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Table 1 Clinical, microbiological and management characteristics of IE by L. garvieae

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

Reference Country Age Sex Associated factors for IE by L. garvieae and comorbidities Symptoms and duration (days) Physical examination Laboratories and Echocardiography (Vegetation size) Identification Susceptibility Therapy and days of treatment Complications and Outcome
Clavero et al. 2017 Chile 72 F AV fistulas, Diverticulosis, CKD, DM 2 and HTN, colonic polyps Chills, fever (1) Fever, systolic murmur, pulmonary crackles TEE: mitral vegetation (4 mm) Labs: Leucocytosis elevated CRP Colonoscopy: Colonic polyps LG: Vitek 2¥, MS and 16S rRNA PCR. MIC: VAN: 2 μg/ml, CTX 0.25 µg/ml PEN: 0.5 µg/ml. Kirby Bauer: Sensitive: ERY, CIP, SXT, AMC Resistant: CLI. Applying the criteria for B-haemolytic streptococci Empiric: CLO + AMK Directed: VAN + GEN µg (NI) Shock, respiratory failure (Died)
Lim and Jenkins 2017 UK 57 M Cooked fish, gallstones, renal stones, Colonic polyps Fever weight loss (60) Pansystolic murmur TEE: mitral valve vegetation (NI) and regurgitation. Colonoscopy: Duodenal polyps LG: MS PEN MIC: 1 mg/L
Etest BioMérieux, S: GEN 200 µg Oxoid by diffusion disc testing.
AMX + GEN (42d) Valve replacement No complications, (Alive)
Landeloos et al. 2017 Belgium 82 F Prosthetic mitral valve, previous endocarditis, Cooked fish, colonic polyps, FA, HTN, Osteoporosis. Fever, hyporexia, dyspnoea (14) Bradycardia, Basal lung crepitations, reinforce caused S2 TEE: mitral vegetation (10x5mm) Labs: Elevated CRP no leucocytosis. Colonoscopy: Colonic polyps. LG: MS, 16S rRNA PCR. NI Empiric: CRO Directed: MXF Changed: PEN + GEN Ambulatory: AMX monotherapy (42d) No valve replacement No complications (Alive)
Bazemore et al. 2016 USA 45 M Multiple substance abuse. Repair of aortic root aneurysm, Hepatitis C and cirrhosis Malaise, weakness (60) Fever, systolic murmur No Echo reported.
Leucocytosis, Elevated CRP and ESR.
LG: MS E-test: sensitive to CRO and VAN Cut-off values for S. bovis Empiric: TZP + VAN
Directed: CRO + GEN (NI) + Valve repair
Aortic valve dehiscence (Alive)
Suh et al. 2016 South Korea 75 F Mitral valve prosthesis, eats sea fresh food. Dyspnoea (3) Holosystolic murmur TTE: mitral vegetation (16 mm) Labs: leucocytosis, Elevated CRP LG: Vitek 2¥, 16S rRNA PCR. MicroScan MICroSTREP plus panel: PEN 0.12 µg/ml, AMC: 0.5/0.25 µg/ml, CRO 0.25 µg/ml, CTX 0.25 µg/ml, MEM 0.06 µg/ml, VAN 1 µg/ml, LVX 1 µg/ml, CLI > 0.5 mcg/ml (only R to CLI). E test (bioMérieux, Marcy lEtoile, France)
PEN 0.75 mg/L, CRO 0.38 mg/L,
TEC 0.125 mg/L. Susceptibility CLSI for viridans streptococci.
Empiric: CRO + GEN + RIF Directed: TEC
Changed: CRO monotherapy (40d)
Aortic and mitral replacement
Heart failure (Alive)
Heras Cañas et al. 2015 Spain 68 M Prosthetic aortic valve, HTN, dyslipidaemia, Hodgkin lymphoma in remission, AV block. Fever, Dyspnoea (10) NI TTE: mitral vegetations (NI).
Laboratories: Leucocytosis, elevate CRP.
LG: MS and 16S rRNA PCR Streptococci breakpoints:
S: CTX: 0.38 µg/ml, ERY: 0.25 mg/dl, VAN 1 µg/ml, LVX 1.5 µg/ml, VAN, AMP, CTX, OXA.
