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      Lactobacillus rhamnosus Endocarditis After Upper Endoscopy

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          Abstract

          Lactobacillus rhamnosus is commonly found in gastrointestinal flora and used in probiotics but is a rare human pathogen. We report a case of L. rhamnosus endocarditis following upper endoscopy in a frequent consumer of yogurt containing the organism, who required aortic and mitral valve replacement for cure.

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          Pathogenic relevance of Lactobacillus: a retrospective review of over 200 cases.

          J Bolaños, James Cannon, L Danziger … (2004)
          Given that Lactobacillus has been reported to be the causative pathogen in many types of infection despite debate regarding the organism's clinical significance, a literature review was conducted to investigate the treatments and outcomes of Lactobacillus infections reported to date. In this article, the characteristics of over 200 reported cases of Lactobacillus-associated infections are summarized. Lactobacillus was found to be frequently associated with endocarditis and bacteremia. Lactobacillus was also associated with a variety of other infections including, but not limited to, peritonitis, abscesses, and meningitis. The species casei and rhamnosus were the most common. The isolates tended to be most sensitive to erythromycin and clindamycin and most resistant to vancomycin. The species that was most sensitive to vancomycin was acidophilus. The overall mortality rate was nearly 30%. There was a significant association between mortality and polymicrobial infection (P=0.004). In the subset of patients with bacteremia, increased mortality was associated with inadequate treatment (P=0.001) and polymicrobial bacteremia (P=0.044).
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            Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG.

            Tuija Poussa, Soile Tynkkynen, Maija Saxelin … (2004)
            Lactobacillus bacteremia is a rare entity, and its clinical significance is poorly defined. We have reviewed the risk factors and outcome for 89 case patients with Lactobacillus bacteremia. Species characterization was done in 53% of the cases, revealing 25 L. rhamnosus strains and 22 other Lactobacillus species. In 11 cases, the strain was identical with the probiotic L. rhamnosus GG. In 82% of the cases, the patients had severe or fatal comorbidities. Predisposing factors to bacteremia were immunosuppression, prior prolonged hospitalization, and prior surgical interventions. No significant differences were observed in these predisposing factors or clinical features between patients with cases associated with the various Lactobacillus species, other than higher C-reactive protein values in patients with L. rhamnosus bacteremia. Mortality was 26% at 1 month and was 48% at 1 year. In multivariate analysis, severe underlying diseases were a significant predictor for mortality (odds ratio [OR], 15.8), whereas treatment with antimicrobials effective in vitro was associated with lower mortality (OR, 0.22). We conclude that lactobacilli in blood cultures are of clinical significance and that their susceptibility should guide decisions about antimicrobial treatment.
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              Lactic acid bacteria and human clinical infection.

              Sarah Collins, Víctor M. Baizabal-Aguirre (1993)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Open Forum Infect Dis
                Journal ID (iso-abbrev): Open Forum Infect Dis
                Journal ID (publisher-id): ofid
                Title: Open Forum Infectious Diseases
                Publisher: Oxford University Press (US )
                ISSN (Electronic): 2328-8957
                Publication date Collection: Spring 2017
                Publication date (Electronic): 02 May 2017
                Publication date PMC-release: 02 May 2017
                Volume: 4
                Issue: 2
                Electronic Location Identifier: ofx085
                Affiliations
                [1 ]Division of Infectious Diseases, Department of Medicine ,
                [2 ]Division of Cardiology, Department of Medicine , and
                [3 ]Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons , New York
                Author notes

                Correspondence: J. G. Aaron, MD, Columbia University Medical Center, 630 W 168 St, P&S Box 82, New York, NY 10032 ( ja2822@ 123456cumc.columbia.edu ).

                Article
                Publisher ID: ofx085
                DOI: 10.1093/ofid/ofx085
                PMC ID: 5499731
                PubMed ID: 28695143
                SO-VID: cda96db5-21c1-4169-860b-bc8cfea6a3c7
                Copyright © © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 01 January 2017
                Date accepted : 20 April 2017
                Page count
                Pages: 3
                Funding
                Funded by: National Institute of Allergy and Infectious Disease
                Award ID: T32- AI100852
                Categories
                Subject: Brief Report

                Keywords: lactobacillus,lactobacillus rhamnosus,endocarditis,endoscopy,yogurt
                Data availability:
                Keywords: lactobacillus, lactobacillus rhamnosus, endocarditis, endoscopy, yogurt

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