1 A U G U S T
`
`Correspondence
`
`Downloaded from https://academic.oup.com/cid/article-abstract/61/3/482/491533 by Cedars Sinai Medical Library user on 11 November 2019
`
`Bifidobacterium Species
`Bacteremia: Risk Factors in
`Adults and Infants
`
`TO THE EDITOR—We read with great inter-
`est the article by Bertelli et al [1], which
`reported 2 cases of Bifidobacterium spe-
`cies bacteremia in newborns receiving
`probiotics. Recently, we managed an adult
`case of Bifidobacterium longum bacter-
`emia in a 74-year-old man treated by
`chemotherapy, hormonotherapy, and ra-
`diotherapy for an active polymetasta-
`tic prostatic adenocarcinoma. He had a
`medical history of diabetes mellitus and
`obesity (body mass index of 32 kg/m2).
`He was admitted to our hospital for an-
`orexia and spasmodic abdominal pain
`of 1 month. His temperature was 39°C,
`and physical examination revealed no
`abnormalities. Laboratory findings were
`C-reactive protein 166 mg/L, and white
`blood cell count of 5 Giga/L. Blood cul-
`tures grew B. longum. The identification
`was performed using matrix-assisted
`laser desorption-ionization–time of flight
`mass spectrometry (MALDI-TOF MS)
`(Bruker Daltonik Bremen, Germany)
`with a score >2. Our patient did not
`report any probiotic treatment or exces-
`sive consumption of dairy products. A
`treatment with intravenous amoxicillin-
`clavulanic acid 1000 mg 3 times daily was
`given for 15 days with a good outcome.
`To deal with this emerging species,
`we performed a literature review up to
`March 2015 using the PubMed database,
`retrieving only 21 cases of human bacter-
`emia due to Bifidobacterium species [1–
`8].These cases are summarized in Table 1.
`The species most frequently reported
`longum and Bifidobacterium
`were B.
`eriksonii reclassified as Bifidobacterium
`dentium [9]. Most cases had abdominal
`symptoms as reported in our case. As
`
`described in Table 1, Bifidobacterium
`species grew from blood cultures in 1–
`10 days. Among these 22 cases, including
`ours, 7 were pediatric cases [1, 5–7]. All
`received probiotics to prevent necrotizing
`enterocolitis, as reported by Bertelli et al
`[1]. In preterm infants, Bifidobacterium
`species bacteremia is therefore related to
`the administration of probiotics, as strains
`from blood and probiotics have been
`found to be genetically similar [1].
`By contrast, in adults, the role of probiot-
`ic administration remains largely unknown.
`Indeed, in our review, none of the reports
`described the use of probiotics in the 15
`adult cases (Table 1). Nonetheless, 5 pa-
`tients were immunocompromised ( pro-
`static cancer, n = 2; rectal cancer, n = 1;
`systematic lupus erythematous, n = 2), and
`4 cases were related to pregnancy (3 occur-
`ring postpartum, 1 during pregnancy).
`Prognosis of treated Bifidobacterium spe-
`cies infections is usually good (Table 1),
`and 16 of 22 patients recovered (73%).
`Bifidobacterium species bacteremia
`seems to be a rare event, but its true inci-
`dence could be underestimated. Indeed,
`Bifidobacterium species could be consid-
`ered as nonpathogenic bacteria, as these
`anaerobic, nonsporulating, gram-positive
`rods are part of the physiological oral,
`vaginal, and intestinal flora. Besides bac-
`teremia, urinary, pleuropulmonary, ob-
`stetric, and gynecologic infections and
`dental caries have been reported [9]. Tra-
`ditional culture techniques for the detec-
`tion, quantification, and identification of
`Bifidobacterium species are now being
`complemented by MALDI-TOF MS and
`molecular techniques [10], improving
`detection and diagnosis of these bac-
`teria. Bacteremia due to Bifidobacterium
`species is an emerging entity, and the role
`of probiotics should be better investigated
`
`in cases occurring in adults, as already
`studied in preterm infants.
`
`Note
`
`Potential conflicts of interest. All authors:
`No reported conflicts.