I: PEN-I MIC 0.75 µg/ml,
R: CLI 1 µg/ml.
Empiric: DAP + AMP + CRO Directed: DAP+AMP + CRO + GEN (NI) + Valve replacement AKI, Aortic valve dehiscence (Alive)
Igneri et al. 2015 USA 83 M Prosthetic aortic valve, Recent dental intervention, CHF, CLL, Prostate cancer, Coarctation of aorta, CABG Malaise, fever, vomit, headache, cough, myalgia, diaphoresis (7) NI TTE: Could not exclude vegetations,
Labs: Leucocytosis, Elevated CRP
NI NI Empiric: AMP + GEN
Directed: CTX + GEN (42d)
Valve surgery
No complication, (Alive)
Ortiz et al. 2014 Spain 70 F No risk factors or comorbidities Dyspnoea (NI) Holosystolic murmur, fever TTE: mitral vegetation (NI) Labs: Leucocytosis and elevated CRP NI S: CTX, CIP, ERY, DAP, VAN. Empiric: AMC + GEN Directed: VAN monotherapy (42d)
valve surgery
No complications (Alive)
  Spain 77 F Colorectal cancer, HTN, CLL Back pain, fever (2) Purpuric lesions in extremities, fever TEE: mitral and aortic vegetation (NI) Labs: NI NI S: PEN, AMC, CIP, VAN. AMP + GEN (NI)
No valve surgery
AKI, Heart failure (Died)
Tsur et al. 2014 Israel 76 M Raw fish, Prosthetic aortic valve, CHF, AF, DM 2, HTN, Oesophageal carcinoma. Constipation, fever (NI) Fever, Tachycardia, Systolic murmur. TEE: Vegetation biologic prosthetic valve (NI)
Labs: Leucocytosis
Lactococcus: API 32 strep kita, 16S rRNA PCR S: CRO and GEN.
Empiric: CRO
Directed: CRO+ GEN (NI)
No valve replacement
No complications (Alive)
Rasmussen et al. 2014 Sweden 81 M Prosthetic aortic valve, rectal diverticulosis, CAD, CABG, AF Malaise, headache, dysphasia (NI) Fever, systolic murmur. TEE: vegetations mitral valve and prosthetic valve (NI)
Labs: Elevated CRP
LG: Vitek 2¥, 16S rRNA PCR PEN: 0.5 mg/L, TOB: 2 mg/L. PEN + TOB (28d)
No valve replacement
Subdural hematoma (Alive)
Navas et al. 2013 USA 64 M Previous mitral valve repair, Dental intervention, CAD, Cardiac defibrillator, DM2, COPD Fatigue, weight loss, hyporexia, weakness, fever (NI) NI Echo not specified: Aortic vegetations LG: Vitek 2¥, 16S rRNA PCR and MS
Wrong ID: Microscanb
Streptococcus breakpoints:
I: PEN and AMP
VAN monotherapy (42d)
Aortic valve replacement. Removal of pacemaker
Intracardiac device infection (Alive)
Fleming et al. 2012 USA 68 M Prosthetic aortic valve, NHL in remission. Colonic polyps Migratory arthralgias, dyspnoea, hyporexia, fatigue, weight loss, fever (21) Systolic ejection murmur. Splinter haemorrhage in nails of left hand Echo not specified: Vegetation mitral valve. (NI)
Labs: Elevated CRP and ESR Colonoscopy: Colonic polyps
LG: Vitek 2¥, 16S rRNA PCR Breakpoints for VGS:
Empiric: AMP + GEN
Directed: VAN monotherapy (42d)
No valve replacement
No information of complications (Died)
Russo et al. 2012 Italy 63 M Ascending aorta and aortic valve replacement, previous endocarditis, HTN. Fever, chills, Pharyngodini, weakness. (7) Systolic murmur, hepatomegaly TEE: mitral vegetation (NI)
Labs: Elevated CRP
LG: API 32b, Vitek 2¥, 16S rRNA PCR EUCAST Streptococci breakpoint:
S: ERY/S: 0.125 μg/ml, CTX 0.5 μg/ml LVX: 0.5 μg/ml, AMP: 0.25 μg/ml, AMC: 0.5 μg/ml, CIP: 0.75 μg/ml, DAP: 0.125 μg/ml, GEN: 2 μg/ml VAN: 2 μg/ml TEC: 0.5 μg/ml
