Lactobacillus bacteremia associated with probiotic use in a pediatric patient with ulcerative colitis

J Clin Gastroenterol. May-Jun 2013;47(5):437-9. doi: 10.1097/MCG.0b013e318279abf0.

Abstract

Probiotic strains of Lactobacillus are currently used in a variety of clinical practices with limited evidence to support their use. Lactobacillus species are a normal part of gastrointestinal flora, and bacteremia with probiotic strains of Lactobacillus is very uncommon. We describe a case of Lactobacillus bacteremia in a 17-year-old boy with ulcerative colitis managed with systemic corticosteroids and infliximab, who presented with fever to 102°F, flushing, and chills 1 week after starting Lactobacillus rhamnosus GG probiotics. Initial blood culture on day 2 of his fever was positive for Lactobacillus, however, subsequent blood cultures on day 3 and 5 were negative. He was treated empirically with antibiotics for 5 days and defervesced by day 8 of his illness. 16 S rRNA sequence analysis identified the organism from the patient's blood culture and probiotic capsule as L. rhamnosus with a 99.78% match for both the strains. This case report highlights the potential risk of Lactobacillus bacteremia in immunosuppressed patients with severe active ulcerative colitis.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / drug therapy
  • Bacteremia / microbiology*
  • Colitis, Ulcerative / therapy*
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Immunocompromised Host
  • Lactobacillus rhamnosus* / classification
  • Lactobacillus rhamnosus* / genetics
  • Lactobacillus rhamnosus* / isolation & purification
  • Lactobacillus rhamnosus* / pathogenicity
  • Male
  • Probiotics / adverse effects*
  • Probiotics / therapeutic use*
  • RNA, Ribosomal, 16S / genetics
  • Risk Factors
  • Sequence Analysis, DNA

Substances

  • Anti-Bacterial Agents
  • RNA, Ribosomal, 16S