Lactobacillus-Cause of Death

Abstract

Lactobacillus, a nonspore-forming gram-positive rod, is a facultative anaerobic organism. It is a commensal of human mucosal tissues and is a nonpathogenic flora of the mouth, gut, and female genital tract. Lactobacillus has been used as a probiotic bacteria to treat diarrhea and is also present in dairy foods. It is hence commonly used. Lactobacillus endocarditis, an exceedingly unusual disorder, is accompanied by high mortality and poor response to treatment. We report a 64-year-old man with nonspecific symptoms of infective endocarditis due to Lactobacillus. Despite adequate therapy, the patient experienced both an embolic and hemorrhagic stroke and subsequently died. (Infect Dis Clin Pract 2010;18: 219Y220)L actobacillus (LB) endocarditis, an exceedingly unusual disorder, is accompanied by high mortality and poor response to treatment. We report a fatal case of LB endocarditis in a 64-year-old man with nonspecific symptoms of infective endocarditis due to LB. Despite therapy, the patient experienced both an embolic and hemorrhagic stroke and died. CASE REPORTA 64-year-old white male with aortic stenosis, status postYbioprosthetic valve replacement in 2005, and a history of recurrent epistaxis presented with a 3-month history of increasing weakness, fatigue, and weight loss. On examination, the blood pressure was 91/59 mm Hg, heart rate 71 beats per minute, and temperature 99-C. There was a grade 2/6 ejection systolic murmur in the aortic area. Blood cultures were taken, and all 4 bottles of 2 sets grew Lactobacillus acidophilus. This was speciated using RapID ANA II System (Remel, Lanexa, Kans). Transesophageal echocardiography was obtained, which showed vegetations on the prosthetic aortic valve (Figs. 1A and B). Intravenous (IV) aqueous penicillin G at 4 million units every 4 hours and gentamicin at 1 mg/kg of body weight were begun, and after a few days, the patient was sent home from the hospital on IV penicillin G. The patient's immunoglobulin levels, complement, and antinuclear antibody were normal. Two sets of blood cultures each were repeated on days 5 and 10 and 33 after therapy, and there were no organisms isolated. Two weeks later, he returned with severe epistaxis and expressive aphasia, which resolved within 9 hours. Computerized tomography (CT) of the brain with contrast showed a left frontal lobe subacute infarct. He was scheduled for aortic valve replacement surgery. While awaiting for a valve replacement surgery, he experienced 2 episodes of falling because his Bleg gave away.[ A second CT of the brain without contrast showed an acute subarachnoid hemorrhage and a possible right middle cerebral artery aneurysm. However, magnetic resonance imaging/magnetic resonance angiogram and CT angiogram failed to confirm an aneurysm, embolus, or vasculitis. The patient was continued on IV penicillin G and moved to a rehabilitation unit. He returned to the emergency room 5 days after discharge from a rehabilitation unit with persistent epistaxis. On the third day of rehospitalization, he was found on the ...