Recurrent Penicillin-Resistant Tonsillitis Due to Lactococcus garvieae, a New Zoonosis from Aquaculture

Abstract

Zoonotic diseases are a group of infectious diseases that are transmitted naturally from animals to humans. L. garvieae is a Gram-positive bacterium which is present in the aquaculture of freshwater and marine fish. Some isolated cases of infection have been described, considering it an opportunistic agent in immunosuppressed patients. The most recent appearance of severe infections in immunocompetent patients or colonizing cardiac prostheses has set off the alarms. This manuscript presents the first two patients with recurrent tonsillitis due to L. garvieae. A 15-year-old male and an 8-year-old male had recurrent tonsillitis with more than three episodes per year. A culture of tonsillar exudate in both cases showed growth of L. garvieae with an antibiogram showing multi-resistance to antibiotics. Given the parents’ wish not to carry out surgery, an autovaccine regimen with lysed bacteria was proposed with good evolution and remission of tonsillitis episodes in both cases. The oral autovaccine produces an immunomodulatory effect and could be a therapeutic weapon in the prevention of this zoonosis. Further studies are needed to determine the importance of foodborne transmission in human L. garvieae infections and to find suitable treatments for this wide range of infections.