A rare cause of sepsis: Lactococcus garvieae

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 pathogenic to aquatic animals, especially fish, molluscs and crustaceans. 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 antibacterial resistance, it is must to be well informed of such unusual infectious agents in order to be better equipped to manage them. 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 emergency 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 saline. Laboratory work up suggested leucocytosis (16.2 × 109/l) with normal hepatic and renal functions. Urinalysis showed leukocyte esterase positivity for which he was started on intravenous ampicillin and ceftazidime. A chest X-ray was performed 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 positive 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 marine 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 before 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 echocardiogram 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 causing his overall status to improve quickly.