Evaluation of secretory activity in carp pancreatocytes (Cyprinus carpio L. ) when using lactobacillus-based chelate and probiotic supplemental feed complexes / Avaliação da atividade secretora em pancreatócitos de carpa (Cyprinus carpio L. ) ao usar quelato à base de lactobacilos e complexos suplementares de alimentação probiótica

The experimental research was carried out on the juvenile carp (Cyprinus carpio L.). The impact from supplemental feeds consisting of variable concentrations of chelate compounds, biogenic trace elements and probiotic lactobacillus-based product Bacillus subtilis VKPM B-2335 was evaluated. Optical and qualitative parameters of the lactobacillus base were studied in order to identify the major group of substances potentially able to influence the end result. The purpose of this research was to identify changes in the structure of the zymogen granules and their dimensions at which supplemental feeds produce a stimulating effect on the synthesis of zymogens in exogenous cells of the secretory part of pancreas. At the outcome of the study, for the first time, it was possible to prove that the integrated action of chelates and lactobacillus-based probiotics complemented each other. Metal chelate compounds contributed to enlargement of the zymogen granules, if compared to the control values. The bacterial products accelerated production of the zymogen granules in acinar cells diffusely located in carp hepatopancreas.

A pesquisa experimental foi realizada em carpas juvenis (Cyprinus carpio L.). O impacto de suplementos alimentares consistindo em concentrações variáveis de compostos quelatos, oligoelementos biogênicos e produto probiótico baseado em lactobacilos Bacillus subtilis VKPM B-2335 foi avaliado. Parâmetros ópticos e qualitativos da base de lactobacilos foram estudados a fim de identificar o maior grupo de substâncias potencialmente capazes de influenciar o resultado final. O objetivo dessa pesquisa foi identificar mudanças na estrutura dos grânulos de zimogênio e suas dimensões nas quais alimentos suplementares produzem um efeito estimulante na síntese de zimogênios em células exógenas da parte secretora do pâncreas. No resultado do estudo, pela primeira vez, foi possível comprovar que a ação integrada dos quelatos e dos probióticos à base de lactobacilos se complementava. Compostos quelatos metálicos contribuíram para o aumento dos grânulos de zimogênio, se comparados aos valores de controle. Os produtos bacterianos aceleraram a produção dos grânulos de zimogênio nas células acinares localizadas difusamente no hepatopâncreas da carpa.

Additive effect of the probiotics Lactobacillus exopolysaccharides and the Satureja calamintha extracts on enteropathogenic Escherichia coli adhesion

Abstract This study assessed the inhibitory potential of the probiotics Lactobacillus (LB) exopolysaccharides (EPS) with or without extracts of Satureja calamintha on enteropathogenic Escherichia coli (EPEc) responsible for gastroenteritis. Methanolic and hydromethanolic extracts were prepared by cold maceration and subjected to phytochemical screening. The compounds of the extracts were determined with the colorimetric assays and identified using high-performance liquid chromatography coupled with diode array detector (HPLC-DAD). Antioxidant activities of the extracts were also evaluated by using 2,2-diphenyl-1-picrylhydrazil (DPPH) radical scavenging. Antibacterial effect on EPEc was evaluated by using both agar disc diffusion and microdilution methods. The in vitro test of auto-aggregation was investigated. Microbiological analysis showed that 63% of the isolated LB were producing EPS, with the amount ranging from 8.21 to 43.13 mg/L. Chemical analysis of the extracts revealed the presence of polyphenols and flavonoids, more abundant in the hydromethanolic extract, which presented the highest content with 2.11 mg EGA/g of polyphenol and 1.64 mg EC/g of flavonoids and 1.71 mg EGA/g of polyphenol and 1.15 mg EC/g of flavonoids in the methanolic extract. Hydromethanolic extracts and EPS exhibited a more important activity than did the methanolic extract against EPEc. The combined action of EPS and extracts reduced the aggregation ability of EPEc and decreased the rate of their adhesion.

Microbiota intestinal y los primeros 1000 días de vida / Gut microbiota and the first 1000 days of life

Introducción: El proceso de colonización del microbioma intestinal en los primeros 1000 días de vida tiene repercusión en la salud y enfermedades del niño dependientes de factores de riesgo. Objetivos: Revisar evidencias importantes sobre el significado de la relación entre la microbiota Intestinal y los primeros 1000 días de vida, y repercusión de los principales factores de riesgo. Métodos: Se revisaron publicaciones en idiomas español e inglés en PubMed, Google Scholar y SciELO: enero 2005-febrero 2020 usando los términos microbiota intestinal, microbiomas, primeros 1000 días de vida, factores de riesgo, enterocolitis necrosante, probióticos y prebióticos. Análisis e integración de la información: Hay demostrados argumentos que vinculan la microbiota intestinal y primeros 1000 días de vida del niño, según modo de parto, tiempo de gestación y lactancia. Se examina los beneficios del parto vaginal, lactancia materna y la aparición de enfermedades a mediano y largo plazo, relacionadas con factores de riesgo, como cesárea, prematuridad, lactancia artificial y exposición antibiótica prenatal y posnatal. Se describe resultados favorables con el uso de bioterapia con probióticos y prebióticos en la enterocolitis necrosante. Conclusiones: Se expone el valor de la microbiota intestinal en los primeros 1000 días de vida para la salud del niño, influenciada por condiciones de normalidad como el parto vaginal y la lactancia materna e implicaciones clínicas relacionadas con factores de riesgo mencionado. Es importante el tratamiento con probióticos multicepas y prebióticos para la recuperación de la microbiota en el niño en enfermedades como la enterocolitis necrosante y estados de sepsis grave(AU)

