Persistent bacteremia secondary to delayed identification of Lactobacillus in the setting of mitral valve endocarditis

Abstract

IntroductionLactobacillus species causing infective endocarditis is rare. Most reported cases arise from the oral ingestion of Lactobacillus via dairy or nutritional supplements in patients with congenital valve disease or replacement. We present a case of native valve bacterial endocarditis caused by Lactobacillus arising from dental abscesses. Additionally, there was an error in identification of the Lactobacillus as Corynebacterium, which led to inadequate treatment.Presentation of caseA 51-year-old male presented to an outside clinic with several weeks of subjective fevers and malaise. The provider obtained two sets of blood cultures. Both grew Gram-positive bacilli identified as Corynebacterium. Once hospitalized he persistently had positive blood cultures despite treatment with vancomycin and gentamicin. The specimens were sent to a reference lab. The cultures were confirmed to be Lactobacillus zeae resistant to vancomycin and gentamicin. Once he was started on appropriate therapy his blood cultures showed no further growth of bacteria. The infected teeth were removed as it was felt they were the source of the bacteremia.DiscussionThis case presents two interesting topics in one encounter. First, Lactobacillus is not a common culprit in endocarditis. Secondly, the incorrect identification of the gram-positive bacilli bacteria led to prolonged bacteremia in our patient.ConclusionThe patient was evaluated by cardiothoracic surgery at our facility and it was determined that he would likely need a mitral valve replacement versus repair. The decision was made to treat the patient with six weeks Penicillin-VK prior to the operation. He is currently completing his antibiotic therapy.

Scientific Opinion on the update of the list of QPS‐recommended biological agents intentionally added to food or feed as notified to EFSA (2017–2019)

“…Revision of their full texts allowed selection of 31 reports that raised safety concerns, all of which described human pathological processes. The claimed aetiological agents comprise L. acidophilus (Cohen et al., ; Haghighat and Crum‐Cianflone, ; Hubbard et al., ), L. animalis (Somayaji et al., ), L. casei (Passera et al., ; Vanichanan et al., ; Pailhories et al., ; Stroupe et al., ; de Seynes et al., ), L. coryniformis (Datta et al., ), L. delbrueckii (Chaini et al., ; Maillet et al., ), L. gasseri (Chaini et al., ; Elikowski et al., ; Esquibel et al., ), L. paracasei (Harding‐Theobald and Maraj, ; Kao et al., ; Kato et al., ; Pararajasingam and Uwagwu, ), L. plantarum (Biesiada et al., ), L. rhamnosus (Felekos et al., ; Molinaro et al., ; Aaron et al., ; Norena et al., ; Boumis et al., ; Kane et al., ; Koyama et al., ; Naqvi et al., ; Nayeem et al., ; Zeba et al., ) and L. salivarius (Garcia Carretero et al., ; Wang et al., ).…”

Recurrent Lactobacillus Rhamnoses Bacteremia and Complications in an Immunocompromised Patient With History of Probiotic Use: A Case Report

“…This can be attributed to inadequate treatment, probably due to the above-mentioned challenges. Recurrent bacteremia has also been attributed to delayed identification [ 14 ].…”

Simultaneous application of oral and intravaginal probiotics for Helicobacter pylori and its antibiotic-therapy-induced vaginal dysbacteriosis

“…Many different clinical risks are related to probiotic supplementation. Specifically, Lactobacillus GG, L. acidophilus, L. casei are the most reported strains that can lead to bacteriaemia [156][157][158] . A meta-analysis containing 60 clinical cases and a total of 93 patients discovered that Lactobacillus and Bifidobacterium are the second and third main agents for bacteremia, respectively, with 26 (27.9%) and 12 (12.8%) in total involved cases 159 .…”