I: PEN: 2 μg/ml
R: CLI: > 64 μg/ml, RIF > 64 µg/ml
Empiric: VAN + GEN
Directed: AMP monotherapy (14d)
No valve replacement
No complications (Alive)
Watanabe et al. 2011 Japan 55 F No risk factors or comorbidities Malaise, myalgia, fever (60) Systolic murmur, painful black induration in finger. TEE: Mitral vegetation (10 mm) Labs: No leucocytosis Elevated CRP LG: Rapid ID32 Strep. a, 16S rRNA E test: (AB Biodisk, Dalvagen, Solna, Sweden): ERY 0.25 mg/L, CLI: > 256, VAN: 0.38 mg/L, LZD: 2 mg/L, PEN 0.5 mg/L, CRO 0.38 1mg/L, GEN: 1.5 mg/L, STR: 64 mg/L Empiric: PEN + GEN. Directed: CRO + GEN (63d) No valve surgery Septic embolism, stroke, aspirative pneumonia (Alive)
Zuily et al. 2011 France 64 F Mitral valve prosthesis, fresh seafood, Pacemaker, Hepatitis C cirrhosis, Fever (NI) Fever, Murmur. TEE: Mitral vegetations (NI) Labs: Elevated CRP and ESR. Leucocytosis LG: PCR NI AMX + GEN (42d)
no surgery
No complications (Alive)
Wilbring et al. 2011 Germany 55 M Fish farmer, mechanical tricuspid valve prosthesis, periodontitis Chills, fever, dyspnoea (14) Murmur TEE: Mechanical prosthetic valve vegetation (7x9mm)
Labs: Leucocytosis and elevated CRP
NI NI Inpatient: GEN + VAN + RIF ambulatory: LVX + AMC (56d)
No valve replacement
No complications (Alive)
Hirakawa et al. 2011 Brazil 58 F Mitral prosthetic valve, fish and cheese often. Dental prosthesis and recent gingival perforation. DM 2, HTN, Dyslipidaemia Fever, chills, diaphoresis, erythematous nodules in hands and legs, myalgia, weakness. (6) Fever, Osler nodes on left hand and legs. TEE: No vegetations Labs: Elevated CRP and ESR no leucocytosis. LG: Not specified biochemical tests. PCR. S: PEN, GEN, VAN.
VAN monotherapy (28d)
No valve surgery
No complications (Alive)
Li et al. 2008 Taiwan 41 M No risk factors or comorbidities Slurred speech (1) Right hemiplegia loss of right body sensation, right positive Babinski sign, murmur, fever TEE: Mitral vegetation and rupture of chordae tendineae (NI)
Labs: Leucocytosis and elevated CRP
LG: Vitek 2¥, Automated Pheonixc, 16S rRNA PCRe I: PEN: 0.75 µg/ml. PEN + GEN (30d)
Valve replacement
Septic emboli, stroke, shock (Alive)
Yiu et al. 2007 China 67 M Heart rheumatic disease, previous endocarditis, eats fresh fish, AF Chills, fever (21) Fever, mitral regurgitation murmur TEE: Mitral vegetation (10x1mm) Labs: Elevated ESR Neutrophilia NI NI AMP monotherapy (42d)
Valve replacement
Partial rupture of mitral valve (Alive)
Wang et al. 2006 Taiwan 72 M Kidney stones, mitral valve prolapse. Raw fish consumption, gastric ulcer Fever, purpuric leg lesions (14) Systolic murmur. Echo not specified: Severe mitral regurgitation, prolapse of posterior mitral valve, echogenic mass on the posterior mitral valve Labs: No leucocytosis. Endoscopy: Gastric ulcer LG: ID32 STREP; BioMérieux, Hazelwood, MO, USA, 16S rRNA PCR NI PEN + GEN (42d) No complications (Alive)
Vinh et al. 2006 Canada 80 M DM2, Hyperlipidaemia, CAD, CHF Dyspnoea, epigastric discomfort. (NI) Midsystolic murmur TEE: Aortic vegetations (24 mm) Labs: NI Wrong ID: API 20d (L. lactis), Vitek 2¥(Enterococcus), 16S rRNA PCR CLSI Enterococcus spp. breakpoints:
