Septicemia: As a result of erroneous parenteral administration of probiotic

Probiotics are formulations of live microbial cells that are administered orally to contribute to intestinal microbial balance. Bacillus clausiiis one such aerobic, spore-forming bacterium that is able to survive in the acidic environment of the stomach and is used as a probiotic. In the past few years, probiotic use has increased to a greater extent. However, there is growing global evidence that the use of probiotics in patients with organ failure, the immunocompromised state can cause infections, but it is extremely rare in immunocompetent persons when given through peroral route. However, it can cause severe sepsis in even immunocompetent individuals when given intravenously inadvertently. This case report shows the importance of establishing safety guidelines for probiotic use and particularly for dispensing probiotics in liquid formulations

Bacteremia after Bacillus clausii administration for the treatment of acute diarrhea: A case report / Bacteriemia tras la administración de Bacillus clausii para el tratamiento de la diarrea aguda: reporte de un caso

Abstract | Bacillus clausii is a gram-positive rod used as a probiotic to treat diarrhea and the side effects of antibiotics such as pseudomembranous colitis. We report a case of B. clausii bacteremia in a non-immunocompromised patient with active peptic ulcer disease and acute diarrhea. The probiotic was administered during the patient's hospitalization due to diarrhea of infectious origin. B. clausii was identified in the bloodstream of the patient through Matrix- Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) days after her discharge. Given the wide use of probiotics, we alert clinicians to consider this microorganism as a causative agent when signs of systemic infection, metabolic compromise, and hemodynamic instability establish after its administration and no pathogens have been identified that could explain the clinical course.

Resumen | Bacillus clausii es un bacilo Gram positivo usado como probiótico para tratar la diarrea y efectos adversos de los antibióticos, como la colitis pseudomembranosa. Se reporta un caso de bacteriemia por B. clausii en una paciente inmunocompetente con enfermedad ulcerosa péptica activa y diarrea aguda. El probiótico le fue administrado durante la hospitalización debido al origen infeccioso de la diarrea. B. clausii se identificó en el torrente sanguíneo de la paciente, utilizando espectrometría de desorción/ionización mediante láser asistido por matriz (Matrix-Assisted Laser Desorption/Ionization, MALDI), acoplada a un detector de iones (Time of Flight, TOF) (MALDI-TOF), días después de haber sido dada de alta. Dado el amplio uso de los probióticos, alertamos a los clínicos para que consideren este microorganismo como agente causal cuando se detecten signos de infección sistémica, compromiso metabólico, e inestabilidad hemodinámica tras su administración, y no se haya identificado ningún patógeno que pueda explicar el cuadro clínico.

Comparative study of Bacillus clausii and multistrain probiotics in the management of acute diarrhoea in children

Background: Diarrhoea is the second most common cause of under-five mortality especially in developing world. Many studies have been conducted so far using different probiotic strains with variable outcome. So, the aim of the present study was to compare the clinical efficacy of Bacillus clausii and multi strain probiotic formulation as adjunct treatment of acute diarrhoea.Methods: This prospective single blind randomized controlled clinical trial included 300 infants and children between 6 months to 6 years of age admitted in a tertiary care hospital Sylhet, Bangladesh with acute watery diarrhoea having varied dehydration status ranging from no to severe dehydration excluding shocked state. Cases were randomly assigned to three groups which were group I (n=100) comprised of children who were treated with standard treatment (according to WHO guideline) only as control group, group II (n=100) who received standard treatment plus Bacillus clausii and group III (n=100) who received standard treatment plus multi strain probiotic formulation (Lactobacillus casei, Lactobacillus rhamnosus, Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobacterium breve, Bifidobacterium infantis, Streptococcus thermophilus). Primary outcome variables were duration, frequency of diarrhoea and consistency of stool. Secondary outcome variable was duration of hospital stay.Results: Mean duration of diarrhoea was significantly shorter (p=0.001) in group III (2.62 days) compared to group I (3.26 days) and group II (3.22 days). Frequency of diarrhoea was significantly lower on day 3 of probiotic administration in group III (p <0.05) and on day 5 of treatment in group II (p <0.05). Stool consistency significantly improved on day 3 in group III (p <0.05) while it was on day 4 in group II. The duration of diarrhoea, hospital stay, stool consistency and frequency of stool on day 3 were not statistically significant (p >0.05) in group II in comparison to group I and group III.Conclusions: Multistrain probiotic formulation is effective in reducing the duration, frequency of diarrhoea and duration of hospital stay.

