Portal de Periódicos da CAPES

Bifidobacterium breve Sepsis in Child with High-Risk Acute Lymphoblastic Leukemia

2015; Centers for Disease Control and Prevention; Volume: 21; Issue: 9 Linguagem: Inglês

10.3201/eid2109.150097

1080-6059

Simona Lucija Avčin, Marko Pokorn, Lidija Kitanovski, Manica Mueller Premru, Janez Jazbec,

Gut microbiota and health

To the Editor: Patients with cancer often consume probiotics as part of their diet, although therapeutic use of probiotics is not recommended because of their potential invasiveness.In a recent review, 5 cases of probiotic treatment-related bacteremia were identified in oncology patients, although no cases of invasive Bifidobacterium spp.infection were included (1).We describe a case of B. breve sepsis in a child with Philadelphia chromosome-positive acute B-cell lymphoblastic leukemia.The patient was a previously healthy 2-year-old boy who had no history of immunodeficiency and whose leukocyte counts had been within reference ranges during checkup visits before his diagnosis.After leukemia was diagnosed, chemotherapy was started (prednisone, vincristine, doxorubicin, and L-asparaginase).During the second week of treatment, the boy experienced abdominal discomfort and constipation.Two weeks later, his condition worsened; he refused food, his abdomen was distended, and he had colicky pain.Thickened intestinal wall and fecal masses were seen ultrasonographically. Twelve hours later he became hypotensive.Laboratory test results showed severe neutropenia and increased inflammatory markers (Figure).Two aerobic and anaerobic blood culture samples were collected from a central venous line (implantable venous access system) in a 30-minute span, and treatment with piperacillin/tazobactam, vancomycin, and gentamicin was empirically initiated according to local recommendations for pediatric febrile neutropenia with shock.Both anaerobic blood cultures were positive.Gram-positive, irregular rods with bifid and branching forms without spores grew anaerobically on blood agar with hemin and vitamin K after 48 hours of incubation and were identified as B. breve by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (Bruker Daltonics, Billerica, MA, USA).The bacteria were susceptible to penicillin (MIC 0.250 µg/mL), ampicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam (MIC 0.125 µg/mL), imipenem, and clindamycin but not metronidazole.Gentamicin and vancomycin were discontinued, and piperacillin/tazobactam was replaced