Skip to main content

Septicemia from Lactobacillus rhamnosus GG, from a Probiotic Enriched Yogurt, in a Patient with Autologous Stem Cell Transplantation


Probiotic-rich foods are consumed without much restriction. We report here, a case of septic shock caused by yogurt derived Lactobacillus species in a 54-year-old male patient with acute promyelocytic leukemia, in second complete remission, and who was an autologous stem cell transplantation recipient. He received high dose chemotherapy and autologous peripheral blood stem cell transplantation. He ingested commercially available probiotic-enriched yogurt because of severe diarrhea. One week later, he developed septic shock, and the pathogen was determined by strain-specific PCR analysis as Lactobacillus rhamnosus GG (ATCC 53103), which was found to be identical with the strain in the yogurt he consumed. Thus, because even low virulent Lactobacilli in the probiotic products can be pathogenic in the compromised hosts, ingestion of such products should be considered with caution in neutropenic patients with severe diarrhea, such as stem cell transplantation recipients.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Salminen S, von Wright A, Morelli L, Marteau P, Brassart D, de Vos WM, Fondén R, Saxelin M, Collins K, Mogensen G, Birkeland SE, Mattila-Sandholm T (1998) Demonstration of safety of probiotics -- a review. Int J Food Microbiol 44:93–106

    CAS  Article  Google Scholar 

  2. Wells JM (2011) Immunomodulatory mechanisms of lactobacilli. Microb Cell Factories 10(Suppl 1):S17

    Article  Google Scholar 

  3. Srinivasan R, Meyer R, Padmanabhan R, Britto J (2006) Clinical safety of lactobacillus casei shirota as a probiotic in critically ill children. J Pediatr Gastroenterol Nutr 42:171–173

    Article  Google Scholar 

  4. Antony SJ, Stratton CW, Dummer JS (1996) Lactobacillus bacteremia: description of the clinical course in adult patients without endocarditis. Clin Infect Dis 23:773–778

    CAS  Article  Google Scholar 

  5. Griffiths JK, Daly JS, Dodge RA (1992) Two cases of endocarditis due to lactobacillus species: antimicrobial susceptibility, review, and discussion of therapy. Clin Infect Dis 15:250–255

    CAS  Article  Google Scholar 

  6. Sussman JI, Baron EJ, Goldberg SM, Kaplan MH, Pizzarello RA (1986) Clinical manifestations and therapy of lactobacillus endocarditis: report of a case and review of the literature. Rev Infect Dis 8:771–776

    CAS  Article  Google Scholar 

  7. Land MH, Rouster-Stevens K, Woods CR, Cannon ML, Cnota J, Shetty AK (2005) Lactobacillus sepsis associated with probiotic therapy. Pediatrics 115:178–181

    Article  Google Scholar 

  8. Vahabnezhad E, Mochon AB, Wozniak LJ, Ziring DA (2013) Lactobacillus bacteremia associated with probiotic use in a pediatric patient with ulcerative colitis. J Clin Gastroenterol 47:437–439

    Article  Google Scholar 

  9. Mehta A, Rangarajan S, Borate U (2013) A cautionary tale for probiotic use in hematopoietic SCT patients-lactobacillus acidophilus sepsis in a patient with mantle cell lymphoma undergoing hematopoietic SCT. Bone Marrow Transplant 48:461–462

    CAS  Article  Google Scholar 

  10. Ward LJ, Timmins MJ (1999) Differentiation of lactobacillus casei, lactobacillus paracasei and lactobacillus rhamnosus by polymerase chain reaction. Lett Appl Microbiol 29:90–92

    CAS  Article  Google Scholar 

  11. Ahlroos T, Tynkkynen S (2009) Quantitative strain-specific detection of lactobacillus rhamnosus GG in human faecal samples by real-time PCR. J Appl Microbiol 106:506–514

    CAS  Article  Google Scholar 

  12. Salminen MK, Rautelin H, Tynkkynen S, Poussa T, Saxelin M, Valtonen V, Järvinen A (2004) Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG. Clin Infect Dis 38:62–69

    Article  Google Scholar 

  13. Fenicia L, Anniballi F, Aureli P (2007) Intestinal toxemia botulism in Italy, 1984-2005. Eur J Clin Microbiol Infect Dis 26:385–394

    CAS  Article  Google Scholar 

  14. Howard FM, Flynn DM, Bradley JM, Noone P, Szawatkowski M (1977) Outbreak of necrotising enterocolitis caused by clostridium butyricum. Lancet 2:1099–1102

    CAS  Article  Google Scholar 

  15. Kimura SI, Fujita H, Kato H, Hiramoto N, Hosono N, Takahashi T, Shigeno K, Hatsumi N, Minamiguchi H, Miyatake J, Handa H, Akiyama N, Kanda Y, Yoshida M, Kiyoi H, Miyazaki Y, Naoe T; Japan Adult Leukemia Study Group (JALSG). (2017) Management of infection during chemotherapy for acute leukemia in Japan: a nationwide questionnaire-based survey by the Japan Adult Leukemia Study Group. Support Care Cancer. Jun 6.

  16. Gardner A, Mattiuzzi G, Faderl S, Borthakur G, Garcia-Manero G, Pierce S, Brandt M, Estey E (2008) Randomized comparison of cooked and noncooked diets in patients undergoing remission induction therapy for acute myeloid leukemia. J Clin Oncol 26:5684–5688

    Article  Google Scholar 

  17. Moody K, Finlay J, Mancuso C, Charlson M (2006) Feasibility and safety of a pilot randomized trial of infection rate: neutropenic diet versus standard food safety guidelines. J Pediatr Hematol Oncol 28:126–133

    Article  Google Scholar 

  18. van Tiel F, Harbers MM, Terporten PH, van Boxtel RT, Kessels AG, Voss GB, Schouten HC (2007) Normal hospital and low-bacterial diet in patients with cytopenia after intensive chemotherapy for hematological malignancy: a study of safety. Ann Oncol 18:1080–1084

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations



Corresponding author

Correspondence to Hiroyuki Fujita.

Ethics declarations

Conflicts of Interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest. The authors declare that the final manuscript has not been published before and the work is not under consideration for publication elsewhere.

Informed Consent

Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent may be requested for review from the corresponding author.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Koyama, S., Fujita, H., Shimosato, T. et al. Septicemia from Lactobacillus rhamnosus GG, from a Probiotic Enriched Yogurt, in a Patient with Autologous Stem Cell Transplantation. Probiotics & Antimicro. Prot. 11, 295–298 (2019).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Lactobacillus
  • Probiotic yogurt, bacteremia
  • Leukemia
  • Stem cell transplantation