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Volume 27, Number 8—August 2021

Fungemia and Other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements

Juha RannikkoComments to Author , 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
Author affiliations: Tampere University, Tampere, Finland (J. Rannikko); Tampere University Hospital, Tampere (J. Rannikko, M. Karppelin, P. Arvola, R. Huttunen, J. Syrjänen); University of Helsinki, Helsinki, Finland (V. Holmberg); Helsinki University Hospital, Helsinki (V. Holmberg, E. Mattila); Oulu University Hospital, Oulu, Finland (N. Kerttula, T. Puhto); Kuopio University Hospital; Kuopio Finland (Ü. Tamm, I. Koivula); Fimlab Laboratories, Tampere (R. Vuento); Turku University Hospital, Turku, Finland (U. Hohenthal)

Main Article

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.

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Page created: May 10, 2021
Page updated: July 14, 2021
Page reviewed: July 14, 2021
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