Can use of probiotics drugs cause fungemia? – a literature review
DOI:
https://doi.org/10.33448/rsd-v11i9.32030Keywords:
Saccharomyces boulardii; Fungemia; Probiotics; Immunocompromised Host.Abstract
Commercially, there are many products sold as probiotics composed by Sacharomyces boulardii, with probiotic drugs being those that are widely used in different clinical situations. The probiotic efficacy of these agents is proven in many studies, as well as their safety in normal use situations. However, there have been some reports of fungemias related to the use of these probiotics in hospitals associated with some factors. Therefore, our objective is to review the knowledge about this association, focusing on the factors that provide it and the development mechanisms. For the development of fungemia associated with the use of probiotics, it is observed that it has greater development potential in patients using a central venous catheter. Although this is the main factor, others that reduce the patient's immune status, as well as reduce the intestinal defense barriers, contribute to this process, increasing the risk of fungemia. Despite the well-documented benefits of probiotics, their use must be carefully evaluated for each patient, due to factors that contribute to associate the use of probiotic drugs with the risk of developing bloodstream infection by S. boulardii. It is necessary, therefore, to include protocols that generate alerts about this risk and establish preventive measures.
References
Acevedo, C. G., Romero, J. O., Espejo, R. T. (2003). Actividad de distintas presentaciones comerciales de Saccharomyces boulardii. Rev chil nutr, 31(1), 33-38.
Antunes, L. C. M., Han, J., Ferreira, R. B. R., Lolić, P., Borchers, C. H., Finlay, B. B. (2011). Effect of antibiotic treatment on the intestinal metabolome. Antimicrob Agents Chemother, 55(4), 1494-503.
Appel-da-Silva, M. C., Narvaez, G. A., Perez LRR, Drehmer L, Lewgoy J. (2017). Saccharomyces cerevisiae var. boulardii fungemia following probiotic treatment. Med Mycol Case Rep, 18, 15-17.
Atıcı, S., Soysal, A., Cerit, K. K., Yılmaz, S., Aksu, B., Kıyan, G., et al. (2017). Catheter-related Saccharomyces cerevisiae Fungemia Following Saccharomyces boulardii Probiotic Treatment: In a child in intensive care unit and review of the literature. Med Mycol Case Rep, 15, 33-35.
Belet, N., Dalgiç, N., Oncel, S., Ciftçi, E., Ince, E., Güriz, H., et al. (2005). Catheter-related fungemia caused by Saccharomyces cerevisiae in a newborn. Pediatr Infect Dis J, 24(12), 1125.
Brainfarma Indústria Química e Farmacêutica. (2015). Flomicin: Saccharomyces boulardii – 17. Responsável técnico Dr. Marco Aurélio Limirio G. Filho. Goiás: Brainfarma Indústria Química e Farmacêutica, 2015.
Buts, J. P., Bernasconi, P. (2005). Saccharomyces boulardii: basic science and clinical applications in gastroenterology. Gastroenterol Clin North Am, 34(3), 515-32.
Cassone, M., Serra, P., Mondello, F., Girolamo, A., Scafetti, S., Pistella, E., et al. (2003). Outbreak of Saccharomyces cerevisiae Subtype boulardii Fungemia in Patients Neighboring Those Treated with a Probiotic Preparation of the Organism. J Clin Microbiol, 41(11), 5340–43.
Chioukh, F. Z., Hmida, H. B., Ameur, K. B., Toumi, A., Monastiri, K. (2013). Septicémie à Saccharomyces cerevisiae chez un prématuré traité par Ultra-Levure®. Med Mal Infect, 8(43), 359-60.
Czerucka, D., Piche, T., Rampal, P. (2007). Yeast as probiotics – Saccharomyces boulardii. Aliment Pharmacol Ther, 26(6), 767-78.
Didari, T., Solki, S., Mozaffari, S., Nikfar, S., Abdollahi, M. (2014). A systematic review of the safety of probiotics. Expert Opin Drug Saf, 13(2), 227-39.
Do Couto, F. M. M., Macedo, D. P. C., Neves, R. P. (2011). Fungemia in a university hospital: na epidemiological approach Fungemia em hospital universitário: uma abordagem epidemiológica. Rev Soc Bras Med Trop, 44(6), 745-48.
Doron, S., Snydman, D. R. (2015). Risk and Safety of Probiotics. Clin Infect Dis, 60(Suppl 2), S129–S134.
EMS Sigma Pharma LTDA. (2014). Repoflor: Saccharomyces boulardii-17. Responsável técnico Dr. Ronoel Caza de Dio. São Paulo: 2014.