Introduction: The process of colonizing the gut microbiome in the first 1000 days of life has an impact on the health and diseases dependent on risk factors of the child. Objectives: Review important evidence on the meaning of the relation between the gut microbiota and the first 1000 days of life and the impact of the main risk factors. Methods: Spanish and English language publications were reviewed on PubMed, Google Scholar and SciELO, from January 2005 to February 2020 using the terms: gut microbiota, microbiomes, first 1000 days of life, risk factors, necrotizing enterocolitis, probiotics and prebiotics. Analysis and information integration: Arguments linking the gut microbiota and the child's first 1000 days of life are demonstrated, depending on the child's mode of delivery, gestation time and lactation. It is conducted an assessment of benefits of vaginal delivery, breastfeeding and the onset of medium- and long-term diseases related to risk factors, such as C-section, prematurity, artificial lactation, and prenatal and postnatal antibiotic exposure. Favorable results with the use of biotherapy with probiotics and prebiotics in necrotizing enterocolitis are described. Conclusions: It is presented the value of the gut microbiota in the first 1000 days of life for the health of the child, influenced by normal conditions such as vaginal delivery and breastfeeding, and clinical implications related to the mentioned risk factors. Treatment with multi-strain probiotics and prebiotics for microbiota recovery in the child is important in diseases such as necrotizing enterocolitis and states of severe sepsis(AU)

Fungemia following Saccharomyces cerevisiae var. boulardii probiotic treatment in an elderly patient / Fungemia posterior al tratamiento con Saccharomyces cerevisiae var. boulardii como probiótico en una paciente anosa

Abstract The yeast Saccharomyces cerevisiae var. boulardii is a biotherapeutic agent used for the prevention and treatment of several gastrointestinal diseases. We report a case of fungemia in a patient suffering from Clostridium difficile-associated diarrhea and treated with metronidazole and a probiotic containing S. cerevisiae var. boulardii. The yeasts isolated from the blood culture and capsules were identified by MALDI-TOF MS and API ID 32 C as S. cerevisiae, and showed the same appearance and color on CHROMAgar Candida. Treatment with fluconazole 400mg/day was initiated and the probiotic was stopped. The patient was discharged from hospital in good condition and was referred to a rehabilitation center. We suggest that the potential benefit of S. cerevisiae var. boulardii should be accurately evaluated, especially in elderly patients. Moreover, all physicians should be trained in the use of probiotic agents and enquire whether the use probiotics was included in the patients'medical histories. © 2019 Asociación Argentina de Microbiología. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Resumen Saccharomyces cerevisiae var. boulardii es un agente bioterapéutico usado en la prevención y el tratamiento de varias enfermedades gastrointestinales. Informamos de un caso de fungemia en una paciente con diarrea asociada a Clostridium difficile, y tratada con metron-idazol y un probiótico que contenía S. cerevisiae var. boulardii. Las levaduras aisladas a partir del hemocultivo y del contenido de las cápsulas tomadas por la paciente se identificaron como S. cerevisiae mediante MALDI-TOF MS y API® ID 32C, las colonias mostraron el mismo color y aspecto en el medio CHROMAgar™ Candida. Se instauró un tratamiento con fluconazol 400mg/día y se suspendió el probiótico. La paciente fue dada de alta del hospital en buenas condiciones, y remitida a un centro de rehabilitación. Sugerimos que el beneficio potencial del uso de S. cerevisiae var. boulardii debe ser evaluado en cada paciente, especialmente en personas añosas. El uso de probióticos debería incluirse en los interrogatorios orientados al diagnóstico y formar parte de la historia clínica. © 2019 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Gut microbiota and the use of probiotics in constipation in children and adolescents: systematic review / Microbiota intestinal e emprego dos probióticos na constipação intestinal em crianças e adolescentes: revisão sistemática

ABSTRACT Objective: To perform a systematic review of literature data on gut microbiota and the efficacy of probiotics for the treatment of constipation in children and adolescents. Data source: The research was performed in the PubMed, the Scientific Electronic Library Online (SciELO) and the Latin American and Caribbean Health Sciences Literature (LILACS) databases in English, Portuguese and Spanish. All original articles that mentioned the evaluation of the gut microbiota or the use of probiotics in children with constipation in their title and abstract were selected. Data synthesis: 559 articles were found, 47 of which were selected for reading. From these, 12 articles were included; they studied children and adolescents divided into two categories: a gut microbiota evaluation (n=4) and an evaluation of the use of probiotics in constipation therapy (n=8). The four papers that analyzed fecal microbiota used different laboratory methodologies. No typical pattern of gut microbiota was found. Regarding treatment, eight clinical trials with heterogeneous methodologies were found. Fifteen strains of probiotics were evaluated and only one was analyzed in more than one article. Irregular beneficial effects of probiotics have been demonstrated in some manifestations of constipation (bowel frequency or consistency of stool or abdominal pain or pain during a bowel movement or flatulence). In one clinical trial, a complete control of constipation without the use of laxatives was obtained. Conclusions: There is no specific pattern of fecal microbiota abnormalities in constipation. Despite the probiotics' positive effects on certain characteristics of the intestinal habitat, there is still no evidence to recommend it in the treatment of constipation in pediatrics.

RESUMO Objetivo: Realizar revisão sistemática dos dados da literatura sobre a microbiota intestinal e a eficácia dos probióticos para o tratamento da constipação intestinal em crianças e adolescentes. Fonte de dados: Foi realizada busca nas bases de dados PubMed, Scientific Electronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), em inglês, português e espanhol. Foram selecionados, pelo título e pelo resumo, todos os artigos originais que avaliaram a microbiota intestinal ou o emprego de probióticos em crianças com constipação intestinal. Síntese dos dados: Foram encontrados 559 artigos, dos quais 47 foram selecionados para leitura. Destes, foram incluídos 12 artigos que estudaram crianças e adolescentes distribuídos em duas categorias: avaliação da microbiota intestinal (n=4) e avaliação do emprego dos probióticos na terapêutica da constipação intestinal (n=8). Os quatro artigos que analisaram a microbiota fecal utilizaram metodologias laboratoriais diferentes. Não foi observado um padrão típico de microbiota intestinal. Quanto ao tratamento, foram encontrados oito ensaios clínicos com metodologias heterogêneas. Foram avaliadas 15 cepas de probióticos e apenas uma foi avaliada em mais de um artigo. Foram evidenciados efeitos benéficos não uniformes dos probióticos em algumas manifestações da constipação intestinal (frequência evacuatória, consistência das fezes, dor abdominal, dor ao evacuar ou flatulência). Em apenas um ensaio clínico foi obtido completo controle da constipação intestinal sem o emprego concomitante de laxantes. Conclusões: Não existe um padrão específico de anormalidades da microbiota fecal na constipação intestinal. Apesar dos efeitos positivos dos probióticos em determinadas características do hábito intestinal, ainda não existem evidências que permitam sua recomendação no tratamento da constipação intestinal em pediatria.