`All authors have submitted the ICMJE Form
`for Disclosure of Potential Conflicts of Interest.
`Conflicts that the editors consider relevant to the
`content of the manuscript have been disclosed.
`
`Emmanuelle Weber,1 Quitterie Reynaud,1
`Florence Suy,2 Amandine Gagneux-Brunon,1,3
`Anne Carricajo,3,4 Aline Guillot,5 and
`Elisabeth Botelho-Nevers1,3
`1Infectious Diseases Department, University Hospital of
`Saint-Etienne, 2MIIT Médical, Villeurbanne, 3Groupe
`Immunité des Muqueuses et Agents Pathogènes,
`University of Lyon, and 4Bacteriologic Laboratory,
`University Hospital, and 5Oncology Department, Institut
`Cancérologique de la Loire, Saint-Etienne,
`France
`
`References
`
`1. Bertelli C, Pillonel T, Torregrossa A, et al. Bi-
`fidobacterium longum bacteremia in preterm
`infants receiving probiotics. Clin Infect Dis
`2015; 60:924–7.
`2. Guillard F, Appelbaum PC, Sparrow FB.
`Pyelonephritis and septicemia due to gram-
`positive rods similar to Corynebacterium
`group E (aerotolerant Bifidobacterium
`adolescentis). Ann Intern Med 1980; 92:
`635–6.
`3. Ha GY, Yang CH, Kim H, Chong Y. Case of
`sepsis caused by Bifidobacterium longum.
`J Clin Microbiol 1999; 37:1227–8.
`4. Mahlen SD, Clarridge JE. Site and clinical
`significance of Alloscardovia omnicolens
`and Bifidobacterium species isolated in the
`clinical laboratory. J Clin Microbiol 2009;
`47:3289–93.
`5. Ohishi A, Takahashi S, Ito Y, et al. Bifidobac-
`terium septicemia associated with postopera-
`tive probiotic therapy in a neonate with
`omphalocele. J Pediatr 2010; 156:679–81.
`6. Jenke A, Ruf E-M, Hoppe T, Heldmann M,
`Wirth S. Bifidobacterium septicaemia in an
`extremely low-birthweight infant under pro-
`biotic therapy. Arch Dis Child Fetal Neonatal
`Ed 2012; 97:F217–8.
`7. Zbinden A, Zbinden R, Berger C, Arlettaz
`R. Case series of Bifidobacterium longum
`
`482 (cid:129) CID 2015:61 (1 August) (cid:129) CORRESPONDENCE
`
`Genome Ex. 1057
`Page 1 of 3
`
`
`
`Correspondence
`
`Downloaded from https://academic.oup.com/cid/article-abstract/61/3/482/491533 by Cedars Sinai Medical Library user on 11 November 2019
`
`Bifidobacterium Species
`Bacteremia: Risk Factors in
`Adults and Infants
`
`TO THE EDITOR—We read with great inter-
`est the article by Bertelli et al [1], which
`reported 2 cases of Bifidobacterium spe-
`cies bacteremia in newborns receiving
`probiotics. Recently, we managed an adult
`case of Bifidobacterium longum bacter-
`emia in a 74-year-old man treated by
`chemotherapy, hormonotherapy, and ra-
`diotherapy for an active polymetasta-
`tic prostatic adenocarcinoma. He had a
`medical history of diabetes mellitus and
`obesity (body mass index of 32 kg/m2).
`He was admitted to our hospital for an-
`orexia and spasmodic abdominal pain
`of 1 month. His temperature was 39°C,
`and physical examination revealed no
`abnormalities. Laboratory findings were
`C-reactive protein 166 mg/L, and white
`blood cell count of 5 Giga/L. Blood cul-
`tures grew B. longum. The identification
`was performed using matrix-assisted
`laser desorption-ionization–time of flight
`mass spectrometry (MALDI-TOF MS)
`(Bruker Daltonik Bremen, Germany)
`with a score >2. Our patient did not
`report any probiotic treatment or exces-
`sive consumption of dairy products. A
`treatment with intravenous amoxicillin-
`clavulanic acid 1000 mg 3 times daily was
`given for 15 days with a good outcome.
