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Mbaye B, Wasfy RM, Alou MT, Borentain P, Gerolami R, Dufour JC, Million M. A catalog of ethanol-producing microbes in humans. Future Microbiol 2024; 19:697-714. [PMID: 38700288 PMCID: PMC11259083 DOI: 10.2217/fmb-2023-0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/13/2024] [Indexed: 05/05/2024] Open
Abstract
Aim: Endogenous ethanol production emerges as a mechanism of nonalcoholic steatohepatitis, obesity, diabetes and auto-brewery syndrome. Methods: To identify ethanol-producing microbes in humans, we used the NCBI taxonomy browser and the PubMed database with an automatic query and manual verification. Results: 85 ethanol-producing microbes in human were identified. Saccharomyces cerevisiae, Candida and Pichia were the most represented fungi. Enterobacteriaceae was the most represented bacterial family with mainly Escherichia coli and Klebsiella pneumoniae. Species of the Lachnospiraceae and Clostridiaceae family, of the Lactobacillales order and of the Bifidobacterium genus were also identified. Conclusion: This catalog will help the study of ethanol-producing microbes in human in the pathophysiology, diagnosis, prevention and management of human diseases associated with endogenous ethanol production.
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Affiliation(s)
- Babacar Mbaye
- Aix Marseille Université, AP-HM, MEPHI, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Reham Magdy Wasfy
- Aix Marseille Université, AP-HM, MEPHI, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Maryam Tidjani Alou
- Aix Marseille Université, AP-HM, MEPHI, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
| | - Patrick Borentain
- Department of Hepatology, La Timone University Hospital, AP-HM, Marseille, France
| | - Rene Gerolami
- Aix Marseille Université, AP-HM, MEPHI, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
- Department of Hepatology, La Timone University Hospital, AP-HM, Marseille, France
| | - Jean-Charles Dufour
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Aix Marseille University, 13385 Marseille, France
- APHM, Hôpital de la Timone, Service Biostatistique et Technologies de l'Information et de la Communication, 13385 Marseille, France
| | - Matthieu Million
- Aix Marseille Université, AP-HM, MEPHI, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France
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Yates SR, Saito A. Auto-Brewery Syndrome After COVID-19 Infection. ACG Case Rep J 2024; 11:e01248. [PMID: 38333721 PMCID: PMC10852359 DOI: 10.14309/crj.0000000000001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/27/2023] [Indexed: 02/10/2024] Open
Abstract
Auto-brewery syndrome (ABS) is a rare medical condition, wherein gut microbiota ferment carbohydrates to alcohol. Risk factors for ABS include diets high in carbohydrates and sugars, diabetes mellitus, prior gastrointestinal surgery, nonalcoholic fatty liver disease, and certain genetic mutations, among others. We provide a case of ABS that developed after known COVID-19 infection, which may be one of the contributing factors to its development.
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Affiliation(s)
- Sarah R. Yates
- Department of Internal Medicine, Indiana School of Medicine, Indianapolis, IN
| | - Akira Saito
- Division of Gastroenterology and Hepatology, Indiana School of Medicine, Indianapolis, IN
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Tamama K, Kruckenberg KM, DiMartini AF. Gut and bladder fermentation syndromes: a narrative review. BMC Med 2024; 22:26. [PMID: 38246992 PMCID: PMC10801939 DOI: 10.1186/s12916-023-03241-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
We recently reported the first clinical case of bladder fermentation syndrome (BFS) or urinary auto-brewery syndrome, which caused the patient to fail abstinence monitoring. In BFS, ethanol is generated by Crabtree-positive fermenting yeast Candida glabrata in a patient with poorly controlled diabetes. One crucial characteristic of BFS is the absence of alcoholic intoxication, as the bladder lumen contains transitional epithelium with low ethanol permeability. In contrast, patients with gut fermentation syndrome (GFS) or auto-brewery syndrome can spontaneously develop symptoms of ethanol intoxication even without any alcohol ingestion because of alcoholic fermentation in the gut lumen. In abstinence monitoring, a constellation of laboratory findings with positive urinary glucose and ethanol, negative ethanol metabolites, and the presence of yeast in urinalysis should raise suspicion for BFS, whereas endogenous ethanol production needs to be shown by a carbohydrate challenge test for GFS diagnosis. GFS patients will also likely fail abstinence monitoring because of the positive ethanol blood testing. BFS and GFS are treated by yeast eradication of fermenting microorganisms with antifungals (or antibiotics for bacterial GFS cases) and modification of underlying conditions (diabetes for BFS and gut dysbiosis for GFS). The under-recognition of these rare medical conditions has led to not only harm but also adverse legal consequences for patients, such as driving under the influence (DUI). GFS patients may be at risk of various alcohol-related diseases.
