Probiotics are increasingly used in critically ill patients without enough safety data. The aim of the present study was to determine the association of probiotics with Saccharomyces cerevisiae fungaemia. Seven patients with S. cerevisiae fungaemia were reported at two hospitals in India between July 2014 and September 2015. Detailed clinical history of patients was recorded. Besides the seven patient isolates, three probiotics sachets used in those patients and five unrelated clinical isolates were used for association study by Fluorescent amplified fragment length polymorphism (FAFLP). Antifungal susceptibility testing was performed by broth microdilution technique of CLSI (M27-A3) and interpreted according to CLSI (M27S4). Two patients were premature neonates and five were adults. They were admitted in intensive care unit and were on probiotics containing S. boulardii (except one adult patient). FAFLP analysis showed 96.4-99.7% similarity between blood and corresponding probiotic isolates. Of the three AFLP types (group I, II, II) identified, all the probiotic isolates clustered in group I (major cluster) including majority of the blood isolates. The isolates were susceptible to all antifungal agents tested. Five patients, who could be evaluated, responded promptly to echinocandins or voriconazole. As the prescription of probiotic containing S. boulardii in critically ill patient's leads to the fungaemia, we recommend avoiding this probiotic in those patients.

HighlightsDengue induced Hemophagocytic lymphohistiocytosis (HLH), is a serious entity and can adversely affect the course of the infection.HLH is a potentially life threatening disorder and early diagnosis and management is crucial for successful outcome.A disproportionately high ferritin level should trigger investigations for HLH.

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The present study illustrates the optimization and characterization of β-glucosidase from a bacterial isolate, strain SG9. Sixty-eight different variables were first screened by one factor at a time method. The screened variable optimization was then performed by Plackett-Burman design followed by Box-Behnken response surface methodology. Thirty-one variables were screened, of which five variables were found to be significant. Box-Behnken design was then performed using the most significant variables, viz., esculin, KHPO and MgSO. The maximum enzyme activity was observed with an optimal medium composition of esculin (1.9 g/L), KHPO (0. 5 g/L) and MgSO (0.3 g/L) with a predicted value of 3392.01 IU. The maximum β-glucosidase production achieved was 3340 IU. The bacterial strain was identified by 16S rRNA gene sequence and biochemical characterization. The strain was identified as Bacillus stratosphericus and is a first report of its kind.