Probióticos en el síndrome de intestino irritable con predominio de diarrea / Probiotics for the treatment of diarrhea predominant irritable bowel syndrome

Una mujer de 36 años, diagnosticada con síndrome de intestino irritable a predominio de diarrea (SII-D) acude a la consulta médica. Ella pregunta si el uso de probióticos sería útil para controlar los episodios de diarrea, ya que los fármacos con los que está siendo tratada no le resultan eficaces. Se realizó una búsqueda bibliográfica con el objetivo de en contrar evidencia en respuesta a su consulta, tras la cual se seleccionaron dos ensayos clínicos y una revisión sistemática. Se evidenciaron diversos resultados en cuanto al uso de probióticos en el SII-D y se discutieron los riesgos y beneficios del tratamiento, así como las implicancias en la vida de la paciente. (AU)

A 36-year-old woman diagnosed with diarrhea predominant irritable bowel syndrome (D-IBS) goes to meet the doctor. She raises whether the use of probiotics would be useful for controlling diarrhea episodes, since the drugs which she is being treated with, are not effective. A bibliographic search was conducted with the objective of finding evidence in response toher query. Two clinical trials and a systematic review were found. Variable results were found regarding the use of probioticsin D-IBS. The risks and benefits of the treatment were discussed, as well as the implications in the patient's lifestyle. (AU)

Sepsis por Lactobacillus reuteri en un recién nacido pretérmino: reporte de un caso / Sepsis due to Lactobacillus reuteri in an extreme preterm newborn: case report

La utilización de probióticos en la población neonatal ha contribuido a una disminución de la morbilidad y mortalidad en esta población a través de la reducción en la incidencia de entidades como enterocolitis necrosante, infecciones asociadas al cuidado de la salud y sepsis neonatal. A pesar de los múltiples efectos beneficiosos descritos, este tipo de medicamentos debe ser administrado con precaución en los pacientes de alto riesgo, debido a que se han documentado reportes de casos de sepsis neonatal por Lactobacillus rhamnosus, Saccharomyces boulardii y Bifidobacterium, entre otros. Se presenta un caso atípico de sepsis neonatal por Lactobacillus reuteri en un recién nacido pretérmino extremo en una institución de alta complejidad en la ciudad de Bogotá D. C., Colombia. El desenlace, en nuestro caso, fue fatal, pese al manejo médico establecido.

The use of probiotics in the neonatal population has contributed to a decrease in morbidity and mortality in this population through the reduction in the incidence of entities such as necrotizing enterocolitis, infections associated with health care and neonatal sepsis. Despite the multiple beneficial effects described due to the use of probiotics, this type of medication should be administered with caution in high-risk patients because reports of cases of neonatal sepsis by Lactobacillus rhamnosus, Saccharomyces boulardii and Bifidobacterium, among others, have been documented. We present an atypical case of neonatal sepsis due to Lactobacillus reuteri in an extreme preterm newborn in a highly complex institution in the city of Bogotá D. C., Colombia. The outcome in our case was fatal despite the established medical management.

Segurança e Benefício do Uso de Probióticos em Pacientes Submetidos ao TCTH: Revisão Integrativa / Safety and Benefit of Using Probiotics in Patients Undergoing HSCT: Integrative Review / Seguridad y Beneficio del Uso de Probióticos en Pacientes Sometidos al TCTH: Revisión Integradora

Introdução: O transplante de células-tronco hematopoiéticas (TCTH) é um dos potenciais tratamentos curativos utilizados para pacientes com doenças hematológicas e outras doenças imunes. Durante o transplante, o paciente é submetido ao condicionamento e a outros tratamentos, como radioterapia e quimioterapia, o que pode causar a perda da diversidade da microbiota intestinal. A manipulação da microbiota intestinal com probióticos vem sendo apontada como uma estratégia de prevenção de complicações nos pacientes submetidos ao TCTH. Objetivo: Identificar se há evidências científicas relacionadas à segurança e aos benefícios da utilização de probióticos em pacientes submetidos ao TCTH. Método: Revisão integrativa com base em estudos que abordassem o uso de probióticos para o caso específico de pacientes submetidos ao TCTH publicados entre 2000 a 2018. Resultados: Foram selecionados cinco estudos que atenderam aos critérios de inclusão e exclusão, com um total de 52 pacientes. A utilização de probióticos na prevenção e/ou tratamento da diarreia tem mostrado resultados positivos em pacientes com diarreia induzida por antibióticos ou por infecções bacterianas, porém os estudos ainda não destacam benefícios no uso de probióticos no caso específico de pacientes submetidos ao TCTH. Poucos estudos mostram o uso de probióticos para auxílio na melhora dos sintomas associados a infecções ou bacteremias em pacientes imunossuprimidos. Conclusão: O uso de probióticos na população submetida ao TCTH e em imunossuprimidos ainda é controverso, sendo necessários mais estudos que demonstrem os benefícios no uso dessa estratégia para esse público.

Introduction: Hematopoietic stem cell transplantation (HSCT) is one of the potential curative treatments used for patients with hematological and other immune diseases. During transplantation, the patient undergoes conditioning and other treatments, such as radiotherapy and chemotherapy, which may cause loss of the intestinal microbiota diversity. The manipulation of the intestinal microbiota with probiotics has been pointed out as a strategy to prevent complications in patients undergoing HSCT. Objective: To identify if there is scientific evidence related to the safety and benefits of the use of probiotics in patients submitted to HSCT. Method: Integrative review based on studies addressing the use of probiotics for the specific case of patients undergoing HSCT published between 2000 and 2018. Results: Five studies that met the inclusion and exclusion criteria were eligible, with a total of 52 patients. The use of probiotics in the prevention and/or treatment of diarrhea has shown positive results in patients with antibiotic-induced diarrhea or bacterial infections, but the studies do not yet emphasize the benefits of using probiotics in the specific case of patients submitted to HSCT. Few studies show the use of probiotics to help the improvement of the symptoms associated to infections or bacteremia in immunosuppressed patients. Conclusion: The use of probiotics in the population submitted to HSCT and immunosuppressed is still controversial, and further studies are necessary to demonstrate the benefits of using probiotics for this public.

