Clinical StudySaccharomyces boulardii probiotic-associated fungemia: questioning the safety of this preventive probiotic's use
Section snippets
Case Summary
A 60-year-old man with a history of hyperlipidemia, paraplegia due to a remote motor vehicle accident, methicillin-resistant Staphylococcus aureus (MRSA) cellulitis, and recurrent urinary tract infections (UTIs) presented to the Emergency Department with abdominal pain. The status of the patient's gastrointestinal tract (GI), evidence of bowel obstruction or GI bleeding, evidence of diverticular disease, and record of colorectal cancer screening are not stated in his chart. He was found to be
Methods
A Florastor probiotic capsule was sent to the medical mycology laboratory for comparison of its contents with the patient's Saccharomyces cerevisiae blood isolate. Both isolates were grown on Sabouraud agar for initial identification. Macroscopic and microscopic examination were performed as well as gene sequencing of the ITS region and the D1/D2 region of the 28S ribosome (Applied Biosystems, Foster City, CA). Strain comparison was then performed using two methods: genetic analysis with the
Results
Both the probiotic isolate and the patient blood isolate were morphologically identical and sequence-identified as S. cerevisiae by ITS and D1/D2 ribosomal DNA sequencing with 100% sequence homology.
The DiversiLab® software-generated report (assay time ~ 4 hours) showed an overall similarity of greater than 95% between the probiotic and patient blood isolates. There was also an overall relatedness, albeit less strong to the 3 other clinical samples included (Fig. 1A).
Similarly, the dendrogram
Discussion
Fungemia is an unusual complication of probiotic use for which patients with CVC are known to be at increased risk. (Hempel et al., 2011) Indeed, Florastor's package insert lists the presence of a CVC line as a contraindication for use. Although this patient's CVC placed him at increased risk of developing fungemia, it remains unclear whether this case represents line colonization or true infection with S. cerevisiae. However, the time of blood culture draw correlated with a worsening of the
Acknowledgements
Financial support: None.
Potential conflicts of interest: All authors report no conflicts of interest relevant to this article.
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Authors contributed equally to this work.