Sarcina ventriculiof the stomach: A case report

Abstract

Sarcina ventriculi is a Gram positive organism, which has been reported to be found rarely, in the gastric specimens of patients with gastroparesis. Only eight cases of Sarcina, isolated from gastric specimens have been reported so far. Sarcina has been implicated in the development of gastric ulcers, emphysematous gastritis and gastric perforation. We report a case of 73-year-old male, with history of prior Billroth II surgery and truncal vagotomy, who presented for further evaluation of iron deficiency anemia. An upper endoscopy revealed diffuse gastric erythema, along with retained food. Biopsies revealed marked inflammation with ulcer bed formation and presence of Sarcina organisms. The patient was treated with ciprofloxacin and metronidazole for 1 wk, and a repeat endoscopy showed improvement of erythema, along with clearance of Sarcina organisms. Review of reported cases including ours suggests that Sarcina is more frequently an innocent bystander rather than a pathogenic organism. However, given its association with life threatening illness in two reported cases, it may be prudent to treat with antibiotics and anti-ulcer therapy, until further understanding is achieved.

Gastric Sarcina organisms in a patient with cystic fibrosis

“…The pathogenicity of this organism in humans has not been well-established and indeed it may instead represent a marker of a disease state rather than a causative agent, as has been suggested by previous authors [2,4,5]. At least one case has been associated with emphysematous gastritis [6], but it is not clear that Sarcina was the cause.…”

“…In mammals with slowing of the enteric flow of food, either by stenosis or dysmotility, the highly acidic environment of the stomach combined with the presence of non-transiting carbohydrates is thought to provide an optimal environment for growth of these organisms [1]. Though Sarcina has been more thoroughly studied in non-human mammals, there have been at least 8 reports of the organism in humans within the last 12 years [2]. Herein, we report the 9th case identified in a tissue biopsy, and the first in a patient with cystic fibrosis.…”

Introduction of a new species, the ferret (Mustela putorius furo), in pathomorphological diagnostics - 7 years of Croatian experience

“…Sarcina spp. are Gram-positive organisms found in cereal seeds, soil, mud and the stomachs of humans, with the ability to survive in a very low pH environment (RATUAPLI et al, 2013). Their tetrad morphology and size are characteristic enough to establish a diagnosis without further testing (LAM- HIMLIN et al, 2011).…”

Clues to uncommon and easily overlooked infectious diagnoses affecting the GI tract and distinction from their clinicopathologic mimics

“…96,[98][99][100] The precise mechanism of injury is uncertain, but in most human cases there is an underlying condition that hampers adequate gastric emptying (gastroparesis, gastric outlet obstruction). 95,101 Carbohydrate stasis, along with the stomach's acidic environment, may provide an ideal medium for S ventriculi growth. Although it is unlikely that S ventriculi initiates gastric injury in affected patients, its presence on biopsy material should be noted because it may be indicative of an underlying obstruction or motility abnormality.…”

“…The chronic disease of the stomach in which S ventriculi was first identified was likely gastroparesis or gastric outlet obstruction, because it is in the context of these conditions that most S ventriculi-related illnesses have been reported. 95 S ventriculi is a fastidious, anaerobic, gram-positive, sugar-fermenting bacterium. It thrives in acidic environments and ferments carbohydrates with production of ethyl alcohol and CO 2 .…”