Introducción: El trasplante de células madre de las hematopoyéticas (TCTH) es uno de los posibles tratamientos curativos utilizados para pacientes con enfermedades hematológicas y otras enfermedades inmunes. Durante el transplante, el paciente es sometido al condicionamiento ya otros tratamientos, como radioterapia y quimioterapia, lo que puede causar la pérdida de la diversidad de la microbiota intestinal. La manipulación de la microbiota intestinal con probióticos viene siendo apuntada como una estrategia de prevención de complicaciones en los pacientes sometidos al TCTH. Objetivo: Identificar si hay evidencias científicas relacionadas con la seguridad y beneficios de la utilización de probióticos en pacientes sometidos al TCTH. Método: Revisión integradora basada em estúdios que abordan el uso de probióticos para el caso específico de pacientes sometidos a TCMH publicados entre 2000 y 2018. Resultados: Fueron elegibles 4 estudios que atendieron a los criterios de inclusión y exclusión, con un total de 52 pacientes. La utilización de probióticos en la prevención y/o tratamiento de la diarrea ha mostrado resultados positivos en pacientes con diarrea inducida por antibióticos o por infecciones bacterianas, pero los estudios aún no aportan beneficios en el uso de probióticos en pacientes sometidos al TCTH. Pocos estudios muestran infecciones o bacterias en pacientes inmunosuprimidos que utilizaron probióticos para ayudar en la mejora de los síntomas asociados al tratamiento. Conclusión: El uso de probióticos en la población sometida al TCTH e inmunosuprimidos aún es controvertido, siendo necesarios más estudios que comprueben los beneficios en el uso de probióticos para este público.

Effect of probiotics on giardiasis. Where are we?

ABSTRACT Giardiasis, an intestinal infection caused by Giardia lamblia, was recently included in the 'Neglected Diseases Initiative' by the World Health Organization. Symptomatic patients can develop mild diarrhea up to a severe malabsorption syndrome, and children may show significantly impaired cognitive and physical development. Currently, nitroimidazoles are the main class of antibiotic used to treat giardiasis. Despite the efficacy of these drugs, adverse effects and reported resistance have increased, encouraging studies to identify and develop therapeutic alternatives. In this context, probiotics may represent an attractive option. Probiotics are defined as live microorganisms that, when administered in suitable amounts, confer a health benefit to the host. The use of probiotics in the treatment of parasitosis has been suggested because of its beneficial effects, such as a reduced time of gastrointestinal symptoms and parasite load in animal models and humans. Probiotics have been studied as an alternative treatment for giardiasis. In this review, we evaluated probiotic effectiveness in the treatment and prevention of this disease. Based on the studies examined herein, we conclude that probiotics have a beneficial effect on the modulation of giardiasis.

The impact of the use of symbiotics in the progression of nonalcoholic fatty liver disease in a rat model / Impacto do uso de simbiótico na doença hepática gordurosa não alcoólica em modelo de ratos

ABSTRACT Background: Non-alcoholic fatty liver disease (NAFLD) is characterized by accumulation of intrahepatic lipid. The use of live microorganisms promotes beneficial effects; however, the use of symbiotic and its role in NAFLD is not yet fully understood. Aim: Verify if the symbiotic administration influences the occurrence and progression of NAFLD in rats, after induction of hepatic steatosis by high calorie diet. Method: Forty-five rats were divided into four groups: G1 (control); G2 (control+symbiotic); G3 (high calorie+symbiotic) and G4 (high calorie), and euthanized after 60 days of diet. Liver disease was evaluated by biochemical analysis, IL6 measurement and histological assessment. Results: Symbiotic had influence neither on weight gain, nor on coefficient dietary intake in G3 and G4. G2 had the greatest weight gain, while G1 had the highest coefficient dietary intake between groups. G1 showed higher expression of aspartate aminotransferase than those from G2 (150±35 mg/dl, and 75±5 mg/dl) while G4 showed higher expression of the enzyme compared to G3 (141±9.7 mg/dl to 78±4 mg/dl). Liver histology showed different stages of NAFLD between groups. G4 animals showed increased serum interleukin-6 when compared to G3 (240.58±53.68 mg/dl and 104.0±15.31 mg/dl). Conclusion: Symbiotic can reduce hepatic aminotransferases and interleukin-6 expression. However, the histology showed that the symbiotic was not able to prevent the severity of NAFLD in rats.

RESUMO Racional: A doença hepática gordurosa não alcoólica (DHGNA) é caracterizada por acúmulo de lipídios intra-hepáticos. O uso de microrganismos vivos promove diversos efeitos benéficos; porém, a utilização de simbióticos e sua atuação na DHGNA ainda não está totalmente esclarecida. Objetivo: Verificar se a administração de simbióticos influencia na ocorrência e na progressão da DHGNA em ratos, após a indução de esteatose hepática por dieta hipercalórica. Método: Quarenta e cinco ratos Wistar foram divididos em quatro grupos: G1 (controle); G2 (controle+simbiótico); G3 (hipercalórica+ simbiótico) e G4 (hipercalórica), e eutanasiados após 60 dias de dieta. Coleta de sangue foi realizada para obtenção de análises bioquímicas e dosagem de IL6, e de tecido para análise histológica do fígado. Resultados: O simbiótico não influenciou no ganho de peso e no coeficiente de consumo alimentar nos grupos G3 e G4. Já G2 obteve maior ganho de peso, enquanto G1 apresentou o maior coeficiente de consumo alimentar entre os grupos. G1 apresentou maior expressão de aspartato aminotransferase em relação ao G2 (150±35 mg/dl e 75±5 mg/dl), enquanto G4 teve maior expressão desta enzima em relação ao G3 (141±9,7 mg/dl e 78±4 mg/dl,). A análise histológica hepática mostrou diferentes estágios de evolução da DHGNA entre os grupos. Animais do G4 apresentaram aumento sérico de interleucina-6 quando comparados a G3 (240,58±53,68 mg/dl, e 104,0±15,31 mg/dl). Conclusão: Os simbióticos reduziram aminotransferases hepáticas e a expressão de interleucina-6. No entanto, a histopatologia demonstrou que o simbiótico não foi capaz de prevenir a severidade da DHGNA em ratos.