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Affiliation(s)
- Kenichi Tamama
- Clinical Laboratories, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, 3477 Euler Way, UPMC Presbyterian Clinical Laboratory Building, Pittsburgh, PA, 15213, USA.
| | - Katherine M Kruckenberg
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, USA
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Xue G, Feng J, Zhang R, Du B, Sun Y, Liu S, Yan C, Liu X, Du S, Feng Y, Cui J, Gan L, Zhao H, Fan Z, Cui X, Xu Z, Fu T, Li C, Huang L, Zhang T, Wang J, Yang R, Yuan J. Three Klebsiella species as potential pathobionts generating endogenous ethanol in a clinical cohort of patients with auto-brewery syndrome: a case control study. EBioMedicine 2023; 91:104560. [PMID: 37060744 PMCID: PMC10139882 DOI: 10.1016/j.ebiom.2023.104560] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Patients with auto-brewery syndrome (ABS) become inebriated after the ingestion of an alcohol-free, high-carbohydrate diet. Our previous work has shown that high-alcohol-producing (HiAlc) Klebsiella pneumoniae can generate excessive endogenous ethanol and cause non-alcoholic fatty liver disease (NAFLD). Therefore, it is reasonable to speculate that such bacteria might play an important role in the pathogenesis of ABS. METHODS The characteristics and metabolites of the intestinal flora from a clinical cohort of patients with ABS were analysed during different stages of disease and compared to a group of healthy controls. An in vitro culture system of relevant samples was used for screening drug sensitivity and ABS-inducing factors. Rabbit intestinal and murine models were established to verify if the isolated strains could induce ABS in vivo. FINDINGS We observed intestinal dysbiosis with decreased abundance of Firmicutes and increased of Proteobacteria in patients with ABS compared with healthy controls. The abundance of the genus Klebsiella in Enterobacteriaceae was strongly associated with fluctuations of patient's blood alcohol concentration. We isolated three species of HiAlc Klebsiella from ABS patients, which were able to induce ABS in mice. Monosaccharide content was identified as a potential food-related inducing factor for alcohol production. Treatments with antibiotics, a complex probiotic preparation and a low-carbohydrate diet not only alleviated ABS, but also erased ABS relapse during the follow-up observation of one of the patients. INTERPRETATION Excessive endogenous alcohol produced by HiAlc Klebsiella species was an underlying cause of bacterial ABS. Combined prescription of appropriate antibiotics, complex probiotic preparation and a controlled diet could be sufficient for treatment of bacteria-caused ABS. FUNDING The funders are listed in the acknowledgement.
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Affiliation(s)
- Guanhua Xue
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China; Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junxia Feng
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Rui Zhang
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China; Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Bing Du
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Ying Sun
- The Department of Immunology, School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Shiyu Liu
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Chao Yan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Xinjuan Liu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Shuheng Du
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Yanling Feng
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Jinghua Cui
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Lin Gan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Hanqing Zhao
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Zheng Fan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Xiaohu Cui
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Ziying Xu
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Tongtong Fu
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China
| | - Chen Li
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Lei Huang
- Department of Infectious Diseases, The Fifth Medical Center of Chinese PLA General Hospital, National Clinical Research Center for Infectious Diseases, Beijing, China
| | - Ting Zhang
- Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
| | - Jing Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
| | - Ruifu Yang
- Beijing Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, China.