Content Analysis of Commercially Available Probiotics

We carried out content analysis of four batches each of 3commercially available probiotic formulations of Bacillus clausii.Species identification was done using MALDI-TOF-MS techniquewhile bacterial count was done using plate colony count. Only oneof the three probiotic formulation analyzed was found to havehomogeneous population of B. clausii while none was found tohave the exact viable bacterial count as suggested on the label.

Prevención de la Diverticulitis Aguda Recurrente on Bacillus clausii

La Enfermedad Diverticular (ED) o Diverticulosis, es una de las enfermedades gastrointestinales más comunes que afectan a la población general en el mundo occidental, un 20 % de los pacientes son sintomáticos y el 75 % de ellos tendrá ED dolorosa: diverticulitis aguda, 25-33 % de estos pacientes pueden tener episodios recurrentes.Cambios en la Microbiota del colon, ocasionando inflamación crónica y proliferación de células epiteliales que se desarrollan en la mucosa del colon en y alrededor de los divertículos. Los prebióticos, restauran el microambiente del colon y de aquí, que se han propuesto para el tratamiento de los pacientes con ED asintomática para evitar la Diverticulitis Aguda. Objetivo del estudio fue investigar la proporción de pacientes que mantuvieron la remisión después de un episodio previo de Diverticulitis Aguda no complicada, cuando recibieron como tratamiento Bacillus clausii: 2 billones cada 8 horas por 1 año. Materiales y métodos: Estudio prospectivo y retrospectivo, con un muestreo no probabilístico de tipo intencional, con grupo control. Grupo A: Los 50 pacientes con el diagnostico de Diverticulitis Aguda no complicada, recibieron como único tratamiento Bacillus clausii 2 billones cada 8 horas, permanente por 1 año. Controles clínicos cada 3 meses. Grupo B (control): 50 pacientes conel diagnostico de Diverticulitis Aguda no complicada no tratados.Resultados:Se introdujo la información necesaria para realizar los análisis de varianza en R, encontrándose diferencia significativa entre las medias de los grupos considerados en el estudio, al obtenerse un F(1,48)=5.259, p <0.05.Conclusión: El Bacillus clausii por su características biológicas previene las complicaciones inflamatorias de la Enfermedad Diverticular como es la Diverticulitis Aguda Recurrente.

Diverticular Disease (DD), or Diverticulitis, is one of the most common gastrointestinal diseases affecting the general population in the western world; approximately 20% of patients are symptomatic and 75% suffer from painful DD: acute diverticulitis, 25-33% of those patients may suffer from recurrent episodes. Changes in colon microbiota cause chronic inflammation and epithelial cell proliferation developed in colon mucosa and around the diverticula. Prebiotics restore colon’s microenvironment, from where the treatment of patients with asymptomatic DD is proposed, in order to avoid the Acute Diverticulitis. The study aimed to investigate the proportion of patients who maintained the referral after a previous episode of uncomplicated Acute Diverticulitis, when treated with Bacillus clausii: two billions every eight hour during one year. Materials and Methods: Prospective and retrospective study, with non-probabilistic, intentional-type sampling and control arm. Arm A: Fifty patients diagnosed with uncomplicated Acute Diverticulitis, were administered with a single treatment of Bacillus clausii, two billions, every eight hours during one year. Clinical controls every three months. Arm B (control): 50 untreated patients diagnosed with uncomplicated Acute Diverticulitis. Outcomes: The necessary information to carry out the R variance analysis was introduced; a significant difference was found between the study’s arm averages; a F(1,48)=5.259, p<0.05 was found. Conclusion: because of its biological characteristics, Bacillus clausii prevents Diverticular Disease’s inflammatory complications such as the Recurrent Acute Diverticulitis.