Bacteriemia por Lactococcus garvieae: primer caso en Colombia / Lactococcus garvieae bloodstream infections: first case in Colombia

Lactococcus garvieae es una causa inusual de bacteriemia. No existen guías diagnósticas y terapéuticas actuales disponibles para tratar las infecciones causadas por estos organismos. Con base en un informe de caso, proporcionamos una revisión de la literatura sobre bacteriemia causada por L. garvieae y destacamos los desafíos de diagnóstico y tratamiento de estas infecciones y las implicaciones para el manejo. Comunicamos el primer caso de bacteriemia por Lactococcus garvieae en Colombia.

Lactococcus garvieae is an unusual cause of bloodstreams infections. Currently, there are no diagnostic and therapeutic guides available to treat infections caused by these organisms. Based on a case report, we provide a literature review on bloodstreams caused by L. garvieae and highlighted the challenges for diagnose and treatment and direct implications for its management. We report the first case of bloodstream infections due to Lactococcus garvieae in Colombia.

Endocarditis por Lactococcus garvieae en un paciente sometido a hemodialisis crónica. Primer caso reportado en Chile y revisión de la literatura / Lactococcus garvieae endocarditis in a patient undergoing chronic hemodialysis. First case report in Chile and review of the literature

Resumen Los casos reportados de infección por Lactococcus garvieae son escasos y sólo uno asociado a hemodiálisis. Comunicamos el caso de endocarditis infecciosa de curso fatal por L. garvieae en un paciente con una enfermedad renal crónica sometido a hemodiálisis y portador de diverticulosis colónica no complicada. Se realiza una revisión de los casos publicados y se discuten los actuales desafíos diagnósticos y terapéuticos de este patógeno, capaz de producir infecciones graves y potencialmente fatales en pacientes susceptibles. Este sería el segundo caso de infección asociada a hemodiálisis y el primero reportado en Chile.

Reports of Lactococcus garvieae infections in humans are scarce, and only one of them in a patient under-going hemodialysis. We report the first case of Lactococcus garvieae infection in Chile, presenting as an infective endocarditis, ultimately fatal, in a patient with uncomplicated colonic diverticulosis and end stage renal failure undergoing chronic hemodialysis. We review the published cases and discuss the diagnostic and therapeutic challenges associated with this new, increasingly diagnosed pathogen, capable of producing serious infections in susceptible patients.

Endocardite por lactococcus garvieae: primeiro relato de caso da América Latina / Lactococcus garvieae endocarditis: first case report in Latin America / Endocarditis por lactococcus garvieae: primer relato de caso de América Latina

Lactococcus garvieae, patógeno zoonótico emergente, é responsável por mastite em ruminantes e septicemia em peixes. Embora seja considerado oportunista e raramente causar infecções em humanos, sua incidência deve estar subestimada devido à dificuldade do diagnóstico. Há pouquíssimos relatos de osteomielite, abscesso hepático e peritonite, e apenas nove casos descritos na literatura mundial de endocardite. Relatamos o primeiro caso de endocardite por Lactococcus garvieae da América Latina em paciente portadora de prótese valvar metálica, com quadro de febre diária, calafrios, nodos de Osler e seis hemoculturas positivas para Lactococcus garvieae, que preenchiam os critérios de Duke para o diagnóstico de "endocardite infecciosa definitiva".

Lactococcus garvieae, an emerging zoonotic pathogen, is responsible for mastitis in rodents and sepsis in fish. Although deemed opportunistic and hardly ever causing infections in humans, its incidence is probably underestimated due to the difficulty in diagnosis. There are very few reports of osteomyelitis, liver abscess, and peritonitis, and only nine cases of endocarditis described in worldwide literature. We describe the first case of Lactococcus garvieae endocarditis in Latin America, in a female patient with metallic prosthetic heart valve who presented with daily fever, chills, Osler nodes and six positive blood cultures for Lactococcus garvieae, which met Duke's criteria for the diagnosis of "definitive infective endocarditis".

Lactococcus garvieae, patógeno zoonótico emergente, es responsable por mastitis en rumiantes y septicemia en peces. Aunque sea considerado oportunista y raramente cause infecciones en humanos, su incidencia debe estar subestimada debido a la dificultad del diagnóstico. Hay poquísimos relatos de osteomielitis, absceso hepático y peritonitis, y apenas nueve casos descriptos en la literatura mundial de endocarditis. Relatamos el primer caso de endocarditis por Lactococcus garvieae de América Latina en paciente portadora de prótesis valvar metálica, con cuadro de fiebre diaria, escalofríos, nódulos de Osler y seis hemocultivos positivos para Lactococcus garvieae, que llenaban los criterios de Duke para el diagnóstico de "endocarditis infecciosa definitiva".

