Epidemiology

General Comments

• Saccharomyces Cerevisiae is Considered an Emerging Opportunistic Pathogen (Med Mycol, 2000) [MEDLINE] (Clin Infect Dis, 2005) [MEDLINE] (Int J Food Microbiol, 2007) [MEDLINE] (Front Microbiol, 2016) [MEDLINE]

Risk Factors for Saccharomyces Cerevisiae Infection (Front Microbiol, 2016) [MEDLINE]

• Advanced Age
• Critical Illness
• Immunsuppression
  • Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS) (see Human Immunodeficiency Virus)
  • Other Immunodeficiency
  • Other Immunosuppression
• Premature Birth

Saccharomyces Cerevisiae Infection with No Known Risk Factors

• Saccharomyces Cerevisiae Infections Have Also Been Reported in Patients with No Known Risk Factors (Arch. Intern. Med, 1976) [MEDLINE] (J Clin Microbiol, 2002) [MEDLINE] (Front Microbiol, 2016) [MEDLINE]

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Microbiology

Species Saccharomyces Cerevisiae is Very Heterogeneous (Front Microbiol, 2016) [MEDLINE]

• Saccharomyces Cerevisiae Strains with Specific Abilities
  • Sherry Wine Saccharomyces Cerevisiae Strains
• Saccharomyces Boulardii
  • Saccharomyces Boulardii is Used as a Probiotic (see Saccharomyces Boulardii) (World J Gastroenterol, 2010) [MEDLINE]
    • Saccharomyces Boulardii is Sold as a Probiotic Under the Brand Names, Florastor/Ultralevura
• Baker/Brewer’s Yeast Saccharomyces Cerevisiae Strains
  • Saccharomyces Cerevisiae is Commonly Found in Home-Brewed Beer, Wines, Breads, Dietary Supplements, etc (Front Microbiol, 2016) [MEDLINE]

Human Colonization

• Saccharomyces Cerevisiae is a Common Colonizer of Human Mucosal Surfaces (Rev Infect Dis, 1990) [MEDLINE]

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Clinical Manifestations

Gastrointestinal/Hepatic Manifestations

Liver Abscess (see xxxx)

• Epidemiology
  • Cases of Invasive Saccharomyces Cerevisiae Disease (Pneumonia, Liver Abscess, Sepsis, Disseminated Infection with Cardiac Tamponade) Have Been Reported (Rev Infect Dis, 1990) [MEDLINE]
    • Risk Factors
      • Prior Antibiotic Therapy
      • Prolonged Hospitalization
      • Prosthetic Cardiac Valve
      • Severe Immunosuppression

Infectious Manifestations

Aortic Graft Infection

• Epidemiology
  • Case of Fatal Saccharomyces Cerevisiae-Associated Aortic Graft Infection Has Been Reported (J Clin Microbiol, 2002) [MEDLINE]

Fungemia

• Epidemiology
  • Case Report of Saccharomyces Cerevisiae Fungemia Has Been Reported in a Patient with Chronic Kidney Disease on Hemodialysis (Diagn Microbiol Infect Dis, 1987) [MEDLINE]
  • Case of Saccharomyces Cerevisiae Fungemia Has Been Reported in a Patient with Head and Neck Cancer Following Chemoradiotherapy (Acta Clin Belg, 2004) [MEDLINE]
  • Cases of Saccharomyces Cerevisiae Fungemia Have Been Reported in Critically Ill Intensive Care Unit Patients (Clin Infect Dis, 2005) [MEDLINE]
    • All 3 Cases were Associated with the Use of the Saccharomyces Boulardii-Containing Probiotic Ultralevura (Bristol-Myers Squibb)
    • Mortality Rate was Approximately 30% in a Review of 57 Cases from the Literature
  • Case of Saccharomyces Cerevisiae Fungemia with Peritoneal Abscess Has Been Reported in an Orthotopic Liver Transplant Patient (Transpl Infect Dis, 2015) [MEDLINE]

Pulmonary Manifestations

Allergic Bronchopulmonary Mycosis (see xxxx)

• Epidemiology
  • Geography (Crit Rev Microbiol, 2014)
    • India Accounts for About 47% of the Globally Reported Cases of Allergic Bronchopulmonary Mycosis: attributed predominantly to Candida Albicans
    • Japan Accounts for 16% of Globally reported Cases: attributed to predominance of Schizophyllum Commune
    • USA/Australia/Europe Account for Approximately 33% of Globally Reported Cases
  • Cases Have Been Reported in Association with Multiple Fungi, Including the Following (Crit Rev Microbiol, 2014) [MEDLINE]
    • Candida Albicans (see Candida Albicans): most common etiology (reported in 60% of cases)
    • Bipolaris Species (reported in 13% of cases)
    • Schizophyllum Commune (reported in 11% of cases)
    • Curvularia Species (reported in 8% of cases)
    • Pseudallescheria Boydii Species Complex (reported in 3% of cases)
    • Alternaria Alternata (rare etiology)
    • Candida Glabrata (rare etiology)
    • Cladosporium Cladosporioides (rare etiology)
    • Fusarium Vasinfectum (rare etiology)
    • Penicillium Species (rare etiology)
    • Rhizopus Oryzae (rare etiology)
    • Saccharomyces Cerevisiae (rare etiology)
    • Stemphylium Languinosum (rare etiology)
    • Trichosporon Beigelii (rare etiology)
• Physiology
  • Hypersensitivity-Mediated Disease
• Diagnosis
  • Elevated Immunoglobulin E (IgE) (see Elevated Immunoglobulin E)
• Clinical
  • Asthma is Present in only 32% of Allergic Bronchopulmonary Mycosis Cases (Crit Rev Microbiol, 2014)
    • In Contrast, Asthma is Present in a Higher Percentage of Allergic Bronchopulmonary Aspergillosis Cases (see Allergic Bronchopulmonary Aspergillosis)

Pneumonia (see Community-Acquired Pneumonia)

• Epidemiology
  • HIV/AIDS-Related Saccharomyces Cerevisiae-Associated Pneumonia Cases Have Been Reported (J Clin Microbiol, 1989) [MEDLINE]
    • Organism was Recovered from Autopsy Cultures of the Lungs, Spleen, Oral Mucosa, and Small Intestine
  • Cases of Invasive Saccharomyces Cerevisiae Disease (Pneumonia, Liver Abscess, Sepsis, Disseminated Infection with Cardiac Tamponade) Have Been Reported (Rev Infect Dis, 1990) [MEDLINE]
    • Risk Factors
      • Prior Antibiotic Therapy
      • Prolonged Hospitalization
      • Prosthetic Cardiac Valve
      • Severe Immunosuppression
• Diagnosis
  • Because Saccharomyces Cerevisiae Can Be a Common Saprophytic Contaminant, Biopsy and Pathologic Confirmation of Infection are Frequently Necessary for a Definitive diagnosis

Reproductive Manifestations

Vaginitis (see Vaginitis)

• Epidemiology
  • Cases of Saccharomyces Cerevisiae-Associated Vaginitis Have Been Reported (Front Microbiol, 2016) [MEDLINE] (Clin Infect Dis, 2022) [MEDLINE]

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Treatment

Amphotericin B (see Amphotericin)

• Treatment of Choice for Invasive Disease

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References

General

• Emerging pathogens. Med Mycol. 2000;38 Suppl 1:225-36. doