Background: Patients with cervical cancer (CC) receiving chemotherapy and radiotherapy have several gastrointestinal adverse effects. Objective: To evaluate the effect of dietary symbiotic supplementation on fecal calprotectin, bacterial DNA levels, and gastrointestinal adverse effects in patients with CC. Methods: Clinical, controlled, randomized, double-blind trial. Patients consumed symbiotics or placebo three times a day for 7 weeks. Fecal calprotectin was assessed by Elisa method. DNA from probiotic and pathogenic bacteria were determined by quantitative real-time polymerase chain reaction. Diarrheal evacuations were evaluated with the Bristol scale and nausea and vomiting were measured using the scale of the National Institute of Cancerology of the United States. Results: Fecal calprotectin concentration was lower in the symbiotic group compared to the control group (p <0.001). The concentrations and total proportions of the probiotic and pathogenic bacteria were similar in both groups. Nausea cases significantly diminished in both groups (p <0.001) at the end of the trial. Furthermore, the symbiotic group had a statistically significant decrease in the frequency and intensity of vomiting when compared to the control group (p <0.001). Conclusions: The symbiotic treatment decreases significantly the fecal calprotectin levels and the frequency and intensity of vomiting in patients with CC. KEYWORDS: faecal calprotectin, cervical cancer, symbiotic, qPCR.

Elizabethkingia meningoseptica is a gram-negative nonmotile, oxidase-positive bacillus mainly found in water and soil and in hospitals and has been linked to nosocomial infections and neonatal meningitis [1]. However, immunocompromised adults are also at risk of systemic infections. Given its resistance to carbapenems and growing number of reported nosocomial infections with E. meningoseptica, it is critical to have suspicion for this organism when considering nosocomial infections in deteriorating patients on conventional empiric antibiotic therapy. CASE PRESENTATION:A 34 year-old female with rheumatoid arthritis on hydroxychloroquine, and immune thrombocytopenic purpura with prior splenectomy, prior septic shock due to pneumonia with streptococcus mitis and streptococcus oralis presented to the emergency department with 12 hours of fever, myalgia and fatigue. She was febrile to 102.6 F, tachycardic to 165 with leukocytosis to 21, normal urine analysis and chest x-ray, and a negative Covid-19 and influenza test. Blood cultures were collected and she was started on vancomycin and cefepime for empiric coverage. Blood cultures grew a gram negative organism. Computed tomography of the abdomen showed signs of enteritis. Infectious disease team discontinued vancomycin and cefepime was continued while awaiting speciation and susceptibilities. However, the patient continued to have intermittent fever with leukocytosis. Elizabethkingia meningioseptica was isolated from her blood with resistance to meropenem and cefepime. Intravenous Levofloxacin was started and sulfamethoxazole/trimethoprim was added to her regimen. Her repeat blood cultures remained negative. She was discharged on IV levaquin and oral sulfamethoxazole/trimethoprim with close follow up in infectious disease clinic.DISCUSSION: E. meningoseptica is a gram-negative nonmotile, oxidase-positive bacillus mainly found in water and soil [2] In hospital settings, saline, lipid and chlorhexidine gluconate solutions have been identified as sources of infection [3]. In adults, nosocomial infections in susceptible patients such as those with malignancy, on steroid therapy, diabetics, neutropenic patients, and organ transplant patients, account for the majority of the cases [2].Currently there are uncertainties regarding the best course of treatment, susceptibility testing methods and minimal inhibitory concentration (MIC) breakpoints. However, vancomycin, fluoroquinolones, and minocycline have been used as the mainstay of treatment. CONCLUSIONS:As the reported number of nosocomial infections with E. meningoseptica increases, the inherent multi-drug resistance nature of this gram negative organism to common antibiotics used for empiric gram negative coverage, mandates raising awareness regarding potential outbreaks in hospital settings.