Reply to “Confused by Weissella confusa Bacteremia”

REPLY

In this issue, Gelfand and Cleveland comment (1) on our recent photo quiz (2, 3) about Weissella confusa bacteremia in a Crohn's disease patient. In particular, they raise the possibility that the bacteremia resulted from the patient's use of a probiotic supplement rather than the other etiologies discussed. We agree that probiotics have been reported in association with Lactobacillus species bacteremia (4) and are a potential etiology when these organisms are found in the bloodstream. The patient under discussion had been taking 1 g of a probiotic containing Lactobacillus acidophilus and L. bulgaricus three times a day, and while this is incongruent with the organism ultimately identified in her bloodstream, it may still have been present in the probiotic supplement. The patient's probiotic was not tested for the presence of W. confusa but had nevertheless been discontinued during the course of her treatment. We agree that probiotic testing is a potential avenue of investigation in cases where the etiology of the bacteremia is in doubt and where it may alter clinical management. Weissella spp. are found in foods and the gastrointestinal tracts of human and animals (5). Regardless of the origin of the Weissella species, we favor gut translocation as the cause of the bacteremia because our patient had multiple abdominal surgeries and altered gastrointestinal flora from Crohn's disease.