乳球菌心内膜炎和免疫功能正常患者的肝脓肿：病例报告及文献复习。

Lactococcus lactis endocarditis and liver abscess in an immunocompetent patient: a case report and review of the literature.

机构信息

Department of Polyvalent Resuscitation Unit, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, Morocco.

Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, Morocco.

出版信息

J Med Case Rep. 2023 Mar 31;17(1):115. doi: 10.1186/s13256-022-03676-1.

DOI:10.1186/s13256-022-03676-1

PMID:36997999

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10064683/

Abstract

BACKGROUND

Over the last two decades, several cases of infections caused by Lactococcus lactis have been reported. This Gram-positive coccus is considered non-pathogenic for humans. However, in some rare cases, it can cause serious infections such as endocarditis, peritonitis, and intra-abdominal infections.

CASE PRESENTATION

A 56-year-old Moroccan patient was admitted to the hospital because of diffuse abdominal pain and fever. The patient had no past medical history. Five days before his admission, he developed abdominal pain in the right lower quadrant along with chills and feverish sensations. Investigations showed a liver abscess, which was drained, and the microbiological study of the pus revealed Lactococcus lactis subsp. cremoris. Three days after admission, control computed tomography objectified splenic infarctions. Cardiac explorations were performed and showed a floating vegetation on the ventricle side of the aortic valve. We retained the diagnosis of infectious endocarditis according to the modified Duke criteria. The patient was declared afebrile on day 5 and the evolution was clinically and biologically favorable. Lactococcus lactis subsp. cremoris, formerly known as Streptococcus cremoris, is a rare cause of human infections. The first case of Lactococcus lactis cremoris endocarditis was reported in 1955. This organism includes three subspecies: lactis, cremoris, and hordniae. A MEDLINE and Scopus search showed only 13 cases of infectious endocarditis due to Lactococcus lactis, with subsp. cremoris identified in four of the cases.

CONCLUSIONS

To our knowledge, this is the first case report of the co-occurrence of Lactococcus lactis endocarditis and liver abscess. Despite its reported low virulence and good response to antibiotic treatment, Lactococcus lactis endocarditis must be considered a serious disease. It is imperative for a clinician to suspect this microorganism of causing endocarditis when they notice signs of infectious endocarditis in a patient with a history of consumption of unpasteurized dairy products or contact with farm animals. The finding of a liver abscess should lead to an investigation of endocarditis, even in previously healthy patients without obvious clinical signs of endocarditis.

摘要

背景

在过去的二十年中，已经报道了几起因乳球菌（Lactococcus lactis）引起的感染病例。这种革兰氏阳性球菌被认为对人类无致病性。然而，在一些罕见的情况下，它可能导致严重的感染，如心内膜炎、腹膜炎和腹腔内感染。

病例介绍

一名 56 岁的摩洛哥患者因弥漫性腹痛和发热而入院。患者既往无病史。在他入院前 5 天，他出现右下腹痛，并伴有寒战和发热感。检查发现肝脓肿，进行了引流，脓液的微生物研究显示出乳球菌（Lactococcus lactis）亚种 cremoris。入院后 3 天，控制计算机断层扫描发现脾梗死。进行了心脏检查，显示主动脉瓣心室侧有浮动赘生物。根据改良的杜克标准，我们保留了感染性心内膜炎的诊断。患者在第 5 天不再发热，病情在临床和生物学上均有所改善。乳球菌（Lactococcus lactis）亚种 cremoris，以前称为乳链球菌（Streptococcus cremoris），是人类感染的罕见原因。乳球菌（Lactococcus lactis）cremoris 亚种的首例心内膜炎病例于 1955 年报道。该生物体包括三个亚种：乳球菌（lactis）、cremoris 和 hordniae。通过 MEDLINE 和 Scopus 搜索，仅发现了 13 例由乳球菌（Lactococcus lactis）引起的感染性心内膜炎病例，其中 4 例确定为乳球菌（Lactococcus lactis）亚种 cremoris。

结论

据我们所知，这是首例乳球菌（Lactococcus lactis）心内膜炎和肝脓肿同时发生的病例报告。尽管乳球菌（Lactococcus lactis）亚种 cremoris 报告的毒力较低，对抗生素治疗的反应良好，但乳球菌（Lactococcus lactis）心内膜炎仍必须被视为一种严重的疾病。当临床医生注意到有食用未经巴氏消毒的乳制品或接触农场动物病史的患者出现感染性心内膜炎的迹象时，必须怀疑这种微生物会引起心内膜炎。即使是在没有明显的心内膜炎临床症状的先前健康患者中，发现肝脓肿也应进行心内膜炎的检查。