Answer to March 2015 Photo Quiz

Vasquez, Amber; Pancholi, Preeti; Balada-Llasat, Joan-Miquel

doi:10.1128/jcm.00956-13

J Clin Microbiol

2015

DOI: 10.1128/jcm.00956-13

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Answer to March 2015 Photo Quiz

Amber Vasquez¹,

Preeti Pancholi²,

Joan-Miquel Balada-Llasat³

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Cited by 2 publications

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Confused by Weissella confusa Bacteremia

Gelfand¹,

Cleveland²

2015

J Clin Microbiol

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The recent photo quiz and discussion of Weissella confusa bacteremia by Vasquez et al. (1,2) was interesting. The authors proposed several possible routes of infection and related factors, including line infection, dependency on total parenteral nutrition, and altered gut flora associated with multiple prior abdominal surgeries related to Crohn's disease.As the patient had a history of prior use of probiotic therapy, the probiotics could also be a potential source of the bacteremia. Many probiotic preparations contain lactobacilli. Weissella strains may be confused with lactobacilli and have been studied as candidate probiotic microorganisms (3). It is plausible that the probiotic ingested by the patient contained W. confusa, either deliberately or as a result of misidentification as a Lactobacillus species. In their discussion, the authors do not mention the name of the probiotic or if it was tested for the presence of Weissella. Other probiotic microorganisms, both bacterial and fungal, have been associated with blood-borne infections (3-5). In these cases, a postulated mechanism of infection was intestinal translocation of the ingested microorganisms.

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Confused by Weissella confusa Bacteremia

Gelfand¹,

Cleveland²

2015

J Clin Microbiol

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Reply to “Confused by Weissella confusa Bacteremia”

Vasquez

Balada-Llasat

2015

J Clin Microbiol

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In this issue, Gelfand and Cleveland comment (1) on our recent photo quiz (2, 3) about Weissella confusa bacteremia in a Crohn's disease patient. In particular, they raise the possibility that the bacteremia resulted from the patient's use of a probiotic supplement rather than the other etiologies discussed. We agree that probiotics have been reported in association with Lactobacillus species bacteremia (4) and are a potential etiology when these organisms are found in the bloodstream. The patient under discussion had been taking 1 g of a probiotic containing Lactobacillus acidophilus and L. bulgaricus three times a day, and while this is incongruent with the organism ultimately identified in her bloodstream, it may still have been present in the probiotic supplement. The patient's probiotic was not tested for the presence of W. confusa but had nevertheless been discontinued during the course of her treatment. We agree that probiotic testing is a potential avenue of investigation in cases where the etiology of the bacteremia is in doubt and where it may alter clinical management. Weissella spp. are found in foods and the gastrointestinal tracts of human and animals (5). Regardless of the origin of the Weissella species, we favor gut translocation as the cause of the bacteremia because our patient had multiple abdominal surgeries and altered gastrointestinal flora from Crohn's disease.

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Answer to March 2015 Photo Quiz

Cited by 2 publications

References 7 publications

Confused by Weissella confusa Bacteremia

Confused by Weissella confusa Bacteremia

Reply to “Confused by Weissella confusa Bacteremia”

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