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Pediatrics. 2018 Sep;142(3). pii: e20180337. doi: 10.1542/peds.2018-0337. Epub 2018 Aug 8.

D-lactic Acidosis: Successful Suppression of D-lactate-Producing Lactobacillus by Probiotics.

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Department of Biomedical Research, Maurice Müller Laboratories, University Clinic of Visceral Surgery and Medicine, Inselspital and.
University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland.
University Children's Hospital, Inselspital, University of Bern, Bern, Switzerland


Intestinal microbiota composition in children with short bowel syndrome (SBS) is an important factor influencing the clinical outcome. An increase of D-lactate-producing bacteria can lead to D-lactic acidosis, also referred to as D-lactate encephalopathy, with severe neurologic impairment. Antibiotic treatments for D-lactic acidosis in children with SBS offer often only short-term relief. Here, we present the case of a boy with SBS who developed recurrent episodes of D-lactic acidosis even under continuous cycling antibiotic treatment. Microbiological analyses were used to detect the presence of D-lactate-producing Lactobacillus species in the stool samples. A probiotic cocktail was introduced to alter the intestinal microbiota. During follow-up under treatment with probiotics, the patient remained stable, and there was no additional need for antibiotic therapy for more than a year. Stool composition of the patient was sequenced regularly over that period. His microbiota profile changed completely in species richness, and a clustering of species according to probiotic usage was seen. Importantly, D-lactate-producing Lactobacillus strains disappeared within a few weeks after probiotic introduction and were no longer detected in the subsequent follow-up specimens.

[Indexed for MEDLINE]

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