Lactobacillus: the not so friendly bacteria

BMJ Case Rep. 2017 Sep 13:2017:bcr2016218423. doi: 10.1136/bcr-2016-218423.

Abstract

We present a 65-year-old diabetic patient with a complex liver abscess and bacteraemia from Lactobacillus paracasei The abscess resulted in a prolonged hospital stay due to ongoing sepsis despite ultrasound-guided drainage and broad-spectrum antibiotics. Furthermore, the patient developed several secondary complications including a right-sided pleural effusion, an inferior vena cava thrombus and septic lung emboli. The abscess was eventually managed successfully with a prolonged course of antibiotics and multiple ultrasound-guided drainage procedures.To our knowledge, this is the first reported case of probiotic consumption, confirmed by strain identification, as the likely source of a liver abscess. Probiotic products have been widely used for many years and are advocated to the general public for their health benefits with no warning of side effects. Lactobacilli are one group of bacteria commonly used in these products. Although rare, complications have been reported. Susceptible patients, such as those who are immunocompromised, should be advised against excessive consumption.

Keywords: GI-stents; diabetes; diet; infections; vitamins and supplements.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Colony Count, Microbial
  • Drainage
  • Female
  • Fluconazole / therapeutic use
  • Humans
  • Immunocompromised Host / immunology*
  • Lactobacillus / classification
  • Lactobacillus / immunology
  • Lactobacillus / isolation & purification
  • Lactobacillus / pathogenicity*
  • Lethargy
  • Linezolid / therapeutic use
  • Liver Abscess / etiology
  • Liver Abscess / microbiology*
  • Metronidazole / therapeutic use
  • Microbial Sensitivity Tests
  • Pleural Effusion / microbiology
  • Probiotics / adverse effects*
  • Sepsis / etiology
  • Sepsis / microbiology*
  • Treatment Outcome
  • Venous Thrombosis / microbiology

Substances

  • Anti-Bacterial Agents
  • Metronidazole
  • Fluconazole
  • Linezolid