CASE REPORT A rare cause of sepsis: Lactococcus garvieae K.K. Sahu 1 , A.A. Sherif 1 , M.P. Syed 1 , A. Rajendran 2 , A.K. Mishra 1 and R. Davaro 3 From the 1 Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA, 2 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN USA and 3 Department of Infectious diseases, Saint Vincent Hospital, Worcester, MA 01608, USA Address correspondence to Dr K.K. Sahu, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA. email: drkksahu85@gmail.com Learning point for clinicians Microbial agents used in the food and agricultural indus- try have potential to cause infections to human beings. Care and caution must be exercised, both while handling these organisms and during the disposal of contami- nated wastes to prevent entry into our food chain and water system. Hence, it is very important to be aware of these rare microbes, their clinical presentations to ensure timely diagnosis and prompt treatment. Introduction Lactococcus garvieae was first described in the 1950s when it was discovered in rainbow trout raised on a Japanese farm. The genus ‘Lactococcus’ includes species of significant importance to the dairy and farm industry. It is well known for being patho- genic to aquatic animals, especially fish, molluscs and crusta- ceans. Lactococcus comprises of eight species out of which Lactococcus lactis and L. garvieae are known to cause infections in humans. With rising rates of zoonotic infections and industrial waste invading our food chain contributing to the rise in anti- bacterial resistance, it is must to be well informed of such un- usual infectious agents in order to be better equipped to manage them. Case presentation An 86-year-old gentleman with known dysphagia secondary to anterior cervical hyperostosis with a long-term gastrostomy feeding tube in situ for enteral feeding was brought to the emer- gency department with complaints of worsening lethargy and altered mentation of 5 days duration. At presentation, he was found to be hypotensive (75/43 mmHg) and tachycardic (110/ min) for which he received a two liters bolus of 0.9% normal sa- line. Laboratory work up suggested leucocytosis (16.2 Â 109/l) with normal hepatic and renal functions. Urinalysis showed leukocyte esterase positivity for which he was started on intra- venous ampicillin and ceftazidime. A chest X-ray was per- formed which showed no evidence of a focal consolidation or any acute cardiopulmonary process. Urine culture didnot grow any organism. His blood culture stained positive for gram posi- tive cocci which later grew L. garvieae. The organism itself is like streptococci and is known to cause infections in marine fauna. In our patient, as such there was no history of contact with mar- ine animals but on further inquiry, the patient revealed that his son, who often helped him with his tube feeds frequently goes for fishing and his most recent expedition was about a week be- fore the patient’s presentation. No other corroborative history regarding the source of this pathogen could be obtained, and no other foci of infection were found. He underwent an echocardio- gram and non-contrast CT imaging of his abdomen to rule out infectious processes such as endocarditis and occult abscesses respectively. Antibiotic therapy was continued, the patient responded well to the ampicillin and ceftazidime regimen caus- ing his overall status to improve quickly. Discussion Lactococcal infections and bacteraemia, while uncommon, are known to cause sepsis in humans and is becoming commoner; however, most reported cases are known to occur in the presence of conditions causing immune compromise. In our case, the pro- longed use of a feeding tube might have contributed to a breach in Received: 20 March 2019 V C The Author(s) 2019. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For permissions, please email: journals.permissions@oup.com 447 QJM: An International Journal of Medicine, 2019, 447–448 doi: 10.1093/qjmed/hcz078 Advance Access Publication Date: 29 March 2019 Case report Downloaded from https://academic.oup.com/qjmed/article-abstract/112/6/447/5423192 by guest on 25 May 2020