| | - Jing Yuan
- Department of Bacteriology, Capital Institute of Pediatrics, Beijing, China; Children's Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Mbaye B, Borentain P, Magdy Wasfy R, Alou MT, Armstrong N, Mottola G, Meddeb L, Ranque S, Gérolami R, Million M, Raoult D. Endogenous Ethanol and Triglyceride Production by Gut Pichia kudriavzevii, Candida albicans and Candida glabrata Yeasts in Non-Alcoholic Steatohepatitis. Cells 2022; 11:cells11213390. [PMID: 36359786 PMCID: PMC9654979 DOI: 10.3390/cells11213390] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/23/2022] [Accepted: 10/24/2022] [Indexed: 11/23/2022] Open
Abstract
Nonalcoholic steatohepatitis (NASH) increases with fructose consumption and metabolic syndrome and has been recently linked with endogenous ethanol production, notably by high alcohol-producing Klebsiella pneumoniae (HiAlc Kpn). Candida yeasts are the main causes of auto-brewery syndromes but have been neglected in NASH. Here, the fecal ethanol and microbial content of 10 cases and 10 controls were compared. Ethanol was measured by gas chromatography-mass spectrometry. Species identification was performed by MALDI-TOF MS, and triglyceride production was assessed by a colorimetric enzymatic assay. The fecal ethanol concentration was four times higher in patients with NASH (median [interquartile range]: 0.13 [0.05–1.43] vs. 0.034 [0.008–0.57], p = 0.037). Yeasts were isolated from almost all cases but not from controls (9/10 vs. 0/10, p = 0.0001). Pichia kudriavzevii was the most frequent (four patients), while Candida glabrata, Candida albicans, and Galactomyces geotrichum were identified in two cases each. The concentration of ethanol produced by yeasts was 10 times higher than that produced by bacteria (median, 3.36 [0.49–5.60] vs. 0.32 [0.009–0.43], p = 0.0029). Using a 10% D-fructose restricted medium, we showed that NASH-associated yeasts transformed fructose in ethanol. Unexpectedly, yeasts isolated from NASH patients produced a substantial amount of triglycerides. Pichia kudriavzevii strains produced the maximal ethanol and triglyceride levels in vitro. Our preliminary human descriptive and in vitro experimental results suggest that yeasts have been neglected. In addition to K. pneumoniae, gut Pichia and Candida yeasts could be linked with NASH pathophysiology in a species- and strain-specific manner through fructose-dependent endogenous alcohol and triglyceride production.
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Affiliation(s)
- Babacar Mbaye
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche Pour le Développement, Aix-Marseille Université, 13005 Marseille, France
| | - Patrick Borentain
- Unité Hépatologie, Hôpital de la Timone, APHM, 13005 Marseille, France
| | - Reham Magdy Wasfy
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche Pour le Développement, Aix-Marseille Université, 13005 Marseille, France
| | - Maryam Tidjani Alou
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche Pour le Développement, Aix-Marseille Université, 13005 Marseille, France
| | - Nicholas Armstrong
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche Pour le Développement, Aix-Marseille Université, 13005 Marseille, France
- Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Giovanna Mottola
- Laboratoire de Biochimie, Hôpital de la Timone, APHM, 13005 Marseille, France
- C2VN, INSERM 1263, INRAE 1260, Team 5, Aix-Marseille Université, 13005 Marseille, France
| | - Line Meddeb
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
| | - Stéphane Ranque
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- VITROME: Vecteurs-Infections Tropicales et Méditerranéennes, Institut de Recherche Pour le Développement, Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Aix Marseille Université, 13385 Marseille, France
| | - René Gérolami
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche Pour le Développement, Aix-Marseille Université, 13005 Marseille, France
- Unité Hépatologie, Hôpital de la Timone, APHM, 13005 Marseille, France
| | - Matthieu Million
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche Pour le Développement, Aix-Marseille Université, 13005 Marseille, France
- Assistance Publique-Hôpitaux de Marseille, 13005 Marseille, France
- Correspondence: ; Tel.: +33-413-732-401; Fax: +33-413-732-402
| | - Didier Raoult
- IHU Méditerranée Infection, 19-21 Boulevard Jean Moulin, 13005 Marseille, France
- Microbes Evolution Phylogeny and Infections (MEPHI), Institut de Recherche Pour le Développement, Aix-Marseille Université, 13005 Marseille, France
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Smędra A, Trzmielak M, Góralska K, Dzikowiec M, Brzeziańska-Lasota E, Berent J. Oral form of auto-brewery syndrome. J Forensic Leg Med 2022; 87:102333. [DOI: 10.1016/j.jflm.2022.102333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 03/01/2022] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
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Dinis-Oliveira RJ. The Auto-Brewery Syndrome: A Perfect Metabolic "Storm" with Clinical and Forensic Implications. J Clin Med 2021; 10:4637. [PMID: 34682761 PMCID: PMC8537665 DOI: 10.3390/jcm10204637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 12/29/2022] Open
Abstract
Auto-brewery syndrome (ABS) is a rare, unstudied, unknown, and underreported phenomenon in modern medicine. Patients with this syndrome become inebriated and may suffer the medical and social implications of alcoholism, including arrest for inebriated driving. The pathophysiology of ABS is reportedly due to a fungal type dysbiosis of the gut that ferments some carbohydrates into ethanol and may mimic a food allergy or intolerance. This syndrome should be considered in patients with chronic obstruction or hypomotility presenting with elevated breath and blood alcohol concentrations, especially after a high carbohydrate intake. A glucose challenge test should be performed as the confirmatory test. Treatment typically includes antifungal drugs combined with changes in lifestyle and nutrition. Additional studies are particularly needed on the human microbiome to shed light on how imbalances of commensal bacteria in the gut allow yeast to colonize on a pathological level.
