Recurrent Lactobacillus Bacteremia in a Patient With Leukemia.

Paurush Ambesh,Stephan Kamholz,Lawrence Wolf,Eva Franzova,Sarah Stroud,Kavita Sharma,Joseph Gotesman

doi:10.1177/2324709617744233

Abstract

Lactobacillus species are a commensal flora of the human gastrointestinal and the female genitourinary tract. Lactobacilli especially the rhamnosus species, are common components of commercial probiotics. They are rarely associated with pathology in immunocompetent people, but they have been known to cause dental caries, bacteremia, and endocarditis in patients with suppressed immune function. Cases of Lactobacillus bacteremia have been reported in patients with acute myeloid leukemia, large granular lymphocytic leukemia, and in transplant recipients. In this article, we report a strange case of recurrent Lactobacillus bacteremia causing multiple episodes of fever of unknown origin in a patient with leukemia. This report is unique as Lactobacillus is not recognized as a common source of bacteremia. Moreover, the source of the bacillus continued to elude us even after extensive investigation.

Highlights

Where there’s smoke, there’s fire —Ancient proverbLactobacillus species are a commensal flora of the human gastrointestinal and the female genitourinary tract.[1]
Cases of Lactobacillus bacteremia have been reported in patients with acute myeloid leukemia, large granular lymphocytic leukemia, and in transplant recipients.[6,7,8,9,10]
Immunosuppression has been reported to be a risk factor for Lactobacillus bacteremia, along with intravenous catheters, prior hospitalization or surgery, and broad-spectrum antibiotic use.[3,5,11,12]. Another population that seems to be at increased risk are patients with loss of integrity of the intestinal mucosal barrier; several occurrences of Lactobacillus bacteremia have been reported in patients with ulcerative colitis.[4,13,14]

Summary

Introduction

Where there’s smoke, there’s fire —Ancient proverbLactobacillus species are a commensal flora of the human gastrointestinal and the female genitourinary tract.[1]. The patient developed fever during the admission and blood cultures were sent. Since the patient had some dental pain, it was suspected that the source of infection could be in the mouth.

Results

Conclusion