Perinephric Abscess and Bacteremia Due to Lactobacillus Species in a Diabetic Adult

Abstract

Lactobacillus species are a group of anaerobic or facultatively anaerobic, catalase-negative, gram-positive non–spore-forming rods that are usually considered benign commensal organisms present in the human mouth and gastrointestinal and genital tracts. Given their indolent nature, the presence of Lactobacillus species in cultures is often considered contaminants. In rare occasions, however, Lactobacillus species have been reported as pathogens causing a broad range of clinically significant conditions including bacteremia, endocarditis, dental abscesses, meningitis, and intra-abdominal infections such as peritonitis, endometritis, and splenic and liver abscesses. Pyelonephritis has only been seldomly reported in literature, and perinephric abscess has never been reported in literature to date. When infection happens, it usually occurs in immunosuppressed individuals such as those with cancer, transplant recipients, chronic steroid use, or human immunodeficiency virus/AIDS. Despite being gram-positive, the bacteria are usually resistant to vancomycin, and treatment with a penicillin-based regimen is preferred. We describe a case of a diabetic and morbidly obese, but otherwise healthy man, who developed bacteremia and perinephric abscess due to Lactobacillus species.

Lactobacilli Infection Case Reports in the Last Three Years and Safety Implications

“…Lactobacilli were isolated from blood [ 15 , 16 , 17 , 18 , 20 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 52 , 55 , 56 , 57 ], diseased valve tissue [ 23 ], abscess fluids [ 48 , 51 , 52 , 54 , 57 , 58 ], cerebrospinal fluid (CSF) [ 46 ], marrow [ 30 ], arthrocentesis aspiration fluid [ 53 ] in anaerobiosis and, in some cases, also in aerobiosis [ 15 , 34 ]. Use of automated microbial detection system, i.e., BACT/ALERT 3D or the BACTEC systems (BioMérieux) with incubation at 35 °C were mentioned in some reports [ 23 , 31 , 34 ].…”

“…De Freitas et al [ 49 ] stated that their facility was not equipped for identification of the level of species.…”

Lactobacilli Infection Case Reports in the Last Three Years and Safety Implications

“…Lactobacilli were isolated from blood [15,16,17,18,20,21,22,23,24,25,26,27,29,30,31,32,33,34,35,36,37,38,40,41,42,43,44,45,46,47,49,52,55,56,57], diseased valve tissue [28], abscess fluids [48,51,52,54,57,58], cerebrospinal fluid (CSF) [46], marrow [36], arthrocentesis aspiration fluid [53] in anaerobiosis and, in some cases, also in aerobiosis [40,15]. Use of automated microbial detection system, i.e.…”

“…De Freitas et al [49] stated that their facility was not equipped for identification to the level of species.…”

“…Susceptility to β-lactams, including amoxicillin, amoxicillin/clavulanic acid, ampicillin, ampicillin-sulbactam, benzylpenicillin, penicillin G, piperacillin/tazobactam and meropenem IV was reported in most cases. These antibiotics were used singly or in association with gentamicin, clindamycin and clarithromycin [16,17,20,21,22,23,24,25,26,27,31,32,33,34,36,37,38,41,43,44,45,46,48,49,51,53,54,55,56,57,58] .…”