Co-existence of Sarcina Organisms and Helicobacter pylori Gastritis/Duodenitis in Pediatric Siblings

Abstract

Sarcina are gram-positive anaerobic bacteria found to be associated with delayed gastric emptying and gastric outlet obstruction. We describe two cases of Sarcina co-existing with Helicobacter pylori organisms in pediatric siblings presenting within four months of each other with pyloric obstruction secondary to severe gastritis/duodenitis. The co-existence of Sarcina and Helicobacter pylori has not, to our knowledge, been previously reported. Its characteristic tetrad packeted morphology permits Sarcina to be readily identified on routine sections. Detection of these organisms in gastric biopsies should prompt consideration of gastric outlet obstruction and/or delayed gastric emptying as a possible etiologic factor.

A Rare Case of Sarcina ventriculi of the Stomach in an Asymptomatic Patient

“…This association between S ventriculi and H pylori has also not been mentioned previously except for an interesting report by Sauter et al, 9 who described a curious case of 2 siblings with coexisting S ventriculi and H pylori in both of them.…”

“…8 The natural habitat of S ventriculi is the soil, and it is generally not present in the normal healthy stomach. 9 However, it has been reported in the setting of pyloric ulceration and stenosis similar to our patient. 10 It has also been noted to occur more commonly in patients with gastric outlet obstruction or delayed gastric emptying, 3 which was suggested in our patient by the retained food seen during upper endoscopy.…”

Coinfection of Sarcina ventriculi and Candida in a patient of gastric outlet obstruction: An overloaded pyloric antrum

“…Delayed gastric emptying resulting in accumulation of carbohydrates and other nutrients coupled with acidic pH of stomach gives rise to conditions, which are conducive for the growth of these bacteria. Most of the cases reported in literature have found S. ventriculi growth as a consequence of accumulation of food debris in conditions inducing gastroparesis like diabetes, gastric surgeries, scarring, pyloric stenosis, or an obstructive mass like carcinoma . Our case also had delayed emptying due to edematous gastric folds, causing narrowing of pyloric antrum.…”

First documented case of Sarcina in esophageal brushing cytology

“…In the index case, a cell block was prepared from the residual brushing sample in hopes of pursuing microdissection and ancillary molecular characterization; however, material was insufficient for additional testing. A frequently cited review article on S. ventriculi states that light microscopic diagnosis (combination of routine morphologic stain plus Gram stain, if necessary) is sufficient to establish a definitive diagnosis, and molecular testing (when pursued) has shown confirmatory and not conflicting results with morphologic interpretations . It is our hope that this report will raise awareness of the possibility of detecting this potential pathogen in slides made from esophageal brushings.…”

“…S. ventriculi has been most commonly reported in adults, and a slight female predominance is suggested in the literature . Sarcina infection has been associated with a gamut of gastrointestinal pathologies with various forms of gastritis predominating . Our index patient was diagnosed with gastroparesis related to diabetic enteropathy; therefore, a Sarcina infection was not an unexpected finding in her prior stomach biopsies.…”