Volume 27, Number 8—August 2021
CME ACTIVITY - Research
Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements
Juha Rannikko
, Ville Holmberg, Matti Karppelin, Pertti Arvola, Reetta Huttunen, Eero Mattila, Niina Kerttula, Teija Puhto, Ülle Tamm, Irma Koivula, Risto Vuento, Jaana Syrjänen, and Ulla Hohenthal
, Ville Holmberg, Matti Karppelin, Pertti Arvola, Reetta Huttunen, Eero Mattila, Niina Kerttula, Teija Puhto, Ülle Tamm, Irma Koivula, Risto Vuento, Jaana Syrjänen, and Ulla Hohenthal
Table 1
Characteristics of 46 case-patients who had Saccharomyces fungemias in 5 hospital districts, Finland, January 1, 2009‒December 31, 2018*
| Patient no. | Hospital district and case no. | Age, y/sex | Year of fungemia | Medical record of S. cerevisiae var. boulardii probiotic use in previous 3 mo | Days alive after fungemia | Central venous catheter | GI tract disease | Antimicrobial drug before fungemia | Change in medication because of fungemia | Main reason for hospital stay |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | A1 | 56/M | 2016 | Yes | >90 | No | Duodenal ulcer | Yes | Yes | Antimicrobial drugs and NSAIDs after tooth surgery led to duodenal ulcer and fungemia |
| 2 | A2 | 42/M | 2013 | No | >90 | No | Achalasia, PEG tube, duodenal ulcer | Yes | Yes | Vomiting, losing weight, duodenal ulcer |
| 3 | A3 | 42/M | 2010 | No | >90 | No | No | No | Yes | Intravenous drug user who had fungemia |
| 4 | A4 | 40/M | 2018 | No | >90 | No | No | No | Yes | Methadone substitution therapy for patient who had fever and was feeling ill |
| 5 | A5 | 77/F | 2011 | Yes | 2 | No | PEG tube | Yes | Yes | Spinocellular carcinoma patient who had problems with PEG tube |
| 6 | B1 | 67/M | 2009 | Yes | >90 | Yes | Pancreatitis | Yes | Yes | Necrotizing pancreatitis |
| 7 | B2 | 66/M | 2010 | Yes | 0 | No | PEG tube | Yes | No | PEG tube not in place |
| 8 | B3 | 52/M | 2012 | NA | >90 | No | No | No | No | HIV positive with illicit drug use in ED and high fever and diarrhea |
| 9 | B4 | 67/M | 2013 (4 different days) | Yes | 7 | Yes | Chronic pancreatitis with pseudocysts | Yes | Yes | Pseudocyst rupturation into lung |
| 10 | B5 | 88/M | 2013 | Yes | 19 | NA | Bowel obstruction and diverticulosis | NA | NA | Diarrhea after antimicrobial drug use that later turned into an occlusion |
| 11 | B6 | 60/M | 2014 | NA | >90 | NA | No | Yes | No | Alcohol abuse, streptococcal septicemia, and bronchopleural fistula |
| 12 | B7 | 70/F | 2015 | Yes | 14 | No | Local intestinal thickening of unknown reason | Yes | Yes | Unspecified neurologic disease that lead to cachexia |
| 13 | B8 | 63/M | 2015 | Yes | 26 | No | Stomach cancer | Yes | Yes | Lung abscess treated with lobectomia |
| 14 | B9 | 91/F | 2015 | Yes | 39 | NA | No | Yes | NA | Varicose ulcer |
| 15 | B10 | 75/F | 2016 | Yes | >90 | No | Pancreatic cancer | Yes | Yes | Recurrent cholangitis |
| 16 | B11 | 67/F | 2017 | NA (suspected) | >90 | NA | PEG tube | NA | NA | Multiple sclerosis, PEG tube, diarrhea |
| 17 | B12 | 55/M | 2018 | Yes | 0 | No | No | Yes | No | Alcohol abuse with delirium and Clostridium difficile diarrhea |
| 18 | B13 | 86/F | 2018 | Yes | 0 | No | Suspected Crohn disease and diverticulosis | Yes | No | Staphylococcus aureus infection after femoro-popliteal reconstruction |
| 19 | C1 | 88/F | 2016 | Yes | 0 | No | Colitis ulcerosa | Yes | No | Deep venous thrombosis and fasciotomia |
