SACCHAROMYCES CEREVISIAE FUNGAEMIA IN AN IMMUNOCOMPETENT TODDLER

We would like to report our recent experience dealing with a 2-year-old boy with Saccharomyces cerevisiae fungaemia. The toddler was presented with high fever and profound diarrhoea. He was prescribed antibiotics for presumed bacterial dysentery and probiotics containing Saccharomyces boulardi. Stool cultures were negative for Salmonella, Shigella, Yersinia and Campylobacter. Two days later due to persistent fever and diarrhoea, blood tests including blood cultures were taken. Two sets of blood cultures following 48 h of incubation grew S. cerevisiae resistant to fluconazole. The child was then admitted to the hospital for detailed evaluation and started antifungal treatment. Inpatient investigations included abdominal ultrasound (liver, spleen and kidneys) and cardiac echocardiogram and did not reveal any evidence of fungal dissemination. Extensive evaluations yielded no evidence of immunodeficiency. He completed a 2-week course of micafungin based on the antifungigram of the isolated agent with good clinical response. One of the most commonly used fungi in probiotics is S. boulardi which is a S. cerevisiae strain. Saccharomyces cerevisiae is an ubiquitus ascomycetous that commonly colonises the mucosal surfaces and is a part of the normal flora of the gastrointestinal and respiratory tract. As a probiotic component, this fungus may cause systemic infection in the immunocompromised adults and children. Apart from immunodeficiency, other risk factors for the development of S. cerevisiae fungaemia are the presence of a central venous catheter, mechanical ventilation, severe systemic gastrointestinal disease, intensive care unit admission. Fungaemia is the commonest manifestation. In immunocompetent individuals, probiotics are considered generally safe yet cases of bloodstream infections following the administration of them have rarely been reported. Probiotics for acute gastroenteritis may reduce the duration of diarrhoea by approximately 1 day as stated in the most recent consensus from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. Given the fact that this benefit is still a matter of debate and that fungi in probiotics can rarely cause bloodstream infection via intestinal translocaton in immunocompetent children, the paediatricians should use them with extreme caution. In addition, the isolation of S. cerevisiae from a normally sterile source should never be regarded as a nonpathogenic fungus and a history of probiotic administration should be carefully sought. In conclusion, the general paediatrician should be aware of the possibility of fungaemia due S. cerevisiae following probiotic administration which although rare can lead to severe complications. Dr Despoina Gkentzi 1 Professor Markos Marangos Professor Ageliki Karatza Dr Anastasia Spiliopoulou Professor Anastasia Varvarigou Professor Gabriel Dimitriou Departments of Paediatrics, Infectious Diseases, and Microbiology University General Hospital of Patras, Patras Medical School Rio Greece