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Breakthrough Lactobacillus rhamnosus GG bacteremia associated with probiotic use in an adult patient with severe active ulcerative colitis: case report and review of the literature

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Abstract

Background

Probiotics are widely investigated in the treatment of various bowel diseases. However, they may also have a pathogenic potential, and the role of Lactobacillus spp. as opportunistic pathogens, mostly following disruption of the intestinal mucosa, is emerging.

Case report

We report on a case of bacteremia caused by L. rhamnosus GG in an adult patient affected by severe active ulcerative colitis under treatment with corticosteroids and mesalazine. Lactobacillus bacteremia was associated with candidemia and occurred while the patient was receiving a probiotic formulation containing the same strain (as determined by PFGE typing), and was being concomitantly treated with i.v. vancomycin, to which the Lactobacillus strain was resistant. L. rhamnosus GG bacteremia, therefore, was apparently related with translocation of bacteria from the intestinal lumen to the blood.

Conclusions

Pending conclusive evidence, use of probiotics should be considered with caution in case of active severe inflammatory bowel diseases with mucosal disruption.

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References

  1. Bringiotti R, Ierardi E, Lovero R, Losurdo G, Di Leo A, Principi M. Intestinal microbiota: the explosive mixture at the origin of inflammatory bowel disease? World J Gastrointest Pathophysiol. 2014;5:550–9.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Liévin-Le Moal V, Servin AL. Anti-infective activities of Lactobacillus strains in the human intestinal microbiota: from probiotics to gastrointestinal anti-infectious biotherapeutic agents. Clin Microbiol Rev. 2014;27:167–99.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Cannon JP, Lee TA, Bolanos JT, Danziger LH. Pathogenic relevance of Lactobacillus: a retrospective review of over 200 cases. Eur J Clin Microbiol Infect Dis. 2005;24:31–40.

    Article  CAS  PubMed  Google Scholar 

  4. Gouriet F, Million M, Henri M, Fournier PE, Raoult D. Lactobacillus rhamnosus bacteremia: an emerging clinical entity. Eur J Clin Microbiol Infect Dis. 2012;31:2469–80.

    Article  CAS  PubMed  Google Scholar 

  5. Tynkkynen S, Satokari R, Saarela M, Mattila-Sandholm T, Saxelin M. Comparison of ribotyping, randomly amplified polymorphic DNA analysis, and pulsed-field gel electrophoresis in typing of Lactobacillus rhamnosus and L. casei strains. Appl Environ Microbiol. 1999;65:3908–14.

    PubMed Central  CAS  PubMed  Google Scholar 

  6. Naidoo K, Gordon M, Fagbemi AO, Thomas AG, Akobeng AK. Probiotics for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev. 2011;12:CD007443.

    PubMed  Google Scholar 

  7. Mallon P, McKay D, Kirk S, Gardiner K. Probiotics for induction of remission in ulcerative colitis. Cochrane Database Syst Rev. 2007;4:CD005573.

    PubMed  Google Scholar 

  8. Zocco MA, dal Verge LZ, Cremonini F, Piscaglia AC, Nista EC, Candelli M, Novi M, Rigante D, Cazzato IA, Ojetti V, Armuzzi A, Gasbarrini G, Gasbarrini A. Efficacy of Lactobacillus GG in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther. 2006;23:1567–74.

    Article  CAS  PubMed  Google Scholar 

  9. Jonkers D, Penders J, Masclee A, Pierik M. Probiotics in the management of inflammatory bowel disease: a systematic review of intervention studies in adult patients. Drugs. 2012;72:803–23.

    Article  PubMed  Google Scholar 

  10. Van Assche G, Dignass A, Bokemeyer B, Danese S, Gionchetti P, Moser G, Beaugerie L, Gomollón F, Häuser W, Herrlinger K, Oldenburg B, Panes J, Portela F, Rogler G, Stein J, Tilg H, Travis S, Lindsay JO. European Crohn’s and Colitis Organisation. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 3: special situations. J Crohns Colitis. 2013;7:1–33.

