title: Severe oral infection due to Lactobacillus rhamnosus during induction chemotherapy for acute myeloid leukemia.
abstract: We report a case of severe oral infection with a high fever due to Lactobacillus rhamnosus during induction chemotherapy for acute myeloid leukemia. The patient did not improve on treatment with meropenem, clindamycin, or vancomycin until neutrophil recovery. Since L. rhamnosus GG is used in dairy products, and the patient ingested dairy products daily before starting chemotherapy, we suspected an association between the ingestion of dairy products and the development of infection. Pulsed-field gel electrophoresis using two different restriction enzymes showed that the strain isolated from the patient was identical to the L. rhamnosus GG strain isolated from dairy products and ATCC #53103. This was confirmed by a PCR assay with species-specific L. rhamnosus GG primers. Since Lactobacillus infection, particularly L. rhamnosus infection, can be fatal in immunocompromised hosts, we should consider Lactobacillus as a causative organism when Gram-positive rods are detected during treatment with broad-spectrum antibiotics and vancomycin. The causal association between the ingestion of dairy products containing Lactobacillus and Lactobacillus infection in immunocompromised hosts warrants further study.
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Ishihara
authors.forename: Junya
authors.initials: J
authors.lastname: Kanda
authors.forename: Kaori
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nakano
authors.forename: Tomotaka
authors.initials: T
authors.lastname: Ugai
authors.forename: Hidenori
authors.initials: H
authors.lastname: Wada
authors.forename: Ryoko
authors.initials: R
authors.lastname: Yamasaki
authors.forename: Koji
authors.initials: K
authors.lastname: Kawamura
authors.forename: Kana
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ashizawa
authors.forename: Miki
authors.initials: M
authors.lastname: Sato
authors.forename: Kiriko
authors.initials: K
authors.lastname: Terasako-Saito
authors.forename: Shun-Ichi
authors.initials: S
authors.lastname: Kimura
authors.forename: Misato
authors.initials: M
authors.lastname: Kikuchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.forename: Rie
authors.initials: R
authors.lastname: Yamazaki
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.forename: Junji
authors.initials: J
authors.lastname: Nishida
authors.forename: Kunitomo
authors.initials: K
authors.lastname: Watanabe
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000328:Adult; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects*; D052201:Lacticaseibacillus rhamnosus / Q000235:genetics; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D008297:Male; D009059:Mouth Diseases / Q000175:diagnosis / Q000209:etiology*