Fungemia por saccharomyces cerevisiae em paciente pediátrico após tratamento com probiótico / Saccharomyces cerevisiae fungemia in a pediatric patient after treatment with probiotics

RESUMO Objetivo: Descrever um paciente com infecção de corrente sanguínea associada ao uso de probiótico em criança de um ano de idade e discutir as principais indicações e precauções com o emprego terapêutico desses microrganismos. Descrição do caso: Paciente masculino, um ano de idade, portador de síndrome de Down, em pós-operatório tardio de correção de cardiopatia congênita, com desnutrição grave e internado desde os dois meses de vida em Unidade de Terapia Intensiva Pediátrica. Durante o período de internação, apresentou inúmeras infecções relacionadas à ventilação mecânica, cateteres vasculares e outros dispositivos, com uso prolongado e recorrente de antibióticos de amplo espectro. Evoluiu com diarreia crônica e intolerância alimentar, que culminou com o uso de probiótico (Saccharomyces boulardii) por quatro dias. Dois dias após o término do probiótico, desenvolveu choque séptico, com hemoculturas central e periférica positivas para Saccharomyces cerevisiae. Após tratamento antifúngico (Anfotericina B), houve negativação das culturas. O paciente evoluiu sem complicações clínicas adicionais após o evento. Comentários: Apesar dos benefícios bem documentados do uso de probióticos em algumas situações clínicas, deve-se ter cautela quanto à indicação de uso, preparo e administração do medicamento, além do manuseio seguro dos dispositivos invasivos do paciente.

ABSTRACT Objective: To report the case of a one-year-old patient with a bloodstream infection associated with probiotics, and to discuss the indications and precautions concerning the therapeutic use of probiotics. Case description: A one-year-old male patient with Down syndrome in a late postoperative period of congenital cardiac disease correction. The patient was severely malnourished and had been hospitalized since he was two months old in the Pediatric Intensive Care Unit. While in the hospital, the patient presented multiple infections related to mechanical ventilation and invasive devices, and received recurrent treatment with broadspectrum antibiotics for long periods. The patient developed chronic diarrhea and feeding intolerance, which lead to the use of probiotics (Saccharomyces boulardii) for four days. Two days after the end of the treatment, the patient developed septic shock, and the Saccharomyces cerevisiae was isolated in the central and peripheral blood cultures. After antifungal treatment (Amphotericin B), the blood cultures were negative. The patient had no further clinical complications after this event. Comments: Despite the well-documented benefits of probiotics in some clinical situations, we should be cautious about the indication of their use, preparation, and administration, in addition to the safe handling of invasive devices.

Inocuidad, prevención y riesgos de los probióticos / Probiotics: innocuousness, prevention and risks

Los probióticos son microorganismos vivos que cuando son administrados en cantidades adecuadas confieren beneficios a la salud del huésped. Su empleo es muy amplio en todas las edades, y los episodios adversos asociados con ellos, incluyendo casos de sepsis, que hagan suponer un riesgo real y manifiesto de invasión del torrente sanguíneo o algún tipo de contagio son muy infrecuentes. Sin embargo, algunos profesionales de la salud manifiestan dudas respecto de su inocuidad. Esta revisión revela que la incidencia de sepsis por probióticos, principalmente lactobacilos y bifidobacterias, evaluada en casuísticas numerosas a lo largo de decenios usando métodos de biología molecular o cultivos, es muy baja: del orden de 0,021% en algunas estadísticas y podría llegar hasta 1 caso/1.000.000 de habitantes. Estos datos son importantes teniendo en cuenta el empleo masivo de diversas especies y cepas, sin restricciones de ninguna especie y en todas las edades. Algunos estudios que comunican otros efectos adversos tienen problemas de diseño que ponen en duda su validez. Por el contrario, se ha demostrado que los probióticos ejercen efectos positivos estimulando la inmunidad innata y adquirida, en el tratamiento de la atopia y eccema y en la prevención de la enterocolitis necrosante en sujetos tan vulnerables como los prematuros.

Probiotics have been defined as live microorganisms which, when ingested in adequate numbers, confer health benefits to the host. They are currently consumed without any age restrictions and adverse effects such as sepsis, a marker of the risk of invasion of the bloodstream, are extremely infrequent. However, some health professionals express doubts about probiotics being truly innocuous. This review discusses the incidence of sepsis secondary to probiotics use, mainly lactobacilli and bifidobacteria, evaluated through molecular biology or classic culture techniques, showing that sepsis in large numbers of individuals along decennia is extremely low, of the order of 0,02% en some centers or as low as 1 case/million population in France. These data are important considering the use different species and strains of these microorganisms. Few studies which have reported other adverse effects but many of these have problems with their design that cast doubt about the validity of their results. On the contrary, it has been shown that probiotic microorganisms exert positive stimulatory effects on innate and acquired immunity, with decrease of the manifestations of atopy and eczema. These positive effects are further evidenced by the beneficial effects of many species of probiotics in preventing necrotizing enterocolitis in patients as functionally labile as premature-born babies.

Há lugar para o uso de probióticos na saúde bucal? / Is there a place for probiotics in oral health? Systematic review

Objetivo: revisar os efeitos dos probióticos na profilaxia e tratamento de doenças da cavidade oral. Material e métodos: buscou-se artigos no Medline, Lilacs e SciELO com as estratégias de busca: treatment and "oral health" and probiotics; probiotics and "oral health"; probiotics and "oral cavity"; prevention and "oral health" and probiotics; probiotics and "mouth diseases". Critérios de inclusão: pesquisas em humanos, em inglês, português e espanhol, e foco nos efeitos dos probióticos na saúde bucal. Critérios de exclusão: estudos em animais, ou publicados em outros idiomas, e não relacionados ao benefício dos probióticos na cavidade oral. Resultados: foram incluídos 14 artigos (revisão, ensaio clínico e caso-controle), publicados na Alemanha, Brasil, Cuba, Dinamarca, Índia, Inglaterra e Peru, todos de alta qualidade metodológica. O uso de probióticos parece favorecer o equilíbrio da microflora bucal e reduzir a incidência de cáries, gengivites, halitoses, candidíase oral e periodontites. Apenas dois artigos declararam conflito de interesse, riscos e danos do uso de probióticos. Conclusão: dada a importância dos probióticos e seu potencial promissor, mais estudos isentos de interesses comerciais são necessários para avaliar o custo/efetividade e segurança dos probióticos na profilaxia, e tratamento de doenças bucais antes que profissionais da saúde e governos possam recomendá-los.

