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Use of Cultured Yogurt Causing Septic Shock and Intra-abdominal Abscesses

Use of Cultured Yogurt Causing Septic Shock and Intra-abdominal Abscesses. Justin Fernandez, M.D., Maha Assi, M.D., M.P.H. KU School of Medicine-Wichita. DISCLOSURE. I have no actual or potential conflict of interest in relation to this topic/presentation. INTRODUCTION.

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Use of Cultured Yogurt Causing Septic Shock and Intra-abdominal Abscesses

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  1. Use of Cultured Yogurt Causing Septic Shock and Intra-abdominal Abscesses Justin Fernandez, M.D., Maha Assi, M.D., M.P.H. KU School of Medicine-Wichita

  2. DISCLOSURE • I have no actual or potential conflict of interest in relation to this topic/presentation.

  3. INTRODUCTION • Brewer’s/baker’s yeast, yogurts • Probiotic – live, beneficial Lactobacillus S. cerevisiae http://www.nutraingredients.com, http://www.art.com/

  4. PRESENTATION • Asymptomatic <---------------> Septicemia • Pneumonia • Abscess • Endocarditis

  5. Patients with fungemia caused by S. cerevisiae (60): • ICU – 60% • Enteral/parenteral nutrition – 71% • Use of probiotics – 26% SaccharomycescerevisiaeFungemia: An Emerging Infectious Disease, Munoz et al. Madrid, Spain, 2003

  6. Patients with invasive Saccharomyces infections (91): • Central venous catheter – 95% • Previous antibiotics – 87% • Digestive tract disease – 64% Invasive SaccharomycesInfection: A Comprehensive Review, Enache et al. Paris, France, 2005

  7. Patients with Lactobacillus bacteremia (89): • Fatal conditions – 80-90% • Previous antibiotic use – 52% • Mechanically ventilated – 45% Lactobacillus Bacteremia, Clinical Significance, and Patient Outcome, Salminen et al. Tampere, Finland, 2004

  8. Patients with Lactobacillus bacteremia: Lactobacillus Bacteremia and Endocarditis: Review of 45 Cases, Rola et al. Cleveland, Ohio, 1997

  9. WHY HAPPENING? • Higher population at risk • Immunosuppressive drugs • Broad spectrum antiobiotics • Parenteral nutrition

  10. WHY RELEVANT? • Ubiquitous • “An Emerging Infectious Disease” SaccharomycescerevisiaeFungemia: An Emerging Infectious Disease, Munoz et al. Madrid, Spain

  11. OFFICIAL RECOMMENDATION(IDSA) • Saccharomyces + poVancomycin C. diff recurrences • Potential fungemia if immunocompromised • Avoid if critically ill • No compelling evidence with other probiotics http://www.idsociety.org

  12. SAFE?

  13. LOCAL and NATIONAL

  14. CONCLUSION • BENEFIT should clearly outweigh RISK • HOWEVER…IF • Immunocompromised • Bowel compromise • Comorbidities • Central Venous Catheter • THEN… CAUTION!!!

  15. NO INTERVENTION IS BENIGN

  16. REFERENCES 1. Stein PD, Folkens AT, Hruska KA. Saccharomycesfungemia. Chest 1970; 58:173–5 2. Saccharomycesboulardiiin critically ill patients. Intensive Care Med 2002; 28:797–801. , Piarroux R, Millon L, Bardonnet K, Vagner O, Koenig H. Are live saccharomyces yeasts harmful to patients? Lancet 1999; 353:1851–2 Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL 3. The epidemiological features of invasive mycotic infections in the San Francisco Bay Area, 1992–1993: results of population-based laboratory active surveillance. Clin Infect Dis 1998; 27:1138–47. Stein PD, Folkens AT, Hruska KA. Saccharomycesfungemia. Chest 1970; 58:173–5 4. Seven cases of fungemia with Saccharomycesboulardiiin critically ill patients. Intensive Care Med 2002; 28:797–801. , Piarroux R, Millon L, Bardonnet K, Vagner O, Koenig H. 5. Are live saccharomyces yeasts harmful to patients? Lancet 1999; 353:1851–2 6. Rees JR, Pinner RW, Hajjeh RA, Brandt ME, Reingold AL. The epidemiological features of invasive mycotic infections in the San Francisco Bay Area, 1992–1993: results of population-based laboratory active surveillance. Clin Infect Dis 1998; 27:1138–47. 7. Hennequin C, Kauffmann-Lacroix C, Jobert A, et al. Possible role of catheters in Saccharomycesboulardiifungemia. Eur J ClinMicrobiol Infect Dis 2000; 19:16–20 8. Piarroux R, Millon L, Bardonnet K, Vagner O, Koenig H. Are live saccharomyces yeasts harmful to patients? Lancet 1999; 353:1851–2. 9. Perapoch J, Planes AM, Querol A, et al. Fungemia with Saccharomycescerevisiaein two newborns, only one of whom had been treated with ultra-levura. Eur J ClinMicrobiol Infect Dis 2000; 19:468–70 10. Hennequin C, Kauffmann-Lacroix C, Jobert A, et al. Possible role of catheters in Saccharomycesboulardiifungemia. Eur J ClinMicrobiol Infect Dis 2000; 19:16–20