CLSI Streptococcus spp. breakpoints:
Empiric inpatient: AMP
Ambulatory: PEN and then switched to AMP again. Monotherapy (56d)
Valve replacement
No complications (Alive)
Fihman et al. 2005 France 86 M Prosthetic aortic valve, Cholecystectomy. Fever, right hip pain (21) Fever, respiratory distress TEE: Aortic vegetation (10 mm) Labs: Leucocytosis and elevated CRP. LG: API 32a, 16S rRNA PCR E test: MIC: PEN: 0.75 μg/ml, AMX: 0.5 μg/ml CTX: 0.38 μg/ml, VAN: 1.5 μg/ml, TEC: 0.38 μg/ml, CLI >8 µg/ml Inpatient: AMX + GEN Ambulatory: AMX monotherapy (49d)
Valve repair
No complications (Alive)
James et al. 2000 UK 56 F Aortic valve prosthesis Low back pain, chills, night sweat, weight loss, hyporexia (63) Low back tenderness, splinter haemorrhages In nails, murmur TTE: No vegetations Labs: Elevated ESR and CRP. No leucocytosis LG: API Strep f With streptococci reference laboratory (Respiratory and systemic reference laboratory London UK). Empiric: VAN Directed: TEC monotherapy (56d) Osteomyelitis (Alive)
Fefer et al. 1998 USA 84 F Pacemaker for heart block, Aortic valve prosthesis, omeprazole, hypertrophic cardiomyopathy, ITP, hypothyroidism. Hyporexia, weakness, dyspnoea (NI) Holosystolic murmur, bilateral pulmonary rales TEE: Ruptured chordae tendineae. Labs: Leucocytosis. Negative colonoscopy. LG: Biochemical tests. NCCLS Staphylococcus spp. breakpoints:
Empiric: AMP + GEN Directed: CRO monotherapy (NI) Intracranial haemorrhage, Rupture of chordae tendineae (Died)
  1. NI No information, AMK amikacin, AMX amoxicillin, AMC amoxicillin-clavulanic acid, AMP ampicillin, CFZ cefazolin, CDN cefditoren, CTX cefotaxime, CRO ceftriaxone, CEF cephalothin, CHL chloramphenicol, CIP ciprofloxacin, CLR clarithromycin, CLI clindamycin, DAP daptomycin, ERY erythromycin, GEN gentamicin, LVX levofloxacin, LZD linezolid, MEM meropenem, MXF moxifloxacin, OFX ofloxacin, PEN penicillin, TZP piperacillin-tazobactam, RIF rifampin, STR streptomycin, TEC teicoplanin, TET tetracycline, TOB tobramycin, SXT trimethoprim-sulfamethoxazole, VAN vancomycin, MIC Minimal inhibitory concentration, S Sensitive, I Intermediate, R resistant, VGS Viridans Group Streptococci, CKD Chronic kidney disease, AKI Acute kidney injury, DM2 Diabetes mellitus type 2, AF Atrial fibrillation, CHF Cardiac heart failure, NHL Non-Hodgkin Lymphoma, COPD Chronic obstructive pulmonary disease, CLL Chronic lymphocytic leukaemia, CAD Coronary artery disease, CABG Coronary artery bypass graft, LG Lactococcus garvieae a Manual API 32 strep kit, automated Vitek 2 kit with GP identification card (BioMérieux Marcy l’etoile, france), b Microscan walk away system (dade behring, inc., Sacramento, CA), c:Automated Phoenix system (Becton Dickinson Diagnostic systems, Franklin Lakes, NJ), d: API 20strep kit (BioMérieux), e: 500 16S ribosomal rRNA bacterial sequencing kit (PE applied Biosystems, Foster city, CA, USA) ABI PRISM 310 Genetic Analyzer (PE applied biosystems), f: API Strep (BioMérieux, Basngstoke, Hants, UK)