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Affiliation(s)
- Ricardo Jorge Dinis-Oliveira
- TOXRUN—Toxicology Research Unit, University Institute of Health Sciences, Advanced Polytechnic and University Cooperative (CESPU), CRL, 4585-116 Gandra, Portugal; or or ; Tel.: +351-224-157-216
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- UCIBIO-Applied Molecular Biosciences Unit, REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira nº 228, 4050-313 Porto, Portugal
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Cordell B, Kanodia A, Miller GK. Factors in an Auto-Brewery Syndrome group compared to an American Gut Project group: a case-control study. F1000Res 2021; 10:457. [PMID: 34567530 PMCID: PMC8422346 DOI: 10.12688/f1000research.52743.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Auto-Brewery Syndrome (ABS), also known as Gut Fermentation Syndrome, is a rare but underdiagnosed condition. While scores of case studies of ABS are published, only one previous study examined ABS patients’ demographics, health history, lifestyle factors, and diet compared to a control group of household members. Methods: We designed a case-control study to identify factors that individuals with a diagnosis of ABS and those who live with them might have that differ from a larger general group. We administered a survey to 46 patients known to have a diagnosis of ABS and their household members. Here, we compare our group of survey takers to a cohort of the American Gut Project (AGP) participants (N=11,297) for the 30 questions that were identical. Results: With a response rate of 88% and using Rank Sum Tests, the data demonstrate that patients with ABS and their household members are more likely than participants of the AGP to own a pet (p=.03 for cat; p=.0001 for dog), get less sleep (p=.0001), and have lesser quality of bowel movements (p=.03). In addition, the ABS group consumes more water (p=.02) and less alcohol (p=.0004), eats at home more often (p=.0056), and reports more aversion to sweets (p=.01). The most striking difference is a higher presence of non-food allergies in all five subcategories of the survey in the ABS group compared to the AGP group. Conclusion: Patients with ABS and their household members show several significant differences in their lifestyle and health, diet, and medical history compared to a large group of AGP participants. These differences lead to several hypotheses about co-morbidities that warrant further research.
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Affiliation(s)
- Barbara Cordell
- Department of Nursing, Panola College, Carthage, TX, 75633, USA
| | - Anup Kanodia
- Ohio State University Medical Center, Columbus, OH, 43210, USA
| | - Gregory K Miller
- Department of Statistics, Stephen F. Austin State University, Nacogdoches, TX, 75962, USA
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Abstract
Background: Although candiduria is an expected encounter and should not be surprising in uncontrolled diabetes with glucose-enriched urine, urinary auto-brewery is rarely thought of by diabetologists. Moreover, endogenous ethanol production in humans from gut microbiome, urinary tract fungi and bacteria, and intermediary metabolism, has been reported for a long time, particularly in diabetics. Case description: To alert physicians to the overlooked implication of endogenously produced ethanol both as a biomarker for poor control of diabetes and as a complicating factor, we report this case of an elderly male smoker alcohol-abstinent insulin-dependent Type 2 diabetic patient. Because of circumstantial treatment and incompliance for one week, he developed endogenously produced alcohol intoxication. We proposed candidal urinary auto-brewery evidence sourced from the case history, urinalysis, and culture/identification tests - without excluding other sources. Fortunately, his diet and glycemic control were fairly controlled and, liver and kidney functions were almost normal. Amphotericin B I/V for five days, insulin, and a fluid therapy regimen greatly improved the case and cleared both the candiduria and ethanol from the urine and blood and the patient regained his base-line normal life. Conclusion: Symptoms of alcohol intoxication should be expected in patients with uncontrolled diabetes that most often correlates with candiduria and/or constipation. These symptoms can be exaggerated in those already suffering a degree of dementia and/or comorbid psychiatric/neurologic affections. Direct wet mount examination of urine under phase contrast microscopy would show the budding yeast cells. Appropriate antifungal, insulin and fluid therapies regained the base-line norms.