`To deal with this emerging species,
`we performed a literature review up to
`March 2015 using the PubMed database,
`retrieving only 21 cases of human bacter-
`emia due to Bifidobacterium species [1–
`8].These cases are summarized in Table 1.
`The species most frequently reported
`longum and Bifidobacterium
`were B.
`eriksonii reclassified as Bifidobacterium
`dentium [9]. Most cases had abdominal
`symptoms as reported in our case. As
`
`described in Table 1, Bifidobacterium
`species grew from blood cultures in 1–
`10 days. Among these 22 cases, including
`ours, 7 were pediatric cases [1, 5–7]. All
`received probiotics to prevent necrotizing
`enterocolitis, as reported by Bertelli et al
`[1]. In preterm infants, Bifidobacterium
`species bacteremia is therefore related to
`the administration of probiotics, as strains
`from blood and probiotics have been
`found to be genetically similar [1].
`By contrast, in adults, the role of probiot-
`ic administration remains largely unknown.
`Indeed, in our review, none of the reports
`described the use of probiotics in the 15
`adult cases (Table 1). Nonetheless, 5 pa-
`tients were immunocompromised ( pro-
`static cancer, n = 2; rectal cancer, n = 1;
`systematic lupus erythematous, n = 2), and
`4 cases were related to pregnancy (3 occur-
`ring postpartum, 1 during pregnancy).
`Prognosis of treated Bifidobacterium spe-
`cies infections is usually good (Table 1),
`and 16 of 22 patients recovered (73%).
`Bifidobacterium species bacteremia
`seems to be a rare event, but its true inci-
`dence could be underestimated. Indeed,
`Bifidobacterium species could be consid-
`ered as nonpathogenic bacteria, as these
`anaerobic, nonsporulating, gram-positive
`rods are part of the physiological oral,
`vaginal, and intestinal flora. Besides bac-
`teremia, urinary, pleuropulmonary, ob-
`stetric, and gynecologic infections and
`dental caries have been reported [9]. Tra-
`ditional culture techniques for the detec-
`tion, quantification, and identification of
`Bifidobacterium species are now being
`complemented by MALDI-TOF MS and
`molecular techniques [10], improving
`detection and diagnosis of these bac-
`teria. Bacteremia due to Bifidobacterium
`species is an emerging entity, and the role
`of probiotics should be better investigated
`
`in cases occurring in adults, as already
`studied in preterm infants.
`
`Note
`
`Potential conflicts of interest. All authors:
`No reported conflicts.
`All authors have submitted the ICMJE Form
`for Disclosure of Potential Conflicts of Interest.
`Conflicts that the editors consider relevant to the
`content of the manuscript have been disclosed.
`
`Emmanuelle Weber,1 Quitterie Reynaud,1
`Florence Suy,2 Amandine Gagneux-Brunon,1,3
`Anne Carricajo,3,4 Aline Guillot,5 and
`Elisabeth Botelho-Nevers1,3
`1Infectious Diseases Department, University Hospital of
`Saint-Etienne, 2MIIT Médical, Villeurbanne, 3Groupe
`Immunité des Muqueuses et Agents Pathogènes,
`University of Lyon, and 4Bacteriologic Laboratory,
`University Hospital, and 5Oncology Department, Institut
`Cancérologique de la Loire, Saint-Etienne,
`France
`
`References
`
`1. Bertelli C, Pillonel T, Torregrossa A, et al. Bi-
`fidobacterium longum bacteremia in preterm
`infants receiving probiotics. Clin Infect Dis
`2015; 60:924–7.
`2. Guillard F, Appelbaum PC, Sparrow FB.
`Pyelonephritis and septicemia due to gram-
`positive rods similar to Corynebacterium
`group E (aerotolerant Bifidobacterium
`adolescentis). Ann Intern Med 1980; 92:
`635–6.
`3. Ha GY, Yang CH, Kim H, Chong Y. Case of
`sepsis caused by Bifidobacterium longum.
`J Clin Microbiol 1999; 37:1227–8.