Objective: review the effects of probiotics in the prevention and treatment of oral cavity diseases. Materials and methods: the Medline, Lilacs, and SciELO databases were screened using the following strategies: treatment and "oral health" and probiotics; probiotics and "oral health"; probiotics and "oral cavity"; prevention and "oral health" and probiotics; probiotics and "mouth diseases". Inclusion criteria: studies performed in humans in English, Portuguese and Spanish, with focus on probiotics' effects on oral health. Exclusion criteria: studies performed in animals, published in different languages, and without direct relationship with the benefi ts of using probiotics for oral health. Results: 14 articles were included (review, clinical trial and case control), published between 2008 and 2013 in Germany, Brazil, Cuba, Denmark, India, England and Peru. Articles included reached high methodological quality. It seems that the use of probiotics enhance balance of the oral microflora, which reduces the incidence of caries, gingivitis, halitosis, periodontitis, and oral candidiasis. Only two articles superficially reported conflict of interests, risks, and damages from probiotics usage. Conclusion: given the importance and potential of probiotics, further studies free of commercial interests are needed to evaluate their cost-effectiveness and safety in the prevention and treatment of oral diseases, before professionals and government programs may recommend their usage.

Intraepithelial lymphocytes in the duodenal mucosa of meat quails receiving diets containing or not containing probiotic and different levels of crude protein / Linfócitos intraepiteliais na mucosa do duodeno de codornas de corte recebendo dietas contendo ou não probiótico e diferentes níveis de proteína bruta / Linfocitos intraepiteliales en la mucosa duodenal de codornices de abate recibiendo dietas con o sin probiótico y diferentes niveles de proteína bruta

The aim of this study is to evaluate the effect of probiotic supplementation associated to different levels of crude protein (CP) on the count of intraepithelial lymphocytes (IELs) in the duodenum of meat quails. A total of 2304 quails were distributed in a completely randomized design in a 2 x 4 factorial scheme (with and without probiotic and four levels of CP - 15, 20, 25 and 30%), with two replicates per treatment in two experimental periods, in a total of 32 experimental units. At seven days old, two quails from each experimental unit were euthanized to harvest the duodenum segment. Semi-serial 7-µm histological sections were obtained, which were subsequently stained with hematoxylin-eosin to perform the IEL count. For the calculation, first 2500 epithelial cells were counted from the mucosa of each animal, and then the IELs present between these cells were counted, with the results expressed in amounts of IELs/100 epithelial cells. No differences were found in the IEL count among the treatments. Under the experimental conditions, it can be concluded that the use of probiotic associated to different levels of CP supplementation does not alter the IEL count in the duodenum of meat quails.

O objetivo deste trabalho foi avaliar o efeito da suplementação de probiótico associado com diferentes níveis de proteína bruta (PB) sobre a contagem de linfócitos intraepiteliais (LIEs) no duodeno de codornas de corte. Um total de 2304 codornas foram distribuídas em um delineamento inteiramente casualizado em esquema fatorial 2 x 4 (com e sem probiótico e quatro níveis de PB ­ 15, 20, 25 e 30%), com duas repetições por tratamento em dois períodos experimentais, totalizando 32 unidades experimentais. Aos sete dias de idade, duas codornas de cada unidade experimental foi eutanasiada para colheita do segmento do duodeno. Cortes histológicos semi-seriados de sete µm foram obtidos, os quais foram posteriormente corados com hematoxilina-eosina para realização da contagem de LIEs. Para o cálculo, primeiro foram contados 2500 células epiteliais da mucosa de cada animal, e então os LIEs presentes entre essas células foram contados e os resultados expressos como quantidade de LIEs /100 células epiteliais. Não foram encontradas diferenças entre os tratamentos na contagem de LIEs. Nas condições em que o experimento foi desenvolvido, conclui-se que o uso de probiótico associado a diferentes níveis de PB não altera a contagem de LIEs do duodeno de codornas de corte.

Esta investigación buscó evaluar el efecto de suplementos probióticos asociados a diferentes niveles de proteína bruta (PB) sobre el contaje de linfocitos intraepiteliales (LIEs) del duodeno de codornices de abate. Un total de 2304 codornices fueron distribuidas en un delineamiento enteramente casualizado en esquema factorial 2x4 (con y sin probiótico y cuatro niveles de PB ­ 15, 20, 25 y 30%), con dos repeticiones por tratamiento, en dos períodos experimentales, totalizando 32 unidades experimentales. A los siete días de edad, dos codornices de cada unidad experimental sufrieron eutanasia, para colecta de segmento del duodeno. Se obtuvo cortes histológicos semi seriados con sete µm, que fueron posteriormente colorados con hematoxilina-eosina para realización de contaje de LIEs. Para el cálculo, primeramente se contó 2500 células del epitelio de la túnica mucosa de cada animal, y en seguida los LIEs presentes entre esas células, siendo los resultados expresos en cantidad de LIEs/100 células epiteliales. No hubo diferencias en el contaje de LIEs en función de los tratamientos. En las condiciones en que el experimento se realizó, se puede concluir que el uso de probiótico asociado a diferentes niveles de suplementos de PB no altera el contaje de LIEs en el duodeno de codornices de abate.

