Lactobacillus gasseri liver abscess and bacteremia: a case report

Abstract

Background Lactobacillus is a genus of Gram-positive non-spore-forming rods usually found in the microbiota of the oral cavity, gastrointestinal tract, and female genitourinary tract. Also, they are commonly used in the food industry as supplements and probiotics. Lactobacilli are normally considered non-pathogenic to the human body, however, under certain circumstances such as immunosuppression, they can cause severe infections, with only a few cases of bacteremia, infective endocarditis, pneumonia, meningitis, and intra-abdominal infections reported. Among these presentations, a pyogenic liver abscess is rather rare. Case presentation We describe the case of a 59-year-old man with a history of diabetes mellitus and multiple abdominal surgeries with the latest being in 2014 presenting with bacteremia and multiple large pyogenic liver abscesses due to Lactobacillus gasseri, which did not appear to be related to the use of probiotics or immunosuppression. Conclusions Given the high prevalence of diabetes mellitus and the increased use of probiotics, it is expected that in the future we will see an increase in infections caused by Lactobacilli. Medical management with antibiotics and percutaneous drainage were successful strategies for the treatment of this unusual case of pyogenic liver abscesses and bacteremia caused by Lactobacillus gasseri.

Lactobacilli Infection Case Reports in the Last Three Years and Safety Implications

“…Susceptibility to quinupristin/dalfopristin, chloramphenicol and linezolid was also reported [ 73 , 74 , 75 ]. Unfortunately, in many of the cases considered here patients were started on vancomycin and cephalosporins and only later switched to β-lactams, thus probably contributing to disease worsening [ 20 , 29 , 32 , 37 , 38 , 39 , 40 , 41 , 45 , 46 , 47 , 49 , 52 , 53 , 56 ]. From the case reports, resistance of lactobacilli to cephalosporins appeared to be a common trait to be further investigated.…”

“…Lactobacilli were isolated from blood [ 15 , 16 , 17 , 18 , 20 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 49 , 52 , 55 , 56 , 57 ], diseased valve tissue [ 23 ], abscess fluids [ 48 , 51 , 52 , 54 , 57 , 58 ], cerebrospinal fluid (CSF) [ 46 ], marrow [ 30 ], arthrocentesis aspiration fluid [ 53 ] in anaerobiosis and, in some cases, also in aerobiosis [ 15 , 34 ]. Use of automated microbial detection system, i.e., BACT/ALERT 3D or the BACTEC systems (BioMérieux) with incubation at 35 °C were mentioned in some reports [ 23 , 31 , 34 ].…”

“…Susceptibility to β-lactams, including amoxicillin, amoxicillin/clavulanic acid, ampicillin, ampicillin-sulbactam, benzylpenicillin, penicillin G, piperacillin/tazobactam, and meropenem IV was reported in most cases. These antibiotics were used singly or in association with gentamicin, clindamycin, and clarithromycin [ 16 , 17 , 20 , 21 , 22 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 35 , 36 , 37 , 38 , 39 , 40 , 43 , 44 , 45 , 46 , 48 , 49 , 51 , 53 , 54 , 55 , 56 , 57 , 58 ].…”

Probiotics against Viral Infections: Current Clinical Trials and Future Perspectives

“…For instance, European Food Safety Authority (EFSA) and the US Food and Drug Administration (FDA) have not yet approved any probiotic formulation as a therapy [128,130]. Regarding the side effects of probiotics (which by definition seems to be somewhat contradictory), the risk of infection by any microorganism considered as a probiotic is very low, but their administration in particular cases must be extremely careful, for example in people with long-term hospitalizations, suppressed immune systems or in post-surgery patients [133][134][135].…”

Prolonged Lactobacillus Bacteremia With Abdominal Abscesses Secondary to Traumatic Injuries From Pet Dogs: A Case Report

“…Predisposing factors risk factors for serious Lactobacillus infections have included structural heart disease, leukemia, and immunosuppression in transplant patients [ 6 , 7 ]. Bacteremia and intra-abdominal abscesses as a result of Lactobacillus is rare, with only 11 cases reported in the literature [ 8 ]. We add to this number by reporting a case of persistent bacteremia and splenic abscess caused by Lactobacillus casei.…”