    Article  PubMed  Google Scholar 

  11. Salminen MK, Rautelin H, Tynkkynen S, Poussa T, Saxelin M, Valtonen V, Jarvinen A. Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG. Clin Infect Dis. 2004;38:62–9.

    Article  PubMed  Google Scholar 

  12. Salminen MK, Rautelin H, Tynkkynen S, Poussa T, Saxelin M, Valtonen V, Järvinen A. Lactobacillus bacteremia, species identification, and antimicrobial susceptibility of 85 blood isolates. Clin Infect Dis. 2006;42:e35–44.

    Article  CAS  PubMed  Google Scholar 

  13. Sullivan A, Nord CE. Probiotic lactobacilli and bacteraemia in Stockholm. Scand J Infect Dis. 2006;38:327–31.

    Article  PubMed  Google Scholar 

  14. Kulkarni HS, Khoury CC. Sepsis associated with Lactobacillus bacteremia in a patient with ischemic colitis. Indian J Crit Care Med. 2014;18:606–8.

    Article  PubMed Central  PubMed  Google Scholar 

  15. Luong ML, Sareyyupoglu B, Nguyen MH, Silveira FP, Shields RK, Potoski BA, Pasculle WA, Clancy CJ, Toyoda Y. Lactobacillus probiotic use in cardiothoracic transplant recipients: a link to invasive Lactobacillus infection? Transpl Infect Dis. 2010;12:561–4.

    Article  PubMed  Google Scholar 

  16. Zein EF, Karaa S, Chemaly A, Saidi I, Daou-Chahine W, Rohban R. Lactobacillus rhamnosus septicemia in a diabetic patient associated with probiotic use: a case report. Ann Biol Clin (Paris). 2008;66:195–8.

    CAS  PubMed  Google Scholar 

  17. Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cnota J, Shetty AK. Lactobacillus sepsis associated with probiotic therapy. Pediatrics. 2005;115:178–81.

    PubMed  Google Scholar 

  18. Vahabnezhad E, Mochon AB, Wozniak LJ, Ziring DA. Lactobacillus bacteremia associated with probiotic use in a pediatric patient with ulcerative colitis. J Clin Gastroenterol. 2013;47:437–9.

    Article  PubMed  Google Scholar 

  19. Farina C, Arosio M, Mangia M, Moioli F. Lactobacillus casei subsp. rhamnosus sepsis in a patient with ulcerative colitis. J Clin Gastroenterol. 2001;33:251–2.

    Article  CAS  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they did not have funding for this work. The authors declare no commercial relationship or potential conflict of interest related to the submission of this work.

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Authors and Affiliations

  1. Internal Medicine Unit, Santa Maria Annunziata Hospital, 50012, Florence, Bagno a Ripoli, Italy

    Simone Meini, Raffaele Laureano & Lucia Fani

  2. Infectious Diseases Unit, Cisanello Hospital, Pisa, Italy

    Carlo Tascini

  3. Department of Medical Biotechnologies, University of Siena, Siena, Italy

    Angelo Galano, Alberto Antonelli & Gian Maria Rossolini

  4. Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy

    Gian Maria Rossolini

  5. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Gian Maria Rossolini

Authors
  1. Simone Meini
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  2. Raffaele Laureano
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  3. Lucia Fani
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  4. Carlo Tascini
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  5. Angelo Galano
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  6. Alberto Antonelli
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  7. Gian Maria Rossolini
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Correspondence to Simone Meini.

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Meini, S., Laureano, R., Fani, L. et al. Breakthrough Lactobacillus rhamnosus GG bacteremia associated with probiotic use in an adult patient with severe active ulcerative colitis: case report and review of the literature. Infection 43, 777–781 (2015). https://doi.org/10.1007/s15010-015-0798-2

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  • DOI: https://doi.org/10.1007/s15010-015-0798-2

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