Abstract
We report the case of a young psychotic intravenous drug user injecting herself with Saccharomyces cervisiae (boulardii). She experienced a 24 h fever, resolving spontaneously confirming, quasi experimentally, the inocuity of this yeast in a non-immunocompromised host.
Keywords: Saccharomyces cerevisiae boulardii, Fungemia, Self-inoculation
1. Introduction
Several cases of fungemia caused by Saccharomyces cerevisae (boulardii) have been reported in literature. A recent review [1] retrieved 60 cases mostly in patients receiving probiotics, and severely ill before the occurrence of fungemia (these particular patients were immunocompromised and/or hospitalized in an intensive care unit). However only one report mentioned 2 cases of Saccharomyces cerevisae (boulardii) fungemia following self-injection of yeast [2]. Here we report a case of fungemia following the self-injection of Sacharomyces cerevisiae (boulardii) (that resolved spontaneously).
2. Case
A 19 year old schizophrenic girl was admitted with fever to hospital. She had been self-injecting hard kind of drugs for years before. She is HIV and hepatitis C negative. On day 0, she self-injected intravenously 1 ml of water containing approximately 150 mg of amoxicillin obtained from a capsule and 15 mg of Saccharomyces cerevisae (boulardii) contained in an ultra-levure® capsule, a probiotic used to prevent or treat diarrhea. Immediately after the injection, she experienced chills that resolved spontaneously; 3 h later she developed chills and a 40 °C fever. Her blood was then sampled for culture. Clinical examination was normal, blood cell count was normal, c-reactive protein was elevated, at 17 mg/l (normal<3), fundoscopy and cardiac auscultation were normal. She recovered spontaneously on the day +2, date when the result of the culture turned out positive for Saccharomyces cerevisae (boulardii). It was identified by MALDI-TOF as previously reported [3]. She did not receive any antifungal treatment, and she is now doing well.
3. Discussion
Two previous cases of self-injected fungemia with Saccharomyces cerevisae (boulardii) have been reported. They were Vietnamese prisoners who were imprisoned in a detention camp in Hong Kong [2]. They were spontaneously cured and stay only one day in the hospital. We did not find reports of self-injection of Saccharomyces cerevisae (boulardii) in psychotic patients. The fungemia here was transient, associated with high fever, and the patient recovered spontaneously. These cases are confirming that Saccharomyces cerevisae (boulardii), contained in probiotics, is not dangerous in patients with normal immunity, with no catheter, no valvulopathy and no organic underlying severe disease. Our case is a quasi experimental model of inocuity of Saccharomyces cerevisae (boulardii) in a non-immunocompromised host.
Conflict of interest
The authors declare no conflict of interest and no funding source.
Acknowledgments
None.
References
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