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Affiliation(s)
- Abdulrahman A. Alduraywish
- Department of Internal Medicine, College of Medicine, Jouf University, 2014 Sakaka, Al-Jouf, 42421, Saudi Arabia
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Takahashi G, Hoshikawa K, Kan S, Akimaru R, Kodama Y, Sato T, Kakisaka K, Yamada Y. Auto-brewery syndrome caused by oral fungi and periodontal disease bacteria. Acute Med Surg 2021; 8:e652. [PMID: 33976897 PMCID: PMC8091436 DOI: 10.1002/ams2.652] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 11/11/2022] Open
Abstract
Background Auto‐brewery syndrome (ABS) is often caused by fungi in the intestinal tract. We describe a rare case of alcohol production by Candida albicans and periodontal disease bacteria in the oral cavity. Case Presentation A man aged in his 60s had a car accident, and alcohol was detected on his breath. At the time, he exhibited alcohol overdose seizures with no alcohol consumption. We carried out a gastrointestinal endoscopy, detected esophageal candidiasis, and diagnosed ABS. His seizures continued despite using miconazole oral gel. Significant tooth decay, periodontal disease, and high C. albicans levels were observed in his oral cavity. Alcohol production was confirmed from periodontal bacteria and C. albicans cultures and alcohol‐degrading enzyme functions were poor. Dental treatment and antifungal drugs reduced seizures, and improved his fatty liver. Conclusion Alcohol can be produced by microorganisms in healthy individuals. Therefore, blood alcohol levels and alcohol‐degrading enzyme functions should be examined in patients with unexplained liver dysfunction.
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Affiliation(s)
- Gaku Takahashi
- Department of Critical Care, Disaster and General Medicine School of Medicine Iwate Medical University Morioka Japan
| | - Koichi Hoshikawa
- Department of Critical Care, Disaster and General Medicine School of Medicine Iwate Medical University Morioka Japan
| | - Shigenori Kan
- Department of Critical Care, Disaster and General Medicine School of Medicine Iwate Medical University Morioka Japan
| | - Rise Akimaru
- Department of Critical Care, Disaster and General Medicine School of Medicine Iwate Medical University Morioka Japan
| | - Yoshiyuki Kodama
- Department of Critical Care, Disaster and General Medicine School of Medicine Iwate Medical University Morioka Japan
| | - Toshiro Sato
- Division of Preventive Dentistry Department of Oral Medicine School of Dentistry Iwate Medical University Morioka Japan
| | - Keisuke Kakisaka
- Division of Hepatology Department of Internal Medicine School of Medicine Iwate Medical University Morioka Japan
| | - Yuki Yamada
- Department of Central Clinical Laboratory Iwate Medical University Hospital Morioka Japan
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Bayoumy AB, Mulder CJJ, Mol JJ, Tushuizen ME. Gut fermentation syndrome: A systematic review of case reports. United European Gastroenterol J 2021; 9:332-342. [PMID: 33887125 PMCID: PMC8259373 DOI: 10.1002/ueg2.12062] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/02/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The gut fermentation syndrome (GFS), also known as the endogenous alcohol fermentation syndrome or auto brewery syndrome, is a rare and underdiagnosed medical condition where consumed carbohydrates are converted to alcohol by the microbiota in the gastrointestinal or urinary tract. The symptoms of GFS can have severe impact on patients' wellbeing and can have social and legal consequences. Unfortunately, not much is reported about GFS. The aim of this systematic review was to assess the evidence for GFS, causal micro-organisms, diagnostics, and possible treatments. METHODS A protocol was developed prior to initiation of the systematic review (PROSPERO 207182). We performed a literature search for clinical studies on 1 September 2020 using PubMed and Embase. We included all clinical studies, including case reports that described the GFS. RESULTS In total, 17 case reports were included, consisting of 20 patients diagnosed with GFS. The species that caused the GFS included Klebsiella pneumoniae, Candida albicans, C. glabrata, Saccharomyces cerevisiae, C. intermedia, C. parapsilosis, and C. kefyr. CONCLUSIONS GFS is a rare but underdiagnosed disease in daily practice. The disease is mostly reported by Saccharomyces and Candida genera, and some cases were previously treated with antibiotics. Studies in Nonalcoholic Fatty Liver disease suggest a bacterial origin of endogenous alcohol-production, which might also be causal micro-organisms in GFS. Current treatments for GFS include antibiotics, antifungal medication, low carbohydrate diet, and probiotics. There might be a potential role of fecal microbiota transplant in the treatment of GFS.