Probiotics for the treatment of upper and lower respiratory-tract infections in children: systematic review based on randomized clinical trials / Probióticos no tratamento das infecções do trato respiratório superior e inferior nas crianças: revisão sistemática baseada em ensaios clínicos randomizados

ABSTRACT OBJECTIVES: Evaluate the effect of probiotics on the symptoms, duration of disease, and the occurrence of new episodes of upper and lower respiratory infections in healthy children. SOURCES: In order to identify eligible randomized controlled trials, two reviewers accessed four electronic databases [MEDLINE/PubMed, Scopus (Elsevier), Web of Science, and Cochrane (Cochrane VHL)], as well as ClinicalTrials.gov until January 2015. Descriptors were determined by using the Medical Subject Headings tool, following the same search protocol. SUMMARY OF THE FINDINGS: Studies showed to be heterogeneous regarding strains of probiotics, the mode of administration, the time of use, and outcomes. The present review identified 11 peer-reviewed, randomized clinical trials, which analyzed a total of 2417 children up to 10 incomplete years of age. In the analysis of the studies, reduction in new episodes of disease was a favorable outcome for the use of probiotics in the treatment of respiratory infections in children. It is noteworthy that most of these studies were conducted in developed countries, with basic sanitation, health care, and strict, well-established and well-organized guidelines on the use of probiotics. Adverse effects were rarely reported, demonstrating probiotics to be safe. CONCLUSIONS: Despite the encouraging results - reducing new episodes of respiratory infections - the authors emphasize the need for further research, especially in developing countries, where rates of respiratory infections in children are higher when compared to the high per capita-income countries identified in this review.

RESUMO OBJETIVOS: Avaliar o efeito do uso de probióticos na redução dos sintomas, da duração da doença e da ocorrência de novos episódios de infecções respiratórias superior e inferior em crianças saudáveis. FONTES DE DADOS: Com a finalidade de identificar ensaios clínicos randomizados elegíveis, dois revisores acessaram quatro bases de dados eletrônicas (Medline/PubMed, Scopus [Elsevier], Web of Science e Cochrane [The Cochrane Library]), além do ClinicalTrials.gov, até janeiro de 2015. Foram usados descritores, por meio da ferramenta Medical Subject Headings, e foi seguido um mesmo protocolo de busca. SÍNTESE DOS DADOS: Os estudos apresentaram grande heterogeneidade em relação às cepas de probióticos, à forma de administração, ao tempo de uso e aos desfechos. Identificamos 11 ensaios clínicos randomizados, revisados por pares, que analisaram 2.417 crianças até 10 anos incompletos. Na análise dos estudos, redução de novos episódios de doença foi o desfecho favorável ao uso dos probióticos no tratamento das infecções respiratórias na criança. Importante salientar que essas pesquisas foram feitas, em sua maioria, em países desenvolvidos, com condições de saneamento, de assistência à saúde e de regulamentação rigorosa ao uso de probióticos bem estabelecidos e organizados. Quanto aos efeitos adversos, pouco relatados, configuram os probióticos como seguros. CONCLUSÕES: Apesar do resultado encorajador - redução de novos episódios de infecções respiratórias - destacamos a necessidade de pesquisas futuras, principalmente em países em desenvolvimento, onde as taxas de infecções respiratórias na criança são maiores quando comparadas com as dos países de elevada renda per capita identificados nesta revisão.

A meta-analysis of probiotics for preventing necrotizing enterocolitis in preterm neonates

Necrotizing enterocolitis (NEC) is one of the most common acquired diseases of the gastrointestinal tract in preterm infants. Some randomized, controlled trials (RCTs) have indicated that probiotics may potentially lower the incidence of NEC and mortality. However, debate still remains about the safety of probiotics and their influence on normal infant growth. We performed this meta-analysis to assess the safety and benefits of probiotic supplementation in preterm infants. We searched in PubMed, Embase, and Cochrane databases for English references, and in Wanfang, VIP, and CNKI databases for Chinese references. Ultimately, 27 RCTs (including 9 Chinese articles) were incorporated into this meta-analysis. Relative risk (RR) and weighted mean difference (WMD) were calculated using a random-effects or fixed-effects model, depending on the data type and heterogeneity. A total of 6655 preterm infants, including the probiotic group (n=3298) and the placebo group (n=3357), were eligible for inclusion in this meta-analysis. For Bell stage ≥I and gestational age <37 weeks, risk of NEC incidence was significantly lower in the probiotic group [RR=0.35, 95% confidence interval (CI)=0.27-0.44, P<0.00001]. For Bell stage ≥II or gestational age <34 weeks, there were likewise significant differences between the probiotic and placebo groups concerning NEC incidence (RR=0.34, 95%CI=0.25-0.48, P<0.00001; and RR=0.39, 95%CI=0.27-0.56, P<0.00001). Risk of death was significantly reduced in the probiotic group (RR=0.58, 95%CI=0.46-0.75, P<0.0001). In contrast, there was no significant difference concerning the risk of sepsis (RR=0.94, 95%CI=0.83-1.06, P=0.31). With respect to weight gain and the age at which infants reached full feeds, no significant differences were found between the probiotic and placebo groups (WMD=1.07, 95%CI=−0.21-2.34, P=0.10; and WMD=−1.66, 95%CI=−3.6-0.27, P=0.09). This meta-analysis has shown that, regardless of gestational age and NEC stage, probiotic supplementation could significantly reduce the risk of NEC in preterm infants. Analysis also indicated that such supplementation did not increase the incidence risk of sepsis or of mortality. Finally, the study showed that probiotic supplementation may have no adverse effect on normal feeding and growth.