| 20 | C2 | 77/M | 2016 | No | 1 | No | No | Yes | No | Alzheimer patient with aspiration pneumonia |
| 21 | C3 | 85/M | 2016 | NA | 82 | No | Colon carcinoma and biliary duct obstruction | Yes | Yes | Liver abscess and septicemia due to Streptococcus sp., Lactobacillus, sp., use of Rhamnonosus, and Saccharomyces sp. |
| 22 | C4 | 39/M | 2015 | Yes | >90 | No | Crohn disease | Yes | Yes | Relapse of Crohn disease and spondylitis of cervical spine |
| 23 | C5 | 80/F | 2012 | Yes | >90 | No | Nasogastric tube | Yes | Yes | Fever, abdominal pain, and vomiting after hip surgery |
| 24 | C6 | 91/M | 2010 | Yes | 2 | No | No | Yes | No | Severe pneumonia |
| 25 | D1 | 60/M | 2017 | No | >90 | Yes (PICC) | Bowel obstruction | Yes | Yes | Bowel obstruction due to adhesion |
| 26 | D2 | 84/M | 2017 | Yes | 1 | No | No | Yes | No | Pneumonia, sepsis, and multiple organ failure |
| 27 | D3 | 76/F | 2017 | Yes | 0 | Yes | Cholecystitis and bowel ischemia | Yes | No | Bowel ischemia and sepsis |
| 28 | D4 | 68/M | 2017 | No | >90 | Yes | Esophageal carcinoma | Yes | No | Esophageal carcinoma surgery and diarrhea |
| 29 | D5 | 80/M | 2017 | NA | NA | NA | NA | NA | NA | Treated in a district hospital |
| 30 | D6 | 78/F | 2012 | Yes | >90 | Yes | Perforation of sigma | Yes | Yes | Sigma operation and wound infection |
| 31 | D7 | 39/M | 2014 | No | >90 | No | No | No | Yes | Alcohol abuse in ED with empyema and sepsis |
| 32 | D8 | 72/F | 2015 | Yes | NA | No | Pancreatic cancer | Yes | Yes | Pancreatic cancer |
| 33 | D9 | 45/M | 2010 | No | >90 | Yes | Necrotizing pancreatitis | Yes | Yes | Necrotizing pancreatitis with necrosis in multiple other organs |
| 34 | D10 | 67/F | 2014 | No | >90 | No | No | Yes | Yes | Heart and kidney failure |
| 35 | D11 | 83/F | 2015 | Yes | NA | Yes | Intestinal perforation | Yes | Yes | Intestinal perforation and abscesses |
| 36 | D12 | 58/F | 2018 | Yes | >90 | No | Diverticulitis | Yes | Yes | Diverticulitis and intestinal perforation |
| 37 | E1 | 68/M | 2011 | Yes | >90 | No | No | Yes | Yes | Alcohol abuse and urinary tract infection |
| 38 | E2 | 83/M | 2013 | NA | 14 | NA | NA | NA | NA | NA |
| 39 | E3 | 72/F | 2015 | No | 0 | Yes | Prepyloric ulcus | Yes | No | Ulcus, peritonitis, and sepsis |
| 40 | E4 | 30/F | 2015 | NA | 10 | NA | NA | NA | NA | Treated in a district hospital |
| 41 | E5 | 52/M | 2015 | Yes | 21 | No | Biliary tract obstruction | Yes | No | Biliary tract obstruction |
| 42 | E6 | 72/F | 2016 | Yes | >90 | No | Radiation colitis and multiple fistulas | Yes | No | Carcinoma of cervix and fever |
| 43 | E7 | 39/M | 2016 | No | >90 | No | No | No | No | Intravenous drug user with dyspnea |
| 44 | E8 | 59/M | NA | NA | NA | NA | NA | NA | NA | Treated in a district hospital |
| 45 | E9 | 72/M | NA | NA | NA | NA | NA | NA | NA | Treated in a district hospital |
| 46 | E10 | 93/M | NA | NA | NA | NA | NA | NA | NA | Treated in a district hospital |
*ED, emergency department; GI, gastrointestinal; NA, medical records not available; NSAIDs, nonsteroidal antiinflammatory drugs; PEG, percutaneous endoscopic gastrostomy; PICC, peripherally inserted central catheter.
Page created: May 10, 2021
Page updated: July 14, 2021
Page reviewed: July 14, 2021
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