  17. 11. SaccharomycescerevisiaeFungemia: An Emerging Infectious Disease Patricia Mun˜ oz,1 Emilio Bouza,1 Manuel Cuenca-Estrella,3 Jose Marı´a Eiros,1 Maria Jesu´sPe´ rez,2 Mar Sa´nchez-Somolinos,1 Cristina Rinco´n,2 Javier Hortal,2 and Teresa Pela´ez1 Departments of 1Clinical Microbiology and Infectious Diseases and 2Heart Surgery, Hospital General Universitario “Gregorio Maran˜o´n,”UniversidadComplutense, and 3Centro Nacional de Microbiologı´a, Instituto de Salud Carlos III, Madrid, Spain 12. Salonen JH, Richardson MD, Gallacher K, et al. Fungal colonization of haematological patients receiving cytotoxic chemotherapy: emergence emergenceofazole-resistant Saccharomycescerevisiae. J Hosp Infect 2000; 45:293–301 13. Jensen DP, Smith DL. Fever of unknown origin secondary to brewer’s yeast ingestion. Arch Intern Med 1976; 136:332–3. 14. McCusker JH, Clemons KV, Stevens DA, Davis RW. Saccharomycescerevisiaevirulence phenotype as determined with CD-1 mice is associated with the ability to grow at 42 degrees C and form pseudohyphae. Infect Immun 1994; 62:5447–55 15. Wheeler RT, Kupiec M, Magnelli P, Abeijon C, Fink GR. A Saccharomycescerevisiaemutant with increased virulence. Proc NatlAcadSci U S A 2003; 100:2766–70 16. Invasive SaccharomycesInfection: A Comprehensive Review Adela Enache-Angoulvant1,2 and Christophe Hennequin1,2 1Laboratoire de Parasitologie, Faculte´ de Me´decine Pierre et Marie Curie, Universite´ Pierre et Marie Curie, and 2Service de Parasitologie, HoˆpitalTenon, Paris, France 17. Eng RHK, Drehmel R, Smith SM, Goldstein EJC. Saccharo- mycescerevisiae infections in man. Sabouraudia 1984; 22: 403–7 18. J. S. Williams, G. J. Mufti,* S. Powell, J. R. Salisbury† and E. M. Higgins Departments of Dermatology, *Haematological Medicine, and Histopathology, King’s College Hospital, London, UK 19. Two Cases of Vaginitis Caused by Itraconazole-Resistant Saccharomycescerevisiae and a Review of Recently Published Studies VincenzoSaviniChiaraCatavitelloAssunta Manna Marzia Talia Fabio Febbo Andrea Balbinot Francesco D’Antonio Giovanni Di Bonaventura Claudio Celentano Marco LiberatiRaffaelePiccolominiDomenicoD’Antonio