`4. Mahlen SD, Clarridge JE. Site and clinical
`significance of Alloscardovia omnicolens
`and Bifidobacterium species isolated in the
`clinical laboratory. J Clin Microbiol 2009;
`47:3289–93.
`5. Ohishi A, Takahashi S, Ito Y, et al. Bifidobac-
`terium septicemia associated with postopera-
`tive probiotic therapy in a neonate with
`omphalocele. J Pediatr 2010; 156:679–81.
`6. Jenke A, Ruf E-M, Hoppe T, Heldmann M,
`Wirth S. Bifidobacterium septicaemia in an
`extremely low-birthweight infant under pro-
`biotic therapy. Arch Dis Child Fetal Neonatal
`Ed 2012; 97:F217–8.
`7. Zbinden A, Zbinden R, Berger C, Arlettaz
`R. Case series of Bifidobacterium longum
`
`482 (cid:129) CID 2015:61 (1 August) (cid:129) CORRESPONDENCE
`
`Genome Ex. 1057
`Page 1 of 3
`
`
`
`Downloaded from https://academic.oup.com/cid/article-abstract/61/3/482/491533 by Cedars Sinai Medical Library user on 11 November 2019
`
`Probiotic
`Use
`
`Yes
`
`Yes
`
`NA
`NA
`
`NA
`
`NA
`
`NA
`Yes
`
`Yes
`
`Yes
`
`Yes
`
`Yes
`
`NA
`NA
`
`NA
`NA
`NA
`
`NA
`NA
`NA
`
`NA
`
`No
`
`Treatment
`
`Outcome
`
`Ceftazidime, vancomycin 7 d then
`imipenem 7 d
`Ceftazidime, amikacin,
`metronidazole
`
`Chloramphenicol 10 d
`Ticarcillin, metronidazole
`
`Recovered, surgical resection
`(intestinal necrosis)
`Recovered, surgical resection
`(intestinal necrosis, jejunal
`perforation)
`Recovered
`Recovered
`
`NA
`
`NA
`
`NA
`Ampicillin-sulbactam,
`meropenem
`Cefotaxime, vancomycin
`
`NA
`
`NA
`
`NA
`Recovered
`
`Recovered
`
`Flucloxacillin, gentamicin
`
`Recovered
`
`Amoxicillin, gentamicin
`
`Recovered
`
`Amoxicillin-clavulanic acid,
`gentamicin
`
`Complications post– surgical
`resection requiring serial
`laparotomy
`Recovered
`Died
`
`Recovered
`Recovered
`Recovered
`
`Recovered
`Recovered
`Recovered
`
`Died
`
`Recovered
`
`Table 1. Characteristics of Published Cases of Bifidobacterium Species Bacteremia
`
`Reference
`
`Sex, Age, y, Underlying
`Conditions
`
`Clinical Description
`
`Bifidobacterium
`Species
`
`Delay of Isolation
`in Blood Cultures
`
`Sepsis and ileus (3 episodes)
`
`B. infantis
`
`Septic shock, coagulopathy, ileus B. infantis
`
`Urinary infection
`Fever, chills, vomiting, diarrhea,
`and hepatomegaly
`Transient bacteremia secondary
`to ileal resection
`NA
`
`Peritonitis
`Post–omphalocele surgery,
`bilious gastric fluid
`Sepsis, distended abdomen
`
`Periumbilical redness with pus
`then marbled, pale skin and
`distended abdomen
`Suspected nosocomial infection
`
`B. adolescentis
`B. longum
`
`B. breve
`
`B. breve
`
`B. breve
`B. breve
`
`B. infantis,
`B. longum
`B. longum
`
`B. longum
`
`Acute necrotizing enterocolitis
`
`B. longum
`
`NA
`
`NA
`
`NA
`2 d
`
`NA
`
`NA
`
`NA
`4 d
`
`3 d
`
`3 d
`
`3 d
`
`3 d
`
`[1]
`
`[2]
`[3]
`
`[4]
`
`[5]
`
`[6]
`
`[7]
`
`[8]
`
`F, 0, low birthweight,
`prematurity
`F, 0, low birthweight,
`prematurity
`
`M, 41, none
`F, 19, recent partial
`laminectomy
`NA, prostate cancer
`
`NA, decubitus ulcer, frequent
`urinary tract infections
`NA
