title: Saccharomyces boulardii fungemia caused by treatment with a probioticum.
abstract: Saccharomyces cerevisiae, known as baker's yeast, is normally considered a non-pathogenic yeast. A genetically very similar subtype, S boulardii, is used in a probioticum (Sacchaflor) to prevent antibiotic-associated diarrhoea and in the treatment of recurrent Clostridium difficile associated diarrhoea. The authors present a case report of a 79-year-old woman with rheumatoid arthritis, who after a bowel resection developed S boulardii fungemia. Her postoperative course was complicated by nutritional problems, anaemia and several nosocomial infections including recurrent C difficile associated diarrhoea. The diarrhoea was treated with metronidazole, vancomycin and Sacchaflor. After 13 days of treatment, the patient developed fungemia with S boulardii. Treatment with Sacchaflor was immediately discontinued and the patient was successfully treated with amphotericin B. Fungemia is a rare, but a serious complication to treatment with probiotics. Accordingly, the authors find it important to remind the clinicians of this risk when prescribing probiotics especially to immunocompromised patients.
authors.affiliation: Department of Internal Medicine, Regionshospitalet Silkeborg, Silkeborg, Denmark.
authors.forename: Julie Bjerre
authors.initials: JB
authors.lastname: Thygesen
authors.forename: Henning
authors.initials: H
authors.lastname: Glerup
authors.forename: Britta
authors.initials: B
authors.lastname: Tarp
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy*; D005260:Female; D016469:Fungemia / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D019936:Probiotics / Q000009:adverse effects*; D012440:Saccharomyces
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B