Effect of supplement with lactic-acid producing bacteria on fatigue and physical activity in patients with chronic fatigue syndrome.

Disturbances in intestinal microbial ecology and in the immune system of the host have been implicated as a part of the pathogenesis in chronic fatigue syndrome. Probiotic lactic acid producing bacteria have been shown to prevent and alleviate gastrointestinal disturbances and to normalize the cytokine profile which might be of an advantage for patients suffering from chronic fatigue syndrome. The aim of the study was to evaluate the effect of Lactobacillus paracasei ssp. paracasei F19, Lactobacillus acidophilus NCFB 1748 and Bifidobacterium lactis Bb12 on fatigue and physical activity in CFS patients. Fifteen patients fulfilling the criteria set by international researchers in the field at the US Centre for Disease Control and Prevention in 1994 for chronic fatigue syndrome, were included in the study. The patients had high fatigue severity scores and high disability scores. During the first two weeks baseline observations without treatment were assessed, succeeded by four weeks of intake of a probiotic product and a four-week follow-up period. The fatigue, health and physical activity was assessed by the use of the Visual Analogue Scales and the SF-12 Health Survey. Faecal samples were collected and the normal microflora was analysed. Neurocognitive functions improved during the study period while there were no significant changes in fatigue and physical activity scores. No major changes occurred in the gastrointestinal microflora. At the end of the study 6 of 15 patients reported that they had improved according to the assessment described. The findings in this study that improvement of health is possible to achieve should encourage further studies with interventions with probiotics in patients with CFS.

Virulence and antimicrobial resistance in clinical Enterococcus faecium.

The aim of the present study was to determine the occurrence of seven virulence determinants in Enterococcus faecium clinical blood culture isolates over a 6-year period and to investigate possible correlations between virulence and antibiotic resistance. Two hundred and sixty-three isolates were screened for the presence of genes coding for aggregation substance (asa1), cytolysin (cylA), collagen-binding protein (ace), Enterococcusfaecalis endocarditis antigen (efaA(fs)), enterococcal surface protein (esp(fm)), gelatinase (gelE) and hyaluronidase (hyl(fm)) by polymerase chain reaction. The minimum inhibitory concentrations (MICs) of ampicillin, ciprofloxacin, gentamicin, imipenem, linezolid and vancomycin were determined by the agar dilution method and the MIC of daptomycin was determined by Etest. The esp(fm) gene was found in 56% of the isolates, hyl(fm) in 4%, whilst the other virulence genes were detected only sporadically (< or = 1%). The level of antibiotic resistance was 77% to ampicillin, 90% to ciprofloxacin and 83% to imipenem; 5% of the isolates were resistant to vancomycin and 2% were resistant to gentamicin (high-level resistance, MIC > or = 500 mg/L). A significant correlation was found between the presence of esp(fm) and resistance to ampicillin, ciprofloxacin and imipenem (P<0.01). Twelve isolates were esp(fm)-positive and ampicillin-susceptible.

Probiotic lactobacilli and bacteraemia in Stockholm.

The objective of the present study was to determine the incidence of lactobacilli-induced bacteraemia in Stockholm, Sweden, between January 1998 and March 2004, and to identify the possible presence of probiotic strains. Isolated strains were checked for growth on selective lactobacilli-agar and the biochemical profiles were determined. The lactobacilli strains were further analysed with molecular methodologies to ascertain eventual similarities with the probiotic strains Lactobacillus paracasei subsp. paracasei F19 (LMG P 17806), Lactobacillus acidophilus NCFB 1748 and Lactobacillus rhamnosus GG (ATCC 53103). The minimum inhibitory concentrations of selected antimicrobial agents were determined by the agar dilution method. The incidence of bacteraemia cases caused by lactobacilli remained at the same level during the study period and constituted to <1% of the total number of bacteraemia cases each y. L. paracasei subsp. paracasei F19, L. acidophilus NCFB 1748 and L. rhamnosus GG were not identified in any of the samples.

Monitoring of antibiotic-induced alterations in the human intestinal microflora and detection of probiotic strains by use of terminal restriction fragment length polymorphism.