Lactococcus garvieae: isolamento ecaracterização fenotípica / Lactococcus garvieae: isolation and phenotypic characterization

Os microrganismos do genero Lactococcus apresentam caracteristicas fenotipicas semelhantes as do genero Enterococcus podendo ser erroneamente identificados como tal no laboratorio clinico. Durante um estudo epidemiologico visando a deteccao de enterococos resistentes a vancomicina, foram avaliadas 155 amostras, inicialmente suspeitas de pertencerem ao genero Enterococcus, isoladas da microbiota intestinal e de diversos materiais clinicos oriundos de pacientes atendidos em Instituicoes de Saude do Municipio de Niteroi, no periodo entre janeiro de 2005 e janeiro de 2006. Duas amostras, que apresentaram caracteristicas fisiologicas naototalmente compativeis com o genero Enterococcus, foram identificadas como Lactococcus garvieae atraves da utilizacao de testes adicionaiscomo a analise do perfil proteico total atraves de eletroforese em gel de poliacrilamida contendo dodecil sulfato de sodio. Esta metodologia pode ser uma alternativa para identificar corretamente L. garvieae visto que e uma tecnica relativamente simples e demenor custo, quando comparada aos testes baseados na analise do DNA.

The members of the genus Lactococcus have phenotypic characteristics that resemble those of the genus Enterococcus and therefore can be erroneously identified in the clinical laboratory. During an epidemiological study aiming the detection of vancomycin-resistant enterococci, were evaluated 155 isolates, initially suspected of belonging to the genus Enterococcus, recovery from the intestinal microflora and different clinical materials obtained from patients at Health Institutions of Niteroi city, in the period between January 2005 and January 2006. Two isolates, which showed physiological characteristics not fully compatible with the genusEnterococcus, 2006. Two isolates, which showed physiological characteristics not fully compatible with the genus Enterococcus, were identified as Lactococcus garvieae by using additional physiological tests and analysis of total protein profiles by polyacrylamide gel electrophoresis, containing sodium dodecyl sulfate. This is an alternative methodology to correctly identify L. garvieae provided it is relatively easy to perform and of lower cost when compared to DNA based tests.

Isolation and characterization of Streptococcus sp. from diseased flounder (Paralichthys olivaceus) in Jeju Island

Streptococcus sp. is gram-positive coccus that causes streptococcal infections in fish due to intensification of aquaculture and caused significant economic losses in fish farm industry. A streptococcal infection occurred from cultured diseased olive flounder (Paralichthys olivaceus) in May, 2005 at a fish farm in Jeju Island, Korea. The diseased flounder exhibited bilateral exophthalmic eyes and rotten gills; water temperature was 16~18oC when samples were collected. Of the 22 fish samples collected, 3 samples were identified as Lactococcus garvieae and 18 samples were identified as Streptococcus parauberis by culture-based, biochemical test. Serological methods such as slide agglutination, hemolysis and antimicrobial susceptibility test were also used as well as multiplex PCRbased method to simultaneously detect and confirm the pathogens involved in the infection. S. parauberis and L. garvieae have a target region of 700 and 1100 bp., respectively. One fish sample was not identified because of the difference in the different biochemical and serological tests and was negative in PCR assay. In the present study, it showed that S. parauberis was the dominant species that caused streptococcosis in the cultured diseased flounder.

Experimental evaluation of pathogenicity of Lactococcus garvieae in black rockfish (Sebastes schlegeli)

Black rockfish (Sebastes schlegeli) is an important mariculture species in Korea. The production of this fish is drastically declined due to bacterial diseases, particularly streptococcosis caused by Lactococcus garvieae. The bacterial surface characteristics of SJ7 and TY6 were found to have capsule but not NB13 and YS18. The experiential evaluation of L. garvieae pathogenicity, the capsular isolates showed high cumulative mortality i.e. SJ7 (100%) and TY6 (60%) compared to non-capsular isolates. Based on this result the capsular isolates L. garvieae were highly suspected as the causative agent of streptococcosis in rockfish.