Z Gastroenterol 2021; 59(04): 317-320
DOI: 10.1055/a-1168-7577
Originalarbeit

Naturjoghurtinduzierte Lactobacillus-Bakteriämie bei einem mit Ustekinumab behandelten Patienten mit Morbus Crohn und begleitender HIV-Infektion

Yoghurt-induced Lactobacillus bacteremia in a patient with Crohn’s disease on therapy with ustekinumab and concomitant HIV-Infection
Drilon Haziri
Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena
,
Florian Prechter
Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena
,
Andreas Stallmach
Klinik für Innere Medizin IV, Universitätsklinikum Jena, Jena
› Author Affiliations

Zusammenfassung

Probiotika werden häufig von Patienten mit chronisch entzündlichen Darmerkrankungen als begleitende Therapie verwendet. Auch wenn für eine positive Wirkung der Probiotika nur wenig Evidenz vorliegt, wird dieses Verhalten durch die Einschätzung als ein nebenwirkungsfreies Therapiekonzept begünstigt. In seltenen Fällen können Probiotika jedoch zu systemischen Infektionen in Form der Bakteriämien führen. Wir berichten über einen Patienten mit Morbus Crohn und begleitender HIV-Infektion der unter einer Therapie mit Ustekinumab ein septisches Krankheitsbild entwickelte. Es zeigte sich eine Bakteriämie mit Lactobacillum lacti, Leuconostoc citreum und Leuconostoc lactis, die anamnestisch auf den Verzehr von selbstgemachtem Joghurt zurückgeführt werden konnten. Die Verwendung von Probiotika bei CED-Patienten mit zusätzlichen immunkompromittierenden Faktoren stellt ein bislang schwer abschätzbares Risiko dar; von ihrer Anwendung sollte daher abgeraten werden.

Abstract

Probiotics are live microorganisms that are often used as adjunctive therapy in patients with inflammatory bowel disease. Although there is a lack of evidence for their benefit, the use of probiotics is encouraged by the perceived lack of adverse events. However, in rare instances, probiotics can cause systemic infections through bacteremia. We report about a patient with Crohn’s disease and HIV-infection, who developed a septicemia. A Lactobacillus-bacteremia was diagnosed, the causative agents could be traced back to the consumption of self-made yoghurt. The utility of probiotics in IBD patients with underlying immune-compromising diseases is a risk which is difficult to predict, therefore their use in these patients should be discouraged.



Publication History

Received: 05 April 2020

Accepted: 27 April 2020

Article published online:
22 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • Literatur

  • 1 Hedin CR, Mullard M, Sharratt E. et al Probiotic and prebiotic use in patients with inflammatory bowel disease: a case-control study. Inflamm Bowel Dis 2010; 16: 2099-2108 . doi: 10.1002/ibd.21286
  • 2 Agathou CL, Beales IL. Factors associated with the use. of probiotics in patients with inflammatory bowel disease. 2013; 2: 69 . doi: 10.12688/f1000research.2-69.v1. eCollection 2013
  • 3 Suzuki A, Mitsuyama K, Koga H. et al. Bifidogenic growth stimulator for the treatment of active ulcerative colitis: a pilot study. Nutrition 2006; 22: 76-81
  • 4 Kruis W, Schütz E, Fric P. et al. Double-blind comparison of an oral Escherichia coli preparation and mesalazine in maintaining remission of ulcerative colitis. Aliment Pharmacol Ther 1997; 11: 853-858
  • 5 Gionchetti P, Rizzello F, Venturi A. et al. Oral bacteriotherapy as maintenance treatment in patients with chronic pouchitis: a double-blind, placebo-controlled trial. Gastroenterology 2000; 119: 305-309
  • 6 Meini S, Laureano R, Fani L. et al. Breakthrough Lactobacillus rhamnosus GG bacteremia associated with probiotic use in an adult patient with severe active ulcerative colitis: case report and review of the literature. Meini S, Laureano R, Fani L, Tascini C, Galano A, Antonelli A, Rossolini GM. Infection 2015; 43: 777-781
  • 7 Sherid M, Samo S, Sulaiman S. et al. Liver abscess and bacteremia caused by lactobacillus: role of probiotics? Case report and review of the literature. Gastroenterol 2016; 16: 138
  • 8 Costa RL, Moreira J, Lorenzo A. et al. Infectious complications following probiotic ingestion: a potentially underestimated problem? A systematic review of reports and case series. BMC Complement Altern Med 2018; 18: 329
  • 9 Cannon JP, Lee TA, Bolanos JT. et al. Pathogenic relevance of Lactobacillus: a retrospective review of over 200 cases. Eur J Clin Microbiol Infect Dis 2005; 24: 31-40
  • 10 Abraham B, Quigley EMM. Antibiotics and probiotics in inflammatory bowel disease: when to use them?. Frontline Gastroenterol 2020; 11: 62-69 . doi: 10.1136/flgastro-2018-101057. Epub 2019 Mar 22
  • 11 Derwa Y, Gracie DJ, Hamlin PJ. et al Systematic review with meta-analysis: the efficacy of probiotics in inflammatory bowel disease. Aliment Pharmacol Ther 2017; 46: 389-400 . doi: 10.1111/apt.14203
  • 12 Bjarnason I, Sission G, Hayee B. A randomised, double-blind, placebo-controlled trial of a multi-strain probiotic in patients with asymptomatic ulcerative colitis and Crohn’s disease. Inflammopharmacology 2019; 27: 465-473 . doi: 10.1007/s10787-019-00595-4
  • 13 Yılmaz İ, Dolar ME, Özpınar H. Effect of administering kefir on the changes in fecal microbiota and symptoms of inflammatory bowel disease: A randomized controlled trial. Turk J Gastroenterol 2019; 30: 242-253 . doi: 10.5152/tjg.2018.18227
  • 14 Van Assche G, Dignass A, Bokemeyer B. et al. European Crohn’s and Colitis Organisation. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis Part 3: special situations. JCrohns Colitis 2013; 7: 1-33
  • 15 Dore MP, Bibbò S, Fresi G. et al. Side Effects Associated with Probiotic Use in Adult Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
  • 16 Yelin I, Flett KB, Merakou C. et al Genomic and epidemiological evidence of bacterial transmission from probiotic capsule to blood in ICU patients. Nat Med 2019; 25: 1728-1732 . doi: 10.1038/s41591-019-0626-9
  • 17 Farina C, Arosio M, Mangia M. et al. Lactobacillus casei subsp. rhamnosus sepsis in a patient with ulcerative colitis. FClin Gastroenterol 2001; 33: 251-252