Maxime Tijskens1,2,5, Filip Couturier1,2, Hilde Smets3, Hermine Van Herrewegen4, Bernard Paelinck1,21Department of Cardiology, Antwerp University Hospital, Belgium
2Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
3Department of Nephrology, Saint-Augustinus Hospital, Belgium
4Department of Clinical Biology, AZ Monica Hospital, Belgium
5Electronic correspondence: firstname.lastname@example.org
Lactococcus garvieae is an emerging zoonotic pathogen which causes lactococcosis in many fish species. Infections in humans are rare and mainly concern infective endocarditis. A 69-year-old man with a history of colon polyposis and a Bentall procedure was hospitalized because of recurrent fever. Hemocultures were persistently positive for L. garvieae. Since three minor Duke’s criteria were met, empiric therapy for possible endocarditis was started with vancomycin and gentamycin. Extensive investigations failed to reveal a source of infection. Transesophageal echocardiography demonstrated a small vegetation on the aortic mechanical prosthesis. Positron emission tomography scanning demonstrated a mildly increased metabolism
of 18F-fluorodeoxyglucose at the aortic valve prosthesis. Antibiotic therapy was switched to ampicillin based on the antibiogram, with gradual improvement of biochemical parameters and no need for surgical intervention. One year later, the patient remained free from symptoms. Herein is described the first case of L. garvieae endocarditis in Belgium and current literature is reviewed. This rare human pathogen is most likely underdiagnosed due to similar morphological and biochemical characteristics as Enterococcus faecalis. Hopefully, future advances in microbiological technology will facilitate adequate pathogen identification, reliable susceptibility analysis and guideline-based therapy.
The Journal of Heart Valve Disease 2018-19;27:328-334
|Infective Endocarditis Caused by Lactococcus garvieae: First Case in Belgium and Review of the Literature|
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