RESUMO
Sarcina ventriculi is a gram-positive bacterium, able to survive in extreme low pH environment. It's first description dates from 1842, by John Goodsir. Since then, just a few cases have been reported. In veterinary medicine, especially in ruminants, it causes bloating, vomiting, gastric perforation and death of the animal. It is commonly associated with delayed gastric emptying or obstruction to gastric outlet, although it's pathogenicity in humans is not fully understood. We report two cases with identification of the bacteria in gastric specimens stained with hematoxylin-eosin staining, in different clinical settings. The first patient is a young female patient, presenting cardiac arrest and death after gastric perforation and the second patient an adult male presenting with gastric adenocarcinoma, treated with partial gastrectomy followed by adjuvant chemoradiation. In our literature review, we identified forty-five cases reporting Sarcina ventriculi appearance, with a sudden increase since 2010.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Pessoa de Meia-Idade , Sarcina/patogenicidade , Infecções por Clostridium/patologia , Gastroparesia/complicaçõesAssuntos
Diabetes Mellitus Tipo 2/complicações , Esvaziamento Gástrico , Gastrite/microbiologia , Gastroparesia/complicações , Infecções por Bactérias Gram-Positivas/microbiologia , Náusea/microbiologia , Sarcina/patogenicidade , Vômito/microbiologia , Antibacterianos/uso terapêutico , Biópsia , Diabetes Mellitus Tipo 2/diagnóstico , Gastrite/diagnóstico , Gastrite/tratamento farmacológico , Gastroparesia/diagnóstico , Gastroparesia/fisiopatologia , Gastroscopia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Sarcina/efeitos dos fármacos , Sarcina/isolamento & purificação , Resultado do TratamentoRESUMO
Sarcina ventriculi is an increasingly common gram-positive coccus, recognized in gastric biopsies, particularly of patients with delayed gastric emptying. It occurs most commonly in adult women and can be identified easily by its characteristic morphologic features, such as basophilic staining, cuboid shape, tetrad arrangement, red blood cell-sized packets, flattened cell walls, and refractile nature on light microscopy. Although the pathogenesis of the organism is debated, it has been implicated in cases of gastric perforation, emphysematous gastritis, and peritonitis as well as occurring in the background of gastric adenocarcinomas. This review of the literature discusses the clinical features, endoscopy findings, histopathology, ancillary studies, microbiology, pathogenesis, differential diagnosis, treatment, and prognosis of this bacterium based on 19 published cases.
Assuntos
Infecções por Clostridium/diagnóstico , Sarcina/isolamento & purificação , Anti-Infecciosos/uso terapêutico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/microbiologia , Infecções por Clostridium/fisiopatologia , Diagnóstico Diferencial , Quimioterapia Combinada , Enfisema/etiologia , Enfisema/prevenção & controle , Feminino , Esvaziamento Gástrico/efeitos dos fármacos , Gastrite/etiologia , Gastrite/prevenção & controle , Humanos , Masculino , Metronidazol/uso terapêutico , Peritonite/etiologia , Peritonite/prevenção & controle , Prognóstico , Sarcina/efeitos dos fármacos , Sarcina/patogenicidade , Ruptura Gástrica/etiologia , Ruptura Gástrica/prevenção & controle , Vômito/etiologia , Vômito/prevenção & controleRESUMO
First identified in humans by Goodsir in 1842, Sarcina were already known to cause fatal abomasal bloat in animals. Their pathogenicity in humans has only recently been characterized. Sarcina is not inherently pathogenic but, with a gastric ulcer and delayed gastric emptying, can result in perforation. We present a case report of a 32-year-old woman status post-gastric banding presenting with epigastric pain. Upper endoscopy revealed a gastric ulcer near the band. After deflation, upper gastrointestinal series showed passage of contrast and no perforation. Ulcer biopsy showed gastric contents composed of Sarcina. Proton pump inhibitors and antibiotics were administered. Follow-up endoscopy at an outside institution resulted in perforation. This case report supports a growing body of literature that Sarcina organisms contribute to ulcers and perforation. This is the first report of Sarcina in elective bariatric surgery patients, highlighting the high suspicion needed among pathologists evaluating ulcers in this unique surgical population.