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Indian Pediatr 2015;52: 814 |
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Lactococcus garvieae: An Emerging
Pathogen
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* Nibedita Mitra and
#Prasanna Kumar
Department of Pediatrics and #Microbiology, Southern
Railway Head Quarter Hospital, Chennai, Tamil Nadu, India.
*Email:
[email protected]
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Lactococcus garvieae is a major pathogen in
aquafarming with an endemic peak season during the summer. It is
considered a rare human pathogen with low virulence [1]. There are very
few reported cases of human infection. Because of the increasing
development of aquafarming, human cases of Lactococcus garvieae
infection are expected to rise.
A 3½-year-old girl weighting 10 kg was admitted to us
with fever of five days duration, loose stools, vomiting and refusal of
feeds due to painful deglutition. She was febrile, pale and dehydrated
with cheilitis, gingivitis, stomatitis, and had white plaque like
lesions on the tongue and angles of the lips with right cervical
lymphadenitis. There was history of recent fish intake and consumption
of unpasteurized milk. After correcting the hydration status, we started
intravenous amoxicillin and metronidazole. Her investigations were:
hemoglobin 7.2 g/dL, platelet count 498×10 9/L,
total leukocyte count 15.6×109/L,
Neutrophils 61%, lymphocytes 31%, eosinophils 6%, monocyte 2%; X-ray
chest was normal. Culture of the swab taken from oral lesions did not
yield any growth. Lactococcus garvieae was identified in blood
culture by automated microbial analyser (Vitek 2
Compact). As the organism was susceptible to
amoxycillin, we continued with the same antibiotic, and patient improved
remarkably.
Lactococci are facultative anaerobic, catalase
negative, gram positive cocci that occur singly, in pairs or in chains
[1]. Susceptibility to clindamycin can be used to differentiate between
L. lactis and L. garvieae as the latter is resistant to
clindamycin [2].
L. garvieae is associated with subclinical
mastitis in water buffalo and in cows [3]. It is a rare pathogen with
low virulence for human infection. It has been reported to be associated
with infective endocarditis, bacteremia, peritonitis, osteomyelitis, and
spondylo-discitis [1]. The presence of gastrointestinal disorders may
facilitate infection [4]. The treatment is not standardized because the
exact criteria of susceptibility test have not been established [3].The
oral lesions as seen in our patient have not been earlier reported with
L. garvieae infection. Anemia, undernutrition and gastrointestinal
infection could have predisposed this child to this opportunistic, low
virulence infection.
References
1. Russo G, Iannetta M, D’Abramo A, Mascellino MT,
Pantosti A, Erario L, et al. Lactococcus garvieae
endocarditis in a patient with colonic diverticulosis: First case report
in Italy and review of the literature. New Microbiologica.
2012;35:495-501.
2. Zlotkin A, Eldar A, Ghitino C, Bercovier H.
Identification of Lactococcus garvieae by PCR. J Clin Microbiol.
1998;36:983-5.
3. Watnabe Y, Naito T, Kikuchi K, Amari Y, Uehara Y,
Isonuma H, et al. Infective endocarditis with Lactococcus
garvieae in Japan: A case report. J Med Case Rep. 2011;5:356.
4. Wang CY, Shie HS, Chen SC, Huang JP, Hsieh IC, Wen
MS, et al. Lactococcus garvieae infections in humans:
Possible association with aquaculture outbreaks. Int J Clin Pract.
2007;61:68-73.
5. Navas ME, Hall G, Bejjani DE. A case of
endocarditis caused by Lactococcus garvieae and suggested methods
of identification. J Clin Microbiol. 2013;51:1990-2.
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