][7][8][9][10][11][12] , tres de prótesis de válvula mitral 7,13,14 , tres válvulas aórticas nativas 2,12,15 , dos prótesis de válvula aórtica 9,16 y una válvula tricúspidea 17 ), dos casos de bacteriemia 4,18 , dos casos de septicemia 4,19 y dos casos de peritonitis 4,20 . Otros fueron casos aislados de absceso hepático 21 , osteomielitis 22 , colecistitis aguda 23 , espondilitis 24 , infección de prótesis de cadera 25 y un hematoma subdural 9 .…”

“…Además son catalasa negativa, PYR positivo, crecen en suero fisiológico al 6,5%, y pueden hidrolizar la esculina. La principal diferencia entre ambos es que Lactococcus es sorbitol negativo y Enterococcus es positivo 10 . Actualmente uno de los métodos de identificación más rápido y confiable para la identificación de L. garvieae es a través de espectrometría de masas, asistida por láser (MALDI-TOF MS).…”

Lactococcus garvieae: emergent pathogen usually misidentified as enterococcalspecies

“…It ferments glucose, mannitol, maltose and fructose but does not ferment arabinose, raffinose and sorbitol, what is a significant differentiation to enterococci. [1][2][3][4] Normal growth at 45°C, on 6.5% NaCl and at pH 9.6 caused L. garvieae to be misidentified as a new species called Enterococcus seriolicida. 5 These atypical phenotypic characteristics combined to genotypic heterogeneity led to the identification of two subspecies: L. garvieae subsp.…”