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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 2Â¥, 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 2Â¥, 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.

I: PEN

R: CLI

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 2Â¥, 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 2Â¥, 16S rRNA PCR and MS

Wrong ID: Microscanb

Streptococcus breakpoints:

I: PEN and AMP

R: CLI

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 2Â¥, 16S rRNA PCR

Breakpoints for VGS:

S: VAN, SAM, CRO, TZP

R: AMP, GEN, CLI.

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 2Â¥, 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.

R CLI

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 2Â¥, 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 2Â¥(Enterococcus), 16S rRNA PCR

CLSI Enterococcus spp. breakpoints:

S: PEN, CIP, OFX, LVX, TET, VAN.

CLSI Streptococcus spp. breakpoints:

S: AMP, VAN, GEN

I: PEN

R: CLI

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:

S: VAN, AMP, CRO

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)