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Affiliation(s)
- Ahmed B Bayoumy
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, The Netherlands
| | - Chris J J Mulder
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jaap J Mol
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Maarten E Tushuizen
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, The Netherlands
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Lefrère B, Wohrer D, Godefroy C, Soichot M, Mihoubi A, Nivet-Antoine V, Oualha M, Houzé P. False-Positive Ethanol Level in Urine and Plasma Samples of a Resuscitated Infant. J Anal Toxicol 2020; 46:e21-e27. [PMID: 33277902 DOI: 10.1093/jat/bkaa188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 11/13/2022] Open
Abstract
We report the case of an 11-month-old male infant with a complex congenital heart disease who was admitted in the intensive care unit following cardiorespiratory arrest at home. Toxicological urine screening reported an ethanol concentration of 0.65 g/L using an enzymatic assay, without suspicion of alcohol intake; significant ethanol concentrations were found in two plasma samples using the same enzymatic assay. Plasma and urine ethanol concentrations were then below the limit of quantification when tested using a gas chromatography method. Urine ethanol level was also below the limit of quantification when tested by enzymatic assay after an initial urine ultrafiltration. These results confirmed our suspicion of matrix interference due to elevated lactate and lactate dehydrogenase levels interfering in the enzymatic assay. This analytical interference, well-known in postmortem samples, extensively studied in vitro, has been rarely reported in vivo, especially in children. To our knowledge, this case is only the sixth one reported in an infant's plasma and the first initially discovered from urine. Indeed, as for ethanol, this last matrix has not been studied in the context of this artifact which may induce false-positive ethanol results while seeking a diagnosis in life-threatening or fatal situations that are potentially subject to forensic scrutiny. In parallel to a synthetic literature review, we propose a simple, informative decision tree, in order to help health professionals suspecting a false-positive result when performing an ethanol assay.
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Affiliation(s)
- B Lefrère
- Laboratoire de Biochimie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, 75015, Paris, France
| | - D Wohrer
- Service de réanimation et surveillance continue médico-chirurgicale, Hôpital Universitaire Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, 75015, Paris, France
| | - C Godefroy
- Laboratoire de Biochimie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, 75015, Paris, France
| | - M Soichot
- Laboratoire de toxicologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 2 rue Ambroise Paré, 75010, Paris, France
| | - A Mihoubi
- Laboratoire de toxicologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 2 rue Ambroise Paré, 75010, Paris, France
| | - V Nivet-Antoine
- Laboratoire de Biochimie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, 75015, Paris, France.,INSERM UMRS-1140, Faculté de Pharmacie, Université de Paris, 4 avenue de l'Observatoire, 75006 Paris, France
| | - M Oualha
- Service de réanimation et surveillance continue médico-chirurgicale, Hôpital Universitaire Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, 75015, Paris, France.,EA7323, Évaluation des thérapeutiques et pharmacologie périnatale et pédiatrique, Université Paris Descartes, 27 rue du Faubourg Saint Jacques, 75014, Paris, France
| | - P Houzé
- Laboratoire de Biochimie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), 149 rue de Sèvres, 75015, Paris, France.,Laboratoire de toxicologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris (AP-HP), 2 rue Ambroise Paré, 75010, Paris, France.,Unité de Technologies Chimiques et Biologiques pour la Santé (UTCBS), CNRS UMR 8258-U1022, Faculté de Pharmacie Paris Descartes, 4 avenue de l'Observatoire, 75006 Paris, France
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Martin M, Alvarez JC. Ethanolémie positive sans consommation d’alcool chez le sujet vivant : le syndrome d’auto-brasserie. Conséquences cliniques et médico-judiciaires. TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2020. [DOI: 10.1016/j.toxac.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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