Boerhaave’s syndrome complicated by aSaccharomyces cerevisiaepleural empyema. Case report and review of the literature

Abstract

Objective and Importance Boerhaave's syndrome is a sudden and rare form of oesophageal rupture and is often complicated by local or systemic infection of the mediastinum or pleural cavity. Several micro-organisms are documented as cause of pleural empyema in patients with Boerhaave's syndrome. Intervention (& Technique) We report on a previously healthy 74-year-old male who was admitted at a regional hospital with severe retrosternal and abdominal pain after an episode of vigorous vomiting the morning after ingestion of large quantity of beer. A CT-scan confirmed the diagnosis of Boerhaave's syndrome, an oesophageal stent was placed and a left-sided pleural empyema necessitated chest tube drainage. Pleural fluid samples were cultured every two days and were positive for Proteus mirabilis on day 2 after admission and for Saccharomyces cerevisiae on day 8 after admission. Intravenous fluconazole 800 mg per day was added to the antibacterial treatment. Pleural fluid culture became negative for P. mirabilis on day 23 and for S. cerevisiae on day 13. Recurrent empyema necessitated intrapleural thrombolysis. The patient could be discharged from the ICU after 43 days, from the normal ward to a rehabilitation centre after an additional 13 days. Conclusion Pleural empyema caused by S. cerevisiae, commonly known as 'Brewers' yeast', has never been described in such patients. Our case illustrates that clinicians should be aware of infection with S. cerevisiae after oesophageal perforation, soon after ingestion of beer. Adequate antimycotic treatment was successful and led to negative culture of pleural fluid after 5 days.

Pleural Empyema Due to Proteus Mirabilis in an Adult: A Rarely Encountered Clinical Scenario

“…We searched the PubMed database in English literature from 1960 for pleural space infections caused by Proteus species in adults with the keywords "Pleural empyema and Proteus," "Pleural effusion and Proteus," "Pleural empyema and gram-negative bacilli," "Pleural effusion and gram-negative bacilli," "parapneumonic pleural effusion and gram-negative bacilli," "pleural space infection and gramnegative bacilli," and "parapneumonic pleural effusion and infectious etiology" and extracted data pertaining only to the adult population, where possible. The search uncovered 49 previously documented cases of pleural space infection (effusion and/or empyema) caused by Proteus species in adults (Table 2) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

Hypothesis of Potential Evolution of SARS-CoV-2 through Hybridization of SARS-CoV-1 with Saccharomyces cerevisiae and Mycobacterium avium naturally inside an immunocompromised Pangolin

“…Radiology: : CT scan showing evidence of right lower lobe consolidation and pleural effusion, (Fig. 8S) [217,218].…”

Update of the list of QPS‐recommended biological agents intentionally added to food or feed as notified to EFSA 10: Suitability of taxonomic units notified to EFSA until March 2019

“…In 2 of those 30 studies (corresponding to 1 article, Awad et al., ), the problem was due to a lack of information regarding the source attribution. In 19 studies (corresponding to 15 articles: Afsarian et al., ; Alobaid and Khan, ; Bharathi, ; Diba et al., ; Das et al., ; Hasan and Yassein, ; Jung et al., ; Kara et al., ; Khedri et al., ; Kaur et al., ; Nagy et al., ; Omran and Mansori, ; Sadrossadati et al., ; Shokohi et al., ; Teblick et al., ), the problem was due to predisposing factors in the exposed subject.…”

“…These 30 articles included description of 45 studies related to different yeast species with QPS status, of which 16 referred to Candida kefyr (teleomorph = Kluyveromyces marxianus ) (Afsarian et al., ; Awad et al., ; Bharathi, ; Diba et al., ; García‐Agudo et al., ; Hasan and Yassein, ; Kaur et al., ; Kesmen et al., ; Khedri et al., ; Nagy et al., ; Okmen et al., ; Omran and Mansori, ; de Paula et al., ; Sadrossadati et al., ; Shokohi et al., ; Simi et al., ), 8 to Saccharomyces cerevisiae including Saccharomyces boulardii (corresponding to 7 articles: Lazo‐Vélez et al., ; Ruelle et al., ; Hasan and Yassein, ; Kara et al., ; Kesmen et al., ; Ochiai et al., ; Teblick et al., ), 10 to Candida famata (teleomorph = Debaryomyces hansenii ) (Afsarian et al., ; Alobaid and Khan, ; Awad et al., ; Cen et al., ; Das et al., ; Diba et al., ; Hasan and Yassein, ; Kesmen et al., ; de Paula et al., ; Simi et al., ), 6 to Candida pelliculosa (synonymus = Pichia anomala , teleomorph = Wickerhamomyces anomalus ) (Ahmadsah et al., ; Arendrup et al., ; Cen et al., ; Jung et al., ; Kesmen et al., ; Soman et al., ), 1 to Candida utilis (teleomorph = Lindnera jadinii ) (Treguier et al., ), 1 to Hanseniaspora uvarum (Kesmen et al., ), 1 Kluyveromyces lactis (Kesmen et al., ) a nd 1 to Schizosaccharomyces pombe (Kesmen et al., ). One of these articles was considered relevant (Pfaller et al., ) to evaluate since it presented new data on antimycotic MIC breakpoints for azoles but it is not associated to any specific yeast TU.…”

“…For 32 of those 45 studies, no potential safety concern was reported, while a potential safety concern was described in the other 13 studies (corresponding to 11 articles: Diba et al., ; Das et al., ; Jung et al., ; Kara et al., ; Khedri et al., ; Nagy et al., ; Omran and Mansori, ; Sadrossadati et al., ; Afsarian et al., ; Shokohi et al., ; Teblick et al., ): 3 for C. famata (Das et al., ; Diba et al., ; Shokohi et al., ), 7 for C. kefyr (Afsarian et al., ; Diba et al., ; Khedri et al., ; Nagy et al., ; Omran and Mansori, ; Sadrossadati et al., ; Shokohi et al., ), 1 for C. pelliculosa (Jung et al., ) and 2 for Saccharomyces cerevisiae (Kara et al., ; Teblick et al., ). All these studies reported isolation of the QPS yeasts from opportunistic infections in patients with serious predisposing factors.…”