  18. 20. Rosa de Llanos a, AmparoQuerol a, Javier Pemánb, Miguel Gobernadob, María Teresa Fernández-Espinar a,⁎ a Departamento de Biotecnología, Instituto de AgroquímicayTecnología de los Alimentos (CSIC), 46100 Burjassot, Valencia, Spain bServicio de Microbiología, Hospital Universitario La Fe, Valencia, Spain Received 2 December 2005; received in revised form 1 March 2006; accepted 25 April 2006 21. Guslandi M., G. Mezzi, M. Sorghi, and P. A. Testoni. 2000. Saccharomycesboulardiiin maintenance treatment of Crohn’s disease. Dig. Dis. Sci. 68: 5998–6004 22. Hennequin, C., C. Kauffmann-Lacroix, A. Jobert, J. P. Viard, C. Ricour, J. L. Jacquemin, and P. Berche. 2000. Possible role of catheters in Saccharomycesboulardiifungemia. Eur. J. Clin. Microbiol. Infect. Dis. 19:16–20 23. Outbreak of SaccharomycescerevisiaeSubtype boulardiiFungemia in Patients Neighboring Those Treated with a Probiotic Preparation of the Organism Marco Cassone,1* Pietro Serra,1 Francesca Mondello,2 Antonietta Girolamo,2 Sandro Scafetti,3 Eleonora Pistella,1 and Mario Venditti1 III ClinicaMedica, DipartimentodiMedicinaClinica, Universita` degliStudidi Roma “La Sapienza,”1 DipartimentodiMalattieinfettive, parassitarieedimmunomediate, IstitutoSuperioredi Sanita`,2 and RepartodiRianimazioneeTerapiaIntensiva, Ospedale “Sandro Pertini,”3 Rome, Italy 24. Stein P, Folkens A, Hruska K. Saccharomycesfungemia. Chest 1970; 58:173–5 25. SaccharomycescerevisiaeFungemia After Saccharomycesboulardii Treatment in Immunocompromised Patients Riquelme, Arnoldo J. M.D.; Calvo, Mario A. M.D.; Guzmán, Ana M. M.D.; Depix, María S.; García, Patricia M.D.; Pérez, Carlos M.D.; Arrese, Marco M.D.; Abarca, Jaime A. M.D. 26. Castagliuolo I, LaMont JT, Nikulasson ST, Pothoulakis C. Saccharomycesboulardiipro- tease inhibits Clostridium difficiletoxin A effects in the rat ileum. Infect Immun 1996; 64: 5225–32 27. Castagliuolo I, LaMont JT, Nikulasson ST, Pothoulakis C. Saccharomycesboulardiipro- tease inhibits Clostridium difficiletoxin A effects in the rat ileum. Infect Immun 1996; 64: 5225–32

  19. 28. SaccharomycescerevisiaeFungemia: An Adverse Effect of SaccharomycesboulardiiProbiotic Administration RaoulHerbrecht and YasmineNivoix Department of Hematology and Oncology and Pharmacy, Hoˆpital de Hautepierre, Strasbourg, France 29. ShadiHamoud MD1, ZoharKeidar MD2 and Tony Hayek MD1 Departments of 1Internal Medicine E and 2Nuclear Medicine, Rambam Medical Center, Haifa, Israel 30. Aguirre M, Collins MD. Lactic acid bacteria and human clinical infection. J ApplBacteriol 1993;75:95-107 31. LactobacillusBacteremia, Clinical Significance, and Patient Outcome, with Special Focus on ProbioticL. Rhamnosus GG Minna K. Salminen1, Hilpi Rautelin2, Soile Tynkkynen3, Tuija Poussa4, Maija Saxelin3, Ville Valtonen1, and Asko Järvinen1 32. Probiotics in the prevention of antibiotic-associated diarrhoea and Clostridium difficile infection Mary Hickson 33. Lactobacillus Bacteremia and Endocarditis: Review of 45 Cases Rola N. Husni, Steven M. Gordon, John A. Washington, From the Departments of Infectious Diseases and Clinical Pathology, and David L. Longworth The Cleveland Clinic Foundation, Cleveland, Ohio 34. Probiotics for the Prevention and Treatment of Antibiotic-Associated DiarrheaA Systematic Review and Meta-analysis FREESusanneHempel, PhD; Sydne J. Newberry, PhD; Alicia R. Maher, MD; Zhen Wang, PhD; Jeremy N. V. Miles, PhD; Roberta Shanman, MS; Breanne Johnsen, BS; Paul G. Shekelle, MD, PhD 35. http://www.idsociety.org

  20. QUESTIONS

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