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Int J Hematol (2014) 100:607610 DOI 10.1007/s12185-014-1650-7
CASE REPORT
Severe oral infection due to Lactobacillus rhamnosus during induction chemotherapy for acute myeloid leukemia
Yuko Ishihara Junya Kanda Kaori Tanaka Hirofumi Nakano Tomotaka Ugai
Hidenori Wada Ryoko Yamasaki Koji Kawamura Kana Sakamoto Masahiro Ashizawa
Miki Sato Kiriko Terasako-Saito Shun-ichi Kimura Misato Kikuchi Hideki Nakasone
Rie Yamazaki Shinichi Kako Junji Nishida Kunitomo Watanabe Yoshinobu Kanda
Received: 22 April 2014 / Revised: 22 July 2014 / Accepted: 22 July 2014 / Published online: 13 August 2014 The Japanese Society of Hematology 2014
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. SinceL. 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-eld 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 conrmed by a PCR assay with species-specic 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.
Keywords Lactobacillus rhamnosus Oral infection
Neutropenic fever Acute myeloid leukemia
Introduction
Lactobacillus spp. are Gram-positive facultative anaerobic organisms that are ubiquitous inhabitants of the human oral cavity, gastrointestinal tract, and vagina. They present as colonization in most cases, are of low pathogenicity, are used as probiotics for some species, and rarely cause infection [1]. However, severe Lactobacillus infection can develop in an immunocompromised host [2]. Lactobacillus casei andL. rhamnosus are the leading causative strains [3]. Various underlying diseases or specic conditions were present in most patients, such as malignancy, diabetes mellitus, the use of broad-spectrum antibiotic therapy, and post-organ transplantation. Leukemia is a leading disease among malignancies. Bacteremia is most common among Lactobacillus infections, followed by infectious...