`F, 0, low birthweight,
`prematurity, omphalocele
`ND, 0, low birthweight,
`prematurity
`F, 0, prematurity, respiratory
`assistance first days
`
`M, 0, prematurity, respiratory
`assistance first days
`F, 0, prematurity, respiratory
`assistance first days
`
`F, 24, none
`M, 58, rectal cancer
`
`F, 39, none
`F, 35, none
`F, 29, none
`
`F, 21, none
`F, 31, none
`F, 34, SLE
`
`F, 60, SLE
`
`Present
`case
`
`M, 74, prostate cancer with
`colorectal invasion,
`diabetes mellitus
`
`CORRESPONDENCE (cid:129) CID 2015:61 (1 August) (cid:129) 483
`
`Delivery, fever
`Bowel obstruction, chills without
`fever
`Cholecystectomy, fever at day 1
`Uterine fibroid section, fever
`Postpartum, septic shock, chills,
`and fever
`Pregnancy, chills, and fever
`Postpartum, fever at day 2
`Multiple staphylococcal
`abscesses, subacute
`endocarditis
`Peritonitis due to diverticulosis,
`fever
`Fever, abdominal pain
`
`Bifidobacterium spp
`B. eriksonii
`
`B. eriksonii
`B. eriksonii
`B. eriksonii
`
`3–5 d of incubation None
`3–5 d of incubation Ampicillin, kanamycin,
`cephalothin
`3–5 d of incubation None
`3–5 d of incubation Ampicillin
`3–5 d of incubation Ampicillin, kanamycin
`
`B. eriksonii
`Bifidobacterium spp
`Bifidobacterium spp
`
`3–5 d of incubation Ampicillin, kanamycin
`3–5 d of incubation Ampicillin, gentamicin
`3–5 d of incubation Oxacillin
`
`B. adolescentis
`
`B. longum
`
`3–5 d of incubation Ampicillin, gentamicin,
`cephalothin
`Amoxicillin-clavulanic acid
`
`26 h
`
`Abbreviations: NA, not available; ND, not disclosed; SLE, systematic lupus erythematous.
`
`Genome Ex. 1057
`Page 2 of 3
`
`
`
`Downloaded from https://academic.oup.com/cid/article-abstract/61/3/482/491533 by Cedars Sinai Medical Library user on 11 November 2019
`
`bacteremia in three preterm infants on pro-
`biotic therapy. Neonatology 2015; 107:56–9.
`8. Bourne KA, Beebe JL, Lue YA, Ellner PD.
`Bacteremia due to Bifidobacterium, Eubacte-
`rium or Lactobacillus; twenty-one cases and
`review of the literature. Yale J Biol Med
`1978; 51:505–12.
`9. Mayo B, van Sinderen D. Bifidobacteria: ge-
`nomics and molecular aspects. Norfolk,
`England: Caister Academic Press, 2010.
`10. Delgado S, Suárez A, Mayo B. Bifidobacterial
`diversity determined by culturing and by 16S
`rDNA sequence analysis in feces and mucosa
`from ten healthy Spanish adults. Dig Dis Sci
`2006; 51:1878–85.
`
`Correspondence: Elisabeth Botelho-Nevers, MD, PhD, Infectious
`Diseases Department, University Hospital of Saint-Etienne,
`42055 Saint-Etienne cedex 2, France (e.botelhonevers@gmail.
`com).
`Clinical Infectious Diseases® 2015;61(3):482–4
`© The Author 2015. Published by Oxford University Press
`on behalf of the Infectious Diseases Society of America. All
`rights reserved. For Permissions, please e-mail: journals.
`permissions@oup.com.
`DOI: 10.1093/cid/civ347
`
`484 (cid:129) CID 2015:61 (1 August) (cid:129) CORRESPONDENCE
`
`Genome Ex. 1057
`Page 3 of 3
`
`
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