Some studies on the effect of protexin on immune status of cultured seabass fingerlings

The present study aimed to investigate the effect of different concentrations of protexin probiotic [Enterococcus faecium] on growth performance, differential leucocytes count, phagocytic activity, phagocytic index, serum total protein, albumin, globulin, Total bacterial count, Total enterobacteriaceae count and Total coliform count of intestinal microbial flora of seabass and disease resistance against challenge with Vibrio alginolyticus. Fish were separated in to four experimental groups of 0.0 g/kg feed [control], 0.1 g/kg feed, 0.2 g/kg feed, 0.3 g/kg feed of commercial probiotic protexin concentrate. Fish fed at 3% body weight per day. Results showed that protexin supplementation have significant improvement in growth performance, significantly increasing in lymphocytes, monocytes, phagocytic activity, phagocytic index, Serum total protein and globulin in all treated groups compared to control Contrary neutrophils and albumin/globulin ratio significantly decreased in all treated groups comparing to the control as well as decreasing in Total bacterial count, Total enterobacteriaceae count and Total coliform count of all treated groups comparing to the control. The mortality rates after challenging with Vibrio alginolyticus were significantly lower in all treated groups than the control. Results indicated that by increasing the concentration of the protexin probiotic results getting better in all examined parameters comparing to control. The present study clearly indicated that inclusion of 0.3gm / kg feed of protexin probiotic in fish diet for not less than 6th weeks can improve the immune status of seabass fingerlings to the favor of resistance to diseases

Efeitos de probióticos sobre a digestibilidade, escore fecal e características hematológicas em cães / Effects of probiotics on digestibility, faecal score, and hematologic characteristics in dogs

Avaliaram-se os efeitos da suplementação de dois tipos de probióticos para cães filhotes, que receberam dois tipos de dieta - de alta e de baixa qualidade -, sobre a digestibilidade dos nutrientes, escore fecal e parâmetros sanguíneos. Foram utilizados 18 animais, distribuídos em três tratamentos. No tratamento 1, controle, os cães receberam somente a ração; no tratamento 2, ração com probiótico 1 (Bifidobacterium) e, no tratamento 3, ração com probiótico 2 (Lactobacillus). O experimento foi dividido em duas fases. Verificaram-se que os valores médios do coeficiente de metabolizabilidade da energia bruta (CMEB) na fase 1, caracterizada pela troca da dieta Super Premium para a dieta Standard, apresentaram resultados significativos (P<0,05), sendo os melhores resultados obtidos nos animais que receberam o probiótico 2. Não houve diferenças significativas (P>0,05) para o escore fecal e para as análises hematológicas.

The effects of supplementation of two probiotics to puppies fed two diets - high and low quality - on nutrient digestibility, faecal score, and blood parameters were evaluated using 18 animals in three treatments. In the treatment 1, control, the dogs received only food; in the treatment 2, food with probiotic 1 (Bifidobacterium) and in the treatment 3, food with probiotic 2 (Lactobacillus). The research was divided in two phases. It was verified that crude metabolizability energy coefficient average values in the phase 1, characterized to changing Super Premium food to Standard, presented significant results (P<0.05) and the best ones were obtained in animals that received the probiotic 2. No differences (P>0.05) on faecal score and blood analysis were obtained.

Identificación, cuantificación y determinación del perfil de sensibilidad a antibióticos de bacterias prebióticas adicionadas a productos de consumo frecuente en Costa Rica / Identification, quantification and antimicrobial susceptibility pattern of probiotic bacteria added to common use food products in Costa Rica

En los últimos años, debido a la alta demanda de los productos adicionados con probióticos y los múltiples beneficios nutricionales y terapéuticos asociados, la investigación sobre estos microorganismos ha progresado considerablemente, se han realizado avances notables en su selección y caracterización. De manera general, diversas entidades como la Organización Mundial de la Salud (OMS) y la Organización de las Naciones Unidas para la agricultura y la alimentación (FAO) recomiendan que se declare en la etiqueta del producto, tanto la especie como la cantidad de microorganismos probióticos viables presentes. En este trabajo se analizaron seis productos adicionados con probióticos, con el fin de evaluar su concentración a lo largo de la vida útil del producto, se identificaron las cepas aisladas para corroborar la información declarada en la etiqueta y se determinó su perfil de susceptibilidad a antibióticos. Como resultado del análisis se encontró que las cepas adicionadas a los productos evaluados se mantienen en concentraciones aceptables durante los 28 días de vida útil de los productos. La identificación de las cepas aisladas no coincidió, en varios casos, con la estipulada por la etiqueta, no obstante, el método utilizado se basa en la capacidad de fermentar carbohidratos y no en pruebas genotípicas. Con respecto a los perfiles de susceptibilidad encontrados para las cepas analizadas, son necesarios estudios adicionales que establezcan la naturaleza intrínseca o adquirida de los determinantes de resistencia, y que evidencien si estos están codificados en elementos transferibles entre bacterias.

In the last years, due to the high demand of food products supplemented with probiotics and the multiple nutritional and therapeutic benefits associated with them, research on these microorganisms has advanced considerably, including their selection and characterization. As a general recommendation, several entities as World Health Organization (WHO) and United Nations Organization for Agriculture and Food recommend that the specification of the alive species contained and their number shall appear in the label of the product. In the present study, six different commercially available products, supplemented with probiotics were analyzed, in order to evaluate the concentration of microorganisms through the shelf life of the product, identify the strains isolated and determine the antibiotic susceptibility pattern of these. Results demonstrated that the strains isolated kept acceptable concentrations during the 28 days of storage. Nevertheless, the identification of these strains variated from the one reported on the label on several of the products tested. This can be due to the commercial method used for the identifications, which is based in the carbohydrate fermentation pattern and not in genotypic trials. The antimicrobials’ susceptibility patterns found show that further research shall be performed in order to establish the intrinsic or acquired nature of the resistance determinants, and if these are codified by transferable elements among bacteria.

Os benefícios dos probióticos, prebióticos e simbióticos na nutrição preventiva / The benefits of probiotics, prebiotics and synbiotics in preventive nutrition

O consumo de alimentos funcionais vem aumentando bastante como resultado de uma preocupação individual com a saúde. Atualmente, os microrganismos probióticos constituem um importante meio para a manutenção, prevenção e recuperação de diversas doenças ligadas à flora microbiana intestinal. São várias as espécies de microrganismos considerados probióticos, sendo as mais utilizadas as espécies de Bifidobacterium e de Lactobacillus. Os principais critérios para a seleção das bactérias probióticas são a capacidade de resistir ao suco gástrico e aos ácidos biliares (importantes para predizer sua sobrevivência no trato gastrointestinal). Este trabalho constitui-se em uma revisão bibliográfica e baseou-se em diferentes autores para o levantamento da literatura existente no período de 1998 a 2006. O uso de alimentos probióticos tende a promover uma evolução favorável em diferentes enfermidades, porém, são necessários mais estudos para elucidar seu papel no organismo humano.