Lactobacillus endocarditis in a healthy patient with probiotic use

Pasala, Swetha; Singer, Lillian; Arshad, Tamoore; Roach, K. David

doi:10.1016/j.idcr.2020.e00915

Cited by 19 publications

(21 citation statements)

References 12 publications

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“…Generally, lactobacilli isolated from blood are overlooked due to their low virulence perceived [ 18 ]. Endocarditis induced by L. paracasei is relatively rare [ 19 , 20 ]. Concerning the antibiotic resistance of lactobacilli, vancomycin and ciprofoxacin show low inhibitory effects among the majority of Lactobacillus species [ 21 , 22 ], which are generally sensitive to chloramphenicol, macrolides, lincosamides, and tetracycline [ 21 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Characterization of a bacterial strain Lactobacillus paracasei LP10266 recovered from an endocarditis patient in Shandong, China

et al. 2021

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Background Lactobacilli are often recognized as beneficial partners in human microbial environments. However, lactobacilli also cause diseases in human, e.g. infective endocarditis (IE), septicaemia, rheumatic vascular disease, and dental caries. Therefore, the identification of potential pathogenic traits associated with lactobacilli will facilitate the prevention and treatment of the diseases caused by lactobacilli. Herein, we investigated the genomic traits and pathogenic potential of a novel bacterial strain Lactobacillus paracasei LP10266 which has caused a case of IE. We isolated L. paracasei LP10266 from an IE patient’s blood to perform high-throughput sequencing and compared the genome of strain LP10266 with those of closely related lactobacilli to determine genes associated with its infectivity. We performed the antimicrobial susceptibility testing on strain LP10266. We assessed its virulence by mouse lethality and serum bactericidal assays as well as its serum complement- and platelet-activating ability. The biofilm formation and adherence of strain LP10266 were also studied. Results Phylogenetic analysis revealed that strain LP10266 was allied with L. casei and L. paracasei. Genomic studies revealed two spaCBA pilus clusters and one novel exopolysaccharides (EPS) cluster in strain LP10266, which was sensitive to ampicillin, penicillin, levofloxacin, and imipenem, but resistant to cefuroxime, cefazolin, cefotaxime, meropenem, and vancomycin. Strain LP10266 was nonfatal and sensitive to serum, capable of activating complement 3a and terminal complement complex C5b-9 (TCC). Strain LP10266 could not induce platelet aggregation but displayed a stronger biofilm formation ability and adherence to human vascular endothelial cells (HUVECs) compared to the standard control strain L. paracasei ATCC25302. Conclusion The genome of a novel bacterial strain L. paracasei LP10266 was sequenced. Our results based on various types of assays consistently revealed that L. paracasei LP10266 was a potential pathogen to patients with a history of cardiac disease and inguinal hernia repair. Strain LP10266 showed strong biofilm formation ability and adherence, enhancing the awareness of L. paracasei infections.

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Section: Discussionmentioning

confidence: 99%

Characterization of a bacterial strain Lactobacillus paracasei LP10266 recovered from an endocarditis patient in Shandong, China

et al. 2021

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“…Among the affected adults, two patients aged 28 [54] and 50 [57] years did not present any comorbidities that constituted risk factors for infection, while the remaining five had bicuspid aortic valve [55], alcoholic liver cirrhosis [58], uncontrolled diabetes mellitus [59], hereditary hemorrhagic telangiectasia [48], paroxysmal atrial fibrillation, and mitral regurgitation of unknown severity [56]. Three patients who had endocarditis recovered after undergoing treatment with ampicillin and gentamicin [54,55,57], one with meropenem [59], one with penicillin and gentamicin [44], and one with amoxicillin/clavulanate and gentamicin [60]. Unfortunately, Naqvi et al reported in 2018 that a 36-year-old woman with alcoholic liver cirrhosis died due to endocarditis caused by L. rhamnosus GG, although she was treated with penicillin and gentamicin [58].…”

Section: Infection Cases Of Probiotic Lactobacillus Strainsmentioning

confidence: 99%

“…He suggested that Bifidobacterium could treat diarrhea and promote the restoration of healthy gut microflora in affected patients [4]. Bacteremia caused by probiotic Bifidobacterium strains seems to be uncommon and not well studied, since these microorganisms are normally regarded as contaminants and not as primary invaders [57]. The occurrence of bacteremia related to Bifidobacterium longum infection was shown in two premature neonates with umbilical vein varix and necrotizing enterocolitis [76], and with respiratory distress syndrome [77].…”

Section: Infection Cases Of Probiotic Bifidobacterium Strainsmentioning

confidence: 99%

Probiotics: Should All Patients Take Them?

2021

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The usefulness of probiotics in the treatment as well as prevention of many infections and disorders has been confirmed by previous clinical studies. They can protect not only against gastrointestinal diseases such as diarrhea or enteritis but they have proven efficacy against pneumonia, urogenital infection, depression/anxiety, cancer metastasis, obesity, and others. However, it should be mentioned that not all clinical trials have shown improvement of health in patients undergoing probiotic treatment, and very rarely have even reported that probiotic strains may be the causative agents of opportunistic infections. Studies have documented cases of sepsis/bacteremia, endocarditis, liver abscess, pneumonia, and fungemia caused by probiotic strains, mainly in high-risk groups. This review summarizes the cases of infections caused by probiotic strains and the potential hazard associated with the supplementation of probiotics in seriously ill and hospitalized patients.

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“…Unlike adult patients, who are described to develop both systemic and deep-seated infections such as liver abscess [21], endocarditis [22,23], pleural empyema [24], and retropharyngeal abscess, children seem to develop primarily systemic bloodstream infections after probiotics' administration [25].…”

Section: Introductionmentioning

confidence: 99%

Invasive Infections Associated with the Use of Probiotics in Children: A Systematic Review

et al. 2021

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Although the effectiveness of probiotics has only been proven in specific conditions, their use in children is massively widespread because of their perception as harmless products. Recent evidence raises concerns about probiotics’ safety, especially but not only in the paediatric population due to severe opportunistic infections after their use. This review aimed at summarising available case reports on invasive infections related to probiotics’ use in children. For this purpose, we assessed three electronic databases to identify papers describing paediatric patients with documented probiotic-derived invasive infections, with no language restrictions. A total of 49 case reports from 1995 to June 2021 were identified. The infections were caused by Lactobacillus spp. (35%), Saccharomyces spp. (29%), Bifidobacterium spp. (31%), Bacillus clausii (4%), and Escherichia coli (2%). Most (80%) patients were younger than 2 years old and sepsis was the most observed condition (69.4%). All the patients except one had at least one condition facilitating the development of invasive infection, with prematurity (55%) and intravenous catheter use (51%) being the most frequent. Three (6%) children died. Given the large use of probiotics, further studies aiming at evaluating the real incidence of probiotic-associated systemic infections are warranted.

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Lactobacillus endocarditis in a healthy patient with probiotic use

Cited by 19 publications

References 12 publications

Characterization of a bacterial strain Lactobacillus paracasei LP10266 recovered from an endocarditis patient in Shandong, China

Characterization of a bacterial strain Lactobacillus paracasei LP10266 recovered from an endocarditis patient in Shandong, China

Probiotics: Should All Patients Take Them?

Invasive Infections Associated with the Use of Probiotics in Children: A Systematic Review

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