Implications of Infective Endocarditis by Probiotic Microorganisms: A Systematic Review of Case Reports

Abstract

Objectives Recent growth in the commercial use of probiotic supplementation has led to an increased demand for investigation behind complications secondary to probiotic use. Of note, there is a vast amount of literature documenting a relationship between onset of infective endocarditis and probiotic supplementation, but the symptomology and treatment interventions can vary. The purpose of this study is to perform a review of recently reported cases of infective endocarditis secondary to probiotic microorganisms for epidemiology and treatment interventions. Methods A systematic review of literature was performed on MEDLINE for infective endocarditis secondary to probiotic microorganism case studies, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Statistical significance was set at P < 0.05. Results Each case was reviewed for the inclusion criteria, which were the following: English language, case reports, full-text, publication within 6 years, pertained to probiotic-related endocarditis, and peer-reviewed. To further ensure that all appropriate studies were identified, the reference list of each identified study was also reviewed, and no further articles met the inclusion criteria. The final analysis included in the qualitative synthesis was 6 patients. Patient cases of infective endocarditis were between 2018 to 2020. Among the adult cohort, the average age of patients was 53.2 ± 17. The most prevalent bacterial culture among the adult cohort was Lactobacillus rhamnoses (80%). The onset of patient symptoms ranged among the adult cohort between 6 months to <1 month. Past medical histories were significant for various comorbidities unique to each patient including diabetes and heritable genetic mutations. Among the patients which underwent aortic valve replacement, there was variable improvement in ejection fraction. Conclusions Healthcare providers ought to be aware to screen for Lactobacillus rhamnoses as a common pathogen of probiotic infective endocarditis. This study has inconclusive evidence to suggest that decreased ejection fraction in probiotic infective endocarditis is different from other primary causes. Funding Sources No funding to disclose. This study was supported by the QUICK Research Institute (Kansas City, MO).

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Accounting for the health risk of probiotics

“…The patient had a ten-year daily probiotic intake and probiotic strains isolated from the patient did not have distinguishable differences from L. rhamnosus , thus indicating that long-term probiotic consumption may have contributed to endocarditis [ 55 ]. Lactobacillus probiotic strains are common opportunistic pathogens of infective endocarditis, especially for susceptible individuals with predisposing risk factors as systematic reviews of clinical case reports of infective endocarditis gathered between 2018 and 2020 showed that the most prevalent bacterial culture among the adult cohort was L. rhamnosus (80%) [ 59 ]. Moreover, one recent study conducted on animals, showed for the first time the occurrence of infective endocarditis in dogs which was associated with Bacillus amyloliquefaciens , a probiotic that is commonly considered beneficial to both humans and animals [ 60 ].…”