An elderly man in Japan developed a fatal bacterial infection after taking a probiotic as part of his treatment for severe COVID-19.
The unidentified patient was first brought to the emergency room after being discovered on the floor of his home. He had a history of colon cancer, chest pain, high blood pressure and pancreatic cysts. He was an active smoker and alcohol drinker at the time of his collapse.
ER medics learned that the man had COVID-19. They treated him with the corticosteroid dexamethasone and the immunosuppressive drug tocilizumab.
His breathing improved, but he developed diarrhea from the drugs. He was given a strain of the bacterium Clostridium butyricum, called C. butyricum MIYAIRI 588. Available in tablet form, CBM 588 is commonly used in Japan to treat diarrhea.
This tablets, prescribed to the man for a month, have “been widely used as probiotics for diarrhea in Japan and are also reported to improve symptoms of C. difficile [bacterial] infection and irritable bowel syndrome,” Fujita Health University Hospital researchers wrote last week in BMJ Case Reports.
CBM 588 capsules cannot be purchased in US stores, but can be bought online. The med is being tested in advanced kidney cancer patients at the City of Hope cancer center in Duarte, California.
On his 33rd day in the hospital, the Japanese man was discharged from the ICU. About 25 days later, he started to feel persistent stomach pain.
He rapidly developed multi-organ failure and died. It had been about two months since he was first admitted to the hospital.
He had suffered C. butyricum bacteremia, when bacteria circulate in the bloodstream, from taking the probiotic, and from non-occlusive mesenteric ischemia, or NOMI, characterized by reduced intestinal blood flow.
“While probiotics are routinely prescribed [to] ill patients with various gastrointestinal symptoms and conditions, rare yet severe adverse events may occur, as exemplified in this report,” the researchers wrote.
They called the man’s death “the first case of definitive probiotics-related C. butyricum [bacteremia ] after treatment of severe COVID-19.” Probiotics are supposed to help maintain a healthy balance of gut bacteria.
In a May study, researchers at Osaka University in Japan identified five cases of C. butyricum-causing bacteremia from probiotics.
“Probiotics can provide a variety of health benefits, but this study shows that even such agents can present with rare but serious adverse events,” lead author Ryuichi Minoda Sada said at the time.
“Our findings underscore the risk for bacteremia resulting from probiotic use, especially in hospitalized patients, necessitating judicious prescription practices,” Sada added.
