[CIS PIDD] [cis-pidd] IgA deficiency and Probiotics

[Yu, Karl [BSD] - PED]

We've seen a few cases of bacteremia associated with Lactobacillus rhamnosus -- and every time associated with a patient who has recently started probiotic therapy on their own.

A commonality that I've seen is that these are usually patients with some propensity for GI dysfunction (e.g., cystic fibrosis, inflammatory bowel disease, short gut syndrome, etc.), and with a standing central line, in for administration of TPN.  I don't think there is much known in the literature withlarger samples sizes, but it would stand to reason that a leaky gut may predispose to bacteremia with a high enough bacterial load -- which most people could clear with no issue -- except if one has intravascular plastic.

No cases in our primary immunodeficient patients -- but we (as a section) do not usually recommend probiotics in immunodeficient patients.

I hope this helps ...

    - K

Karl O. A. Yu, M.D., Ph.D., FAAP
Clinical Instructor and Research Fellow, Pediatric Infectious Diseases
Comer Children's Hospital  |  University of Chicago
5841 South Maryland Avenue, MC 6054, Chicago, IL 60637
tel  773.702.9281   |   fax  773.702.1196   |   pager  773.702.6800 @ 3285

________________________________________
From: Martelius Timi [Timi.Martelius at hus.fi]
Sent: Friday, April 17, 2015 12:49 AM
To: CIS-PIDD
Subject: VS: [cis-pidd] IgA deficiency and Probiotics

Hi

An old article from our hospital about the subject. Not PID though.

Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG.<http://www.ncbi.nlm.nih.gov/pubmed/14679449>
Salminen MK, Rautelin H, Tynkkynen S, Poussa T, Saxelin M, Valtonen V, Järvinen A.
Clin Infect Dis. 2004 Jan 1;38(1):62-9. Epub 2003 Dec 4.
PMID:
14679449
Free Article<http://www.ncbi.nlm.nih.gov/pubmed/14679449>

Timi Martelius MD
Infectious Diseases
Helsinki University Hospital
PO BOX 348
00029HUS
Helsinki
Finland

Lähettäjä: Boyce, Thomas G., M.D. [mailto:Boyce.Thomas at mayo.edu]
Lähetetty: 16. huhtikuuta 2015 15:50
Vastaanottaja: CIS-PIDD
Aihe: Re: [cis-pidd] IgA deficiency and Probiotics

We have seen lactobacillus bloodstream infection in a patient receiving it as a probiotic. There are a handful of similar reports in the literature. In addition, the benefits of probiotics are dubious.

Tom


On Apr 15, 2015, at 11:21 PM, Soheil Chegini <schegini at yahoo.com<mailto:schegini at yahoo.com>> wrote:
There is a paucity of published information about the safety of probiotics in patients suffering from various immunodeficiency disorders. Given the widespread use of probiotics, one would expect to find at least some published reports or anecdotal evidence to the contrary. I can only recall having this discussion with a couple of patient with CVID, who did not have any intestinal involvement. I did a search and found only a handful of case reports of rather loose association rather than definitive causation of lacobacillemia or abscess formation. However, I could not find any substantial evidence in the literature, which supported the assumption that probiotics containing lactobacilli or bifidobacteria increase the risk of opportunistic infection in immunodeficient patients. Hence, I could not recommend against using probiotics. I suggested to those patients starting with a single, well established organism, i.e. lactobacillus rhamnosus GG, and so far they have done OK. It is difficult to know, whether they are any better off now taking that.

I would be a lot more concerned, if she were born and raised in a germ-free environment, and were naive to lactobacilli and bifidobacteria. By all likelihood in her 16 years she has already had yogurt that is chuck full of probiotics. Any woman would be at risk of vaginal candidiasis, if her vagina were not naturally colonized with lactic acid producing lactobacilli and bifidobacteria, which actually is a well recognized side effect of antibiotic therapy. Much the same human intestine naturally harbors those organisms, and it would be unusual to live for 16 years without natural encounter with them. For that reason, I would believe that the purported benefits would outweigh the risk, even in somebody with a leaky gut and IgA deficiency, who actually would stand to benefit more from it.

I hope learn more about this issue when others on this forum, who take care of other more troubling PID would share their experience.

Best regards,
sc

Soheil Chegini, MD
Exton Allergy & Asthma Associates
656 West Lincoln Hwy
Exton, PA 19341


________________________________
From: "Church, Joseph" <JChurch at chla.usc.edu<mailto:JChurch at chla.usc.edu>>
To: CIS-PIDD <cis-pidd at lyris.dundee.net<mailto:cis-pidd at lyris.dundee.net>>
Sent: Wednesday, April 15, 2015 7:16 PM
Subject: [cis-pidd] IgA deficiency and Probiotics

Colleagues:

I follow a 16yo F with IgA deficiency (IgA repeatedly <7mg/dL), specific antibody deficiency and inflammatory bowel disease.

She and her parents asked if a particular brand of probiotics (25 billion cfu’s of various lactobacilli and bifidobacteria) is “safe.”

Given her leaky gut and IgA deficiency, I am hesitant to respond in the affirmative.

Any thoughts or experiences you would be willing to share are most welcome.

Joe Church
Children’s Hospital Los Angeles


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