Lactobacillemia: Epidemiolgy, clinical features, diagnosis and treatment

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Bacteremia: Risk Factors, Treatment and Potential Complications

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© 2014 Nova Science Publishers, Inc. Lactobacillemia is a rare cause of bacteremia and the true clinical significance of this entity is just being delineated. Lactobacillus is a gram-positive bacillus that is for the most part intrinsically resistant to vancomycin but appears to be susceptible to most beta-lactams, erythromycin and clindamycin. Lactobacilli are a part of the normal gastrointestinal and genitourinary flora and for many years was regarded as non-pathogenic. There have been several case reports of Lactobacillus causing infections such as bacteremia, abscesses, peritonitis, meningitis and endocarditis. L. rhamonosus, L. acidophilus and L. casei seem to have been implicated in a variety of infections. Interestingly, pre-administration of commercially available probiotics seem to have been implicated in sepsis in some of these cases. Lactobacillemia may be seen as an isolated infection or more often, as a poly-microbial infection. It tends to occur in patients who have been treated with antibiotics that have no activity on Lactobacillus. Many of the patients described in the literature are immuno-compromised with underling disease processes such as cancer, recent surgery, diabetes, and immunosuppressive therapy. However, patients with normal immune systems and Lactobacillus infection have also been described in the literature. Diagnosis is usually made on the isolation of the pathogens on blood cultures but more recently can be made using a rapid molecular method using terminal restriction fragment polymorphism analysis of the 16S rRNA gene. Some interesting questions still remain to be addressed such as recommendations in the use of prophylactic Lactobacillus on diseases such as irritable bowel syndrome, Clostridium difficile colitis and even routine use of this supplement and the risk of bacteremia.

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