Reactions 1413 - 4 Aug 2012

SSaccharomyces boulardii

Fungaemia in an elderly patient: case reportA 79-year-old woman developed fungaemia while

receiving Saccharomyces boulardii [Sacchaflor] capsules;one capsule (280mg) contained 5 × 109 S boulardii plusmannan oligosaccharides.

The woman, who had been treated with adalimumab forrheumatoid arthritis, underwent a bowel resection and hadpostoperative complications including the occurrence ofCandida albicans, recurrent urinary tract infections,suspected inflammatory bowel disease and recurrentClostridium difficile-associated diarrhoea (CDAD). HerCDAD was treated with vancomycin and metronidazole;Sacchaflor 280 mg/day was later added due to recurrentCDAD. Her diarrhoea resolved, but she developed feverand increasing inflammatory markers 13 days after her firstdose of Sacchaflor. S boulardii was detected from bloodcultures, and cultures obtained from Sacchaflor capsulesappeared positive with the same type of S boulardii asisolated in the blood cultures.

Sacchaflor was stopped, and the woman startedreceiving amphotericin B. Blood cultures revealed negativeresults for S boulardii 3 days later and treatment wascontinued for an additional 15 days. Her conditionimproved and her inflammatory markers normalised.However, she subsequently died, but without a sign offungaemia.

Author comment: "The patient developed S boulardiifungemia as an adverse effect to treatment with theprobioticum, Sacchaflor. . . [C]linicians must be cautiouswhen prescribing probiotics to patients belonging to riskgroups, that is, immunocompromised, critically ill patients orpatients with severe IBD or similar bowel diseases."Thygesen JB, et al. Saccharomyces boulardii fungemia caused by treatment with aprobioticum. BMJ Case Reports : [3 pages], 27 Mar 2012. Available from: URL:http://dx.doi.org/10.1136/bcr.06.2011.4412 - Denmark 803074555

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Reactions 4 Aug 2012 No. 14130114-9954/10/1413-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved