Catheter-related Saccharomyces cerevisiae Fungemia Following Saccharomyces boulardii Probiotic Treatment: In a child in intensive care unit and review of the literature

Abstract

Although Saccharomyces boulardii is usually a non-pathogenic fungus, in rare occasions it can cause invasive infection in children. We present the case of an 8-year-old patient in pediatric surgical intensive care unit who developed S. cerevisiae fungemia following probiotic treatment containing S. boulardii. Caspofungin was not effective in this case and he was treated with amphotericin B. We want to emphasize that physicians should be careful about probiotic usage in critically ill patients.

The Unregulated Probiotic Market

“…S. boulardii has been reported to be associated with fungemia in critically ill patients as well as in immunocompromised individuals. 14,15 An analysis of the side effects versus the benefits of this biotherapy is beyond the scope of this article mainly focused on lactobacilli and bifidobacteria).…”

Strategies to Reduce Mortality in Adult and Neonatal Candidemia in Developing Countries

“…Clinical trials conducted in preterm neonates demonstrated a favorable effect of Saccharomyces boulardii containing probiotics without any evidence of fungemia or sepsis [ 136 ]. However, few studies reported occasional cases of fungemia subsequent to the use of probiotics, questioning the safety of these products [ 136 , 137 , 138 , 139 , 140 ]. It is therefore recommended to use probiotics cautiously in pre-term neonates and immunocompromised patients [ 139 ].…”

Biochemical characteristics, virulence traits and antifungal resistance of two major yeast species isolated from kefir: Kluyveromyces marxianus and Saccharomyces unisporus

“…; Atıcı et al . ). Saccharomyces boulardii is the only yeast currently acknowledged as generally regarded as safe (GRAS) by the Food and Drug Administration; however, with further research based on the current study, additional probiotic yeast strains with no safety issues could potentially be developed in the future.…”

“…Instead, studies were limited to those defined as pathogenic yeasts, such as Candida species (Budtz-J€ orgensen 1990; Odds 1994). The functional properties of potential probiotic yeasts should be investigated in parallel to the safety assessment of yeast strains, as outbreaks of fungaemia due to probiotic treatments are commonly reported (Cassone et al 2003;Atıcı et al 2017). Saccharomyces boulardii is the only yeast currently acknowledged as generally regarded as safe (GRAS) by the Food and Drug Administration; however, with further research based on the current study, additional probiotic yeast strains with no safety issues could potentially be developed in the future.…”