Terminal restriction fragment length polymorphism (T-RFLP) was investigated as a tool for monitoring the human intestinal microflora during antibiotic treatment and during ingestion of a probiotic product. Fecal samples from eight healthy volunteers were taken before, during, and after administration of clindamycin. During treatment, four subjects were given a probiotic, and four subjects were given a placebo. Changes in the microbial intestinal community composition and relative abundance of specific microbial populations in each subject were monitored by using viable counts and T-RFLP fingerprints. T-RFLP was also used to monitor specific bacterial populations that were either positively or negatively affected by clindamycin. Some dominant bacterial groups, such as Eubacterium spp., were easily monitored by T-RFLP, while they were hard to recover by cultivation. Furthermore, the two probiotic Lactobacillus strains were easily tracked by T-RFLP and were shown to be the dominant Lactobacillus community members in the intestinal microflora of subjects who received the probiotic.

Ecological effects of perorally administered pivmecillinam on the normal vaginal microflora.

The knowledge of the effects of antimicrobial agents on the normal vaginal microflora is limited. The objective of the present study was to study the ecological impact of pivmecillinam on the normal vaginal microflora. In 20 healthy women, the estimated day of ovulation was determined during three subsequent menstrual cycles. Microbiological and clinical examinations were performed on the estimated day of ovulation and on day 3 in all cycles and also on day 7 after ovulation in cycles 1 and 2. Anaerobic and facultative anaerobic gram-positive rods, mainly species of lactobacilli and actinomycetes, dominated the microflora. One woman was colonized on the third day of administration with a resistant Escherichia coli strain, and Candida albicans was detected in one woman on days 3 and 7 in cycle 2. No other major changes in the normal microflora occurred during the study. Administration of pivmecillinam had a minor ecological impact on the normal vaginal microflora.

Effect of Lactobacillus F19 on the emergence of antibiotic-resistant microorganisms in the intestinal microflora.

OBJECTIVES: Probiotic lactic-acid-producing bacteria have been used for prevention of gastrointestinal diseases. The aim of the present study was to examine whether Lactobacillus F19 in conjunction with treatment with penicillin, ciprofloxacin or norfloxacin prevents establishment of resistant bacteria in the gastrointestinal tract. METHODS: Twenty patients admitted to hospital due for treatment with penicillin and 16 patients due for treatment with ciprofloxacin or norfloxacin were included in the study. In either group, the patients were randomized into two groups, receiving placebo or an active probiotic product. Faecal samples were collected before treatment, on day 10 and 1 month after the start of the treatment. Isolates of enterococci, enterobacteria and Bacteroides fragilis species were screened for resistance to penicillin and ciprofloxacin, respectively. RESULTS: Administration of penicillin did not influence resistance in enterococci while quinolone resistance increased during quinolone treatment. Susceptibility to ampicillin and piperacillin/tazobactam decreased in enterobacteria during penicillin treatment and ciprofloxacin resistance increased in the quinolone group. Penicillin and quinolones did not influence the resistance rates of Bacteroides isolates. No major differences were observed between the probiotic- and placebo-supplemented groups. CONCLUSIONS: There was a limited effect of Lactobacillus F19 on the emergence of resistant isolates during treatment with penicillin and quinolones.

Lactobacillus acidophilus, Bifidobacterium lactis and Lactobacillus F19 prevent antibiotic-associated ecological disturbances of Bacteroides fragilis in the intestine.

OBJECTIVE: The objective of this study was to compare the effect of clindamycin on the intestinal microflora in subjects ingesting yogurt with added probiotic microorganisms with the microflora in subjects ingesting placebo yogurt. MATERIALS AND METHODS: Twenty-four healthy subjects were included in the study. All subjects received 150 mg clindamycin four times daily for 7 days and 250 ml yogurt twice daily for 14 days. Faecal samples were collected before, during and after administration of clindamycin. RESULTS: In the aerobic intestinal microflora, the numbers of enterococci increased after treatment in both groups, whereas other Gram-positive microorganisms decreased. In both groups, the numbers of Escherichia coli also decreased, whereas there was a concomitant increase in numbers of other Gram-negative bacilli. In the anaerobic microflora in subjects receiving yogurt with added microorganisms, the numbers of lactobacilli and bacteroides remained at the same levels throughout the study, whereas the numbers decreased in the placebo group. Other anaerobic bacteria decreased in both groups. The minimum inhibitory concentration of clindamycin against strains of bacteroides increased in both groups during the study. CONCLUSIONS: The probiotic microorganisms evaluated in this study prevented ecological disturbances in the numbers of intestinal Bacteroides fragilis group species during clindamycin administration.