Eren, Z., Gurol, Y., Sonmezoglu, M., Eren, H. S., Celik, G., Kantarci, G. (2014). Probiyotik tedavisinden sonra yasli bir hastada gelisen Saccharomyces cerevisiae fungemisi. / [Saccharomyces cerevisiae fungemia in an elderly patient following probiotic treatment]. Mikrobiyol Bul, 48(2), 351-55.
Eschete, M. L., West, B. C. (1980). Saccharomyces cerevisiae septicemia. Arch Int Med, 140, 1539.
Fadhel, M., Patel, S., Liu, E., Levitt, M., Asif, A. (2019). Saccharomyces cerevisiae fungemia in a critically ill patient with acute cholangitis and long term probiotic use. Med Mycol Case Rep, 23, 23–25.
Food and Agriculture Organization, World Health Organization. (2022). Joint FAO/WHO Working Group Report on Drafting Guidelines for the Evaluation of Probiotics in Food London, Ontario, Canada, April 30 and May 1, 2002. https://www.who.int/foodsafety/fs_management/en/probiotic_guidelines.pdf (Updated on DEZ 11).
Galeev, Y., Lishmanov, Y., Aparcin, K., Popov, M., Salato, O. (2009). Bacterial scintigraphy at experimental intestinal obstruction. Journal of Nuclear Medicine, 50(2), 1318-1318.
Goldin, B. R., Gorbach, S. L. (2008). Clinical indications for probiotics: an overview. Clin Infect Dis, 46(2), S144-51.
Gordon, S. (2008). Elie Metchnikoff: father of natural immunity. Eur J Immunol, 38(12), 3257-64.
Graf, C., Gavazzi, G. (2007). Saccharomyces cerevisiae fungemia in na immunocompromised patient not treated with Saccharomyces boulardii preparation. J Infect, 54(3), 310-11.
Guimarães, A., Abrunhosa, L., Pastrana, L. M., Cerqueira, M. A. (2018). Edible Films and Coatings as Carriers of Living Microorganisms: A New Strategy Towards Biopreservation and Healthier Foods. Compr Rev Food Sci Food Saf, 17(3), 594-614.
Im, E., Pothoulakis, C. (2010). Recent advances in Saccharomyces boulardii research. Gastroenterol Clin Biol, 34, S62-S70.
Imre, A., Rácz, H. V., Antunovics, Z., Rádai, Z., Kovács, R., Lopandic, K., et al. (2019). A new, rapid multiplex PCR method identifies frequent probiotic origin among clinical Saccharomyces isolates. Microbiol Res, 227, 126298.
Kara, I., Yıldırım, F., Özgen, Ö., Erganiş, S., Aydoğdu, M., Dizbay, M., et al. (2018). Saccharomyces cerevisiae fungemia after probiotic treatment in an intensive care unit patient. J Mycol Med, 28(1), 218-21.
Kotharia, D., Patelb, S., Kima, S. K. (2019). Probiotic supplements might not be universally-effective and safe: A review. Biomed Pharmacother, 111, 537-47.
Landaburu, M. F., Daneri, G. A. L., Relloso, S., Zarlenga, L. J., Vinante, M. A., Mujica, M. T. (2020). Fungemia following Saccharomyces cerevisiae var. boulardii probiotic treatment in an elderly patient. Rev Argent Microbiol, 52(1), 27-30.
Lawley, T. D., Clare, S., Walker, A. W., Goulding, D., Stabler, R. A., Croucher, N., et al. (2009). Antibiotic treatment of Clostridium difficile carrier mice triggers a supershedder state, spore-mediated transmission, and severe disease in immunocompromised hosts. Infect Immun, 77(9), 3661-69.
Lilly, D. M., Stillwell, R. H. (1965). Probiotics: growth-promoting factors produced by microorganisms. Science, 147(3659), 747-48.
Lolis, N., Veldekis, D., Moraitou, H., Kanavaki, S., Velegraki, A., Triandafyllidis, C., et al. (2008). Saccharomyces boulardii fungaemia in an intensive care unit patient treated with caspofungin. Crit Care, 12(2), 414.
Lourens-Hattingh, A., Viljoen, B. C. (2001). Growth and survival of a probiotic yeast in dairy products. Food Research International, 34(9), 791-96.
Martin, I. W., Tonner, R., Trivedi, J., Miller, H., Lee, R., Liang, X., et al. (2017). Saccharomyces boulardii probiotic-associated fungemia: questioning the safety of this preventive probiotic's use. Diagn Microbiol Infect Dis, 87(3), 286-88.
McFarland, L. V. (2010). Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol, 16(18), 2202-22.
McFarland, L. V., Bernasconi, P. (1993) Saccharomyces boulardii. A review of an innovative biotherapeutic agent. Microb Ecol Health Dis, 6(4), 157-71.
Merck. (2015). Floratil: Saccharomyces boulardii – 17. Responsável técnico Alexandre Canellas de Souza. Rio de Janeiro: Merck, 2015.
Muñoz, P., Bouza, E., Cuenca-Estrella, M., Eiros, J. M., Pérez, M. J., Sánchez-Somolinos, M., et al. (2005). Saccharomyces cerevisiae fungemia: an emerging infectious disease. Clin Infect Dis, 40(11), 1625-34.
Neish, A. S. (2009). Microbes in gastrointestinal health and disease. Gastroenterology, 136(1), 65-80.
Perapoch, J., Planes, A. M., Querol, A., Lopez, V., Martinez-Bendayan, I., Tormo, R., et al. (2000). Fungemia with Saccharomyces cerevisiae in two newborns, only one of whom had been treated with ultra-levura. Eur J Clin Microbiol Infect Dis, 19, 468–70.
Poncelet, A., Ruellea, L., Konopnicki, D., Miendje Deyi, V. Y., Daubya, N. (2021). Saccharomyces cerevisiae fungemia: Risk factors, outcome and links with S. boulardii-containing probiotic administration. Infectious Diseases Now, 51, 293–295.
Rannikko, J., Holmberg, V., Karppelin, M., Arvola, P., Huttunen, Mattila, E., et al. (2021). Fungemia and other Fungal Infections Associated with Use of Saccharomyces boulardii Probiotic Supplements. Emerging Infectious Diseases, 27, 2103-2109.
Romanio, M., Coraine, L. A., Maielo, V. P., Abramczyc, M. L. (2017). Fungemia por Saccharomyces cerevisiae em paciente pediátrico após tratamento com probiótico. Rev Paul Pediatr, 35(3), 361-64.
Roy, U., Jessani, L. G., Rudramurthy, S. M., Gopalakrishnan, R., Dutta, S., Chakravarty, C., et al. (2017). Seven cases of Saccharomyces fungaemia related to use of probiotics. Mycoses, 60(6), 375-80.
Santino, I., Alari, A., Bono, S., Teti, E., Marangi, M., Bernardini, A., et al. (2017). Saccharomyces cerevisiae fungemia, a possible consequence of the treatment of Clostridium difficile colitis with a probioticum. Int J Immunopathol Pharmacol, 27(1), 143-46.
Sazawal, S., Hiremath, G., Dhingra, U., Malik, P., Deb, S., Black, R. E. (2006). Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Lancet Infect Dis, 6(6), 374-82.
Sekirov, I., Finlay, B. B. (2009). The role of the intestinal microbiota in enteric infection. J Physiol, 587(17), 4159-67.
Sekirov, I., Russell, S. L., Antunes, L. C. M., Finlay, B. B. (2010). Gut microbiota in health and disease. Physiol Ver, 90(3), 859-904.
Sekirov, I., Tam, N. M., Jogova, M., Robertson, M. L., Li, Y., Lupp, C., et al. (2008). Antibiotic-induced perturbations of the intestinal microbiota alter host susceptibility to enteric infection. Infect Immun, 76(10), 4726-36.
Sindhu, S. C., Khetarpaul, N. (2002). Effect of probiotic fermentation on antinutrients and in vitro protein and starch digestibilities of indigenously developed RWGT food mixture. Nutr Health, 16(3), 173-81.
Schrezenmeir, J., De Vrese, M. (2001). Probiotics, prebiotics, and synbiotics—approaching a definition–. Am J Clin Nutr, 73(2), 361s-64s.
Thygesen, J. B., Glerup, H., Tarp, B. (2012). Reminder of important clinical lesson: Saccharomyces boulardii fungemia caused by treatment with a probioticum. BMJ Case Rep, 2012, bcr0620114412.
Tomičić, Z. M., Čolović, R. R., Čabarkapa, I. S., Vukmirović, D. M., Đuragić, O. M., Tomičić, R. M. (2016). Beneficial properties of probiotic yeast Saccharomyces boulardii. Food and Feed Research, 43(2), 103-10.
Vandenplas, Y., Huys, G., Daube, G. (2015). Probiotics: an update. J Pediatr (Rio J), 91(1), 6-21.
Venugopalan, V., Shriner, K. A., Wong-Beringer, A. (2010). Regulatory oversight and safety of probiotic use. Emerg Infect Dis, 16(11), 1661.
Ypsilantis, P., Panopoulou, M., Lambropoulou, M., Tsigalou, C., Pitiakoudis, M., Tentes, I., et al. (2010). Bacterial translocation in a rat model of large volume hepatic radiofrequency ablation. J Surg Res, 161(2), 250-58.
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