Saccharomyces cerevisiae Fungemia in an Elderly Patient Following Probiotic Treatment

Abstract

Saccharomyces cerevisiae, known as baker's yeast, is also used as a probiotic agent to treat gastroenteritis by modulating the endogenous flora and immune system. However, since there have been increasing reports of fungemia due to S.cerevisiae and its subspecies S.boulardii, it is recommended that probiotics should be cautiously used in immunosuppressed patients, people with underlying diseases and low-birth weight babies. To emphasize this phenomenon, in this report, a case of S.cerevisiae fungemia developed in a patient given probiotic treatment for antibiotic-associated diarrhea, was presented. An 88-year-old female patient was admitted to our hospital with left hip pain, hypotension, and confusion. Her medical history included hypertension, chronic renal failure, left knee replacement surgery, and recurrent urinary tract infections due to neurogenic bladder. She was transferred to the intensive care unit with the diagnosis of urosepsis. After obtaining blood and urine samples for culture, empirical meropenem (2 x 500 mg) and linezolid (1 x 600 mg) treatment were administered. A central venous catheter (CVC) was inserted and after one day of inotropic support, her hemodynamic parameters were stabilized. The urine culture obtained on admission yielded extended-spectrum beta-lactamase-producing Klebsiella pneumoniae and Escherichia coli. Urine culture was repeated after three days and no bacteria were isolated. On the 4th day of admission she developed diarrhea. Toxin A/B tests for Clostridium difficile were negative. To relieve diarrhea, S.boulardii (Reflor 250 mg capsules, Sanofi Aventis, Turkey) was administered twice a day, without opening capsules. Two days later, her C-reactive protein (CRP) level increased from 23.2 mg/L to 100 mg/L without fever. Her blood culture taken from the CVC yielded S.cerevisiae. Linezolid and meropenem therapies were stopped on the 13th and 14th days, respectively, while prophylactic fluconazole therapy was replaced with caspofungin 1 x 50 mg on the fifth day. After seven days of therapy CRP and serum creatinine levels decreased to 9.1 mg/L and 1.2 mg/dl, respectively; and she was discharged from the hospital with improvement. The probiotic capsules were used unopen, thus, it was proposed that S.cerevisiae fungemia originated from translocation from the intestinal mucosa. Since it was not possible to investigate the molecular genetics of the strain isolated from the blood culture and the strain present in the probiotic, a definite conclusion about the origin of the strain could not be reached. It was thought that old age and underlying disease of the patient were the related predisposing factors for S.cerevisiae fungemia. This case emphasized that clinicians should be cautious in case of probiotic application even though in encapsulated form, even in immunocompetent patients with a history of long-term hospital stay and use of broad-spectrum antimicrobials since there may be a risk of S.cerevisiae fungemia development.

Infectious Agents and Inflammation: The Role of Microbiota in Autoimmune Arthritis

“…Changes of permeability at mucosal sites or altered immune functions strongly condition the persistence of antigenic stimulation, not only at the place of microbial entry but also in faraway locations, such as articular sites ( Asquith et al, 2014 ). Moreover, in frail patients, the administration of Saccharomyces cerevisiae as a probiotic has been anecdotally reported to induce sepsis ( Montineri et al, 2008 ; Eren et al, 2014 ).…”

Çocuklarda Mikafungin Kullanımının Değerlendirilmesi

“…Bu olguda predispozan olarak uzun süre kortikosteroid kullanımı nedeniyle immünsupresyonun olduğu ve ishal nedeniyle S.cerevisiae içeren probiyotik verildiği saptanmıştır. Ülkemizde ve yurt dışında ekinokandin tedavisi ile iyileşen benzer olgular bildirilmiştir 21,22 .…”

Investigation of therapeutic effect of Saccharomyces boulardii and translocation in immunosuppressed rats infected with Shigella sonnei

“…boulardii usage in immunosuppressed patients resulting in S. boulardii associated fungemia [29,30]. For this reason, the therapeutic usage of probiotics should be carefully evaluated by taking into consideration its risks as well as its potential benefits.…”