Man develops fatal bacterial infection after taking ‘widely used’ probiotic

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 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 a heavy smoker and alcoholic at the time of his collapse.

ER doctors learned the man had COVID-19. They treated him with the corticosteroid dexamethasone and the immunosuppressive drug tocilizumab.

His breathing improved, but he had diarrhea from the medication. He was given Clostridium butyricum MIYAIRI 588 (CBM588) tablets, commonly used in Japan to treat diarrhea.

This drug, which was given to the man for a month, “is widely used as a probiotic for diarrhea in Japan and is 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.

CBM588 capsules cannot be purchased in US stores, but can be purchased online. The drug is being tested in advanced kidney cancer patients at the City of Hope Comprehensive Cancer Center in California.

On his 33rd hospital day, the Japanese man was discharged from the ICU. About 25 days later, he started feeling constant pain in his stomach.

He rapidly developed multi-organ failure and died about two months after arriving at the hospital.

He had suffered from C. butyricum bacteremia, when bacteria circulate in the blood, from taking probiotics and non-occlusive mesenteric ischemia (NOMI), characterized by reduced blood flow to the gut.

“While probiotics are routinely prescribed among sick patients with various gastrointestinal symptoms and conditions, rare but serious adverse events can occur, as shown in this report,” the researchers wrote.

They called the man’s death “the first case of definitive C. butyricum bacteremia associated with probiotics after treatment of severe COVID-19.” Probiotics are supposed to help maintain a healthy balance of gut bacteria.

In a May study, Osaka University Hospital 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 appear with rare but serious adverse events,” lead study author Ryuichi Minoda Sada said at the time.

“Our findings highlight the risk for bacteremia resulting from the use of probiotics, particularly in hospitalized patients, calling for judicious prescribing practices,” Sada added.