Sarcina ventriculi associated gastritis: Mimicking lymphoma on endoscopy

Sarcina Ventriculi is a gram-positive anaerobic coccus rarely reported in patients with delayed gastric emptying, emphysematous gastritis, gastric ulcers, and perforation. So far, less than 30 cases of sarcina isolated from the stomach have been reported. Herein, we describe a case of a 66-year-old male with a history of persistent epigastric pain and regurgitation. The upper gastrointestinal (GI) endoscopy revealed gastric erythema, edema, ulceration, and food bezoar. A gastric biopsy was done to rule out lymphoma. On histopathological examination, sarcina Ventriculi was identified. This organism is likely to get underreported as it may not be that obvious on routinely stained biopsies. Given its association with life-threatening illness such as emphysematous gastritis and perforation, awareness of this organism is important. It's presence in gastric biopsies must be mentioned in the report and should prompt the clinicians to investigate further for functional causes of delayed gastric emptying and gastric outlet obstruction like occult malignancy.

Sarcina Ventriculi of Gastrointestinal Tract: A Clinicopathologic Study

Background: Sarcina ventriculi, a gram-positive coccus, are occasionally found in gastric biopsies. Although Sarcina had been described more than 150 years ago, little is known about its pathogenicity in humans. Method: This retrospective case series included patients who were identified with Sarcina infection. We report clinicopathologic characteristics of 13 patients with Sarcina in gastric or duodenal biopsies. Result: The presenting symptoms included: epigastric discomfort (n=6), epigastric pain (n=4), anorexia (n=6), nausea and vomiting (n=5), constipation (n=2), diarrhoea (n=2) and weight loss (n=3).All patients had evidence of mucosal injury.Sarcina was found on mucosal surface.12 patients had food residue on oesophagogastroduodenoscopy (OGD). 10 patients had gastric outlet obstruction (GOO), antral narrowing in 7 and duodenal obstruction in 3. 6 patients had malignant GOO. Causes of benign GOO included Helicobacter Pylorigastritis (n=1), eosinophilic gastritis (n=1) and duodenal ulcers (n=2, 1 NSAIDs). Of the 5 patients that had follow-up OGD, 2 had gastric residue. One patient had recurrence of symptoms with the persistence of sarcina on biopsy at 3 months. Symptoms improved at 6 months and no evidence of sarcina on biopsy at 6 months. Conclusion: Our findings suggest GOOcan be considered as a predisposing factor for Sarcina infection. Sarcina infection may not be the aetiology for GOObut may complicate recovery and may lead to life-threatening complications. Clinicians and pathologists must be aware of such microorganisms and must be documented in the histology report for further investigation and therapeutic consideration.

Sarcina ventriculi a rare pathogen

Sarcina ventriculi is a gram-positive bacterium, able to survive in extreme low pH environment. It's first description dates from 1842, by John Goodsir. Since then, just a few cases have been reported. In veterinary medicine, especially in ruminants, it causes bloating, vomiting, gastric perforation and death of the animal. It is commonly associated with delayed gastric emptying or obstruction to gastric outlet, although it's pathogenicity in humans is not fully understood. We report two cases with identification of the bacteria in gastric specimens stained with hematoxylin-eosin staining, in different clinical settings. The first patient is a young female patient, presenting cardiac arrest and death after gastric perforation and the second patient an adult male presenting with gastric adenocarcinoma, treated with partial gastrectomy followed by adjuvant chemoradiation. In our literature review, we identified forty-five cases reporting Sarcina ventriculi appearance, with a sudden increase since 2010.

Emphysematous abomasitis in a lamb by bacteria of the Sarcina genus in Southern Brazil / Abomasite enfisematosa por bactérias do gênero Sarcina em um cordeiro no sul do Brasil

ABSTRACT: Abomasal bloat associated with Sarcina genus bacteria is a rare condition reported in young ruminants. An outbreak characterized by the sudden death of eight lambs from a total of 80 lambs (30 days-old) occurred on a property located in the city of Palmares do Sul in the state of Rio Grande do Sul. Deaths began to occur after the introduction of supplementation into the diet of lambs. At necropsy, the abomasum was distended by gas and had diffusely thickened walls and emphysema. On microscopic examination, the abomasum showed marked diffuse emphysema and multifocal areas of mild superficial necrosis with many coccoid structures measuring approximately 2µm in diameter, arranged in tetrads, compatible with Sarcina genus bacteria. After removing supplementation from the diet, no more deaths occurred. The diagnosis of this case was established by gross and microscopic lesions in addition to the clinical and epidemiological findings. Therefore, it was concluded that it was an outbreak of emphysematous abomasitis by Sarcina genus bacteria in lambs.

RESUMO: Timpanismo abomasal associado a bactérias do gênero Sarcina é uma enfermidade relativamente rara e reportada em ruminantes jovens. Um surto com morte súbita, acometendo oito cordeiros (30 dias de idade), de um total de 80, ocorreu em uma propriedade localizada no município de Palmares do Sul, Rio Grande do Sul. As mortes começaram a ocorrer após a introdução de suplementação na dieta dos cordeiros. Um cordeiro foi necropsiado e apresentava o abomaso distendido por gás, com parede espessada e aspecto enfisematoso. No exame microscópico, o abomaso apresentou, além de enfisema difuso acentuado, áreas multifocais de discreta necrose superficial, com inúmeras estruturas cocoides, de aproximadamente 2µm de diâmetro, arranjadas em tétrades, compatíveis com bactérias do gênero Sarcina. Após a remoção da suplementação da dieta, não ocorreram mais óbitos. O diagnóstico desse caso foi estabelecido a partir dos achados macroscópicos e microscópicos observados no abomaso e, devido à apresentação clínica e epidemiológica dos demais casos, concluiu-se que se tratou de um surto de abomasite enfisematosa em cordeiros por bactérias do gênero Sarcina.

Microbial transformation of isonicotinic acid hydrazide and isonicotinic acid by Sarcina sp.

Metabolism of isonicotinic acid and isoniazid by Sarcina sp. led to the formation of two metabolites which were characterised as 2-hydroxyisonicotinic acid and citrazinic acid. The blue pigment formed during fermentation was shown to be derived from the auto-oxidation of citrazinic acid. 2-Oxo-glutarate accumulated as the major keto acid when isonicotinic acid or isonicotinic acid hydrazide metabolism was inhibited by 1 mM sodium arsenite. Isonicotinic acid, 2-hydroxyisonicotinic acid and 2-oxo-glutarate were oxidised by isonicotinic acid hydrazide or isonicotinic acid-grown cells; citrazinic acid was, however, not oxidised. Isoniazid hydrazine hydrolase, isonicotinic acid and 2-hydroxyisonicotinic acid hydroxylases were detected in the cell-free extract of Sarcina sp. grown on isonicotinic acid hydrazide or isonicotinic acid.