Lactobacillus Sepsis Associated With Probiotic Therapy

Abstract

Probiotic strains of lactobacilli are increasingly being used in clinical practice because of their many health benefits. Infections associated with probiotic strains of lactobacilli are extremely rare. We describe 2 patients who received probiotic lactobacilli and subsequently developed bacteremia and sepsis attributable to Lactobacillus species. Molecular DNA fingerprinting analysis showed that the Lactobacillus strain isolated from blood samples was indistinguishable from the probiotic strain ingested by the patients. This report indicates, for the first time, that invasive disease can be associated with probiotic lactobacilli. This report should not discourage the appropriate use of Lactobacillus or other probiotic agents but should serve as a reminder that these agents can cause invasive disease in certain populations.

Impact of probiotic supplements on microbiome diversity following antibiotic treatment of mice

“…46 In some rare incidents, such as patients with underlying medical conditions, the probiotic strain can become the pathogen causing an adverse event. [47][48][49] Collectively, a better understanding of the impacts of probiotics on the microbial flora is required to ascertain how best to use them to treat disease.…”

Oral probiotics: Lactobacillus sporogenes for prevention of necrotizing enterocolitis in very low-birth weight infants: a randomized, controlled trial

“…Lactobacilli and Bifidobacteria are generally regarded as non-pathogenic, except a few reported cases of Lactobacillus bacteremia that seemed to occur in immunocompromised or extremely sick infants receiving high doses of Lactobacillus (Land et al, 2005). Kunz et al (2004) described L. bacteremia in two premature infants who received L. rhamnosus GG, and both of those infants had short-gut syndrome.…”

Using a mathematical model to analyze the role of probiotics and inflammation in necrotizing enterocolitis

“…In a study by Dani et al [21], infants treated with Lactobacillus were shown to have an increased incidence of sepsis, and the observed decrease in NEC incidence was not statistically significant. Similarly, Land et al [22] observed cases of Lactobacillus sepsis in infants treated with probiotics. However, lactobacillemia can occur naturally and thus may or may not have been related to probiotic treatment.…”

“…However, point E lies in the region where the model predicts that probiotic treatment can actually be harmful, lowering the level of B L (0) needed to induce disease, for a certain range of k. For this parameter set, probiotics contribute to threshold crossing in the model, enhancing the immune response and further increasing permeability in a way that is not resolved by subsequent decreases in luminal bacterial levels. The existence of such a region may help explain clinical studies in which probiotics did not reduce the incidence of NEC and in fact led to bacterial sepsis [21,22]. Figure 6D provides a summary of predicted health and disease regions in the (k,r 1 ) plane.…”

“…The larger the value of parameter k, the lower this necessary number of pathogenic bacteria becomes ( Figure 6C). Clinical studies have shown both positive and negative outcomes when probiotics are administered to premature infants [18][19][20][21][22]. Points A-E in Figure 6C have been selected to illustrate how outcomes of different treatment strategies could depend quite sensitively on the size of an initial pathogenic insult, the virulence of the pathogen, and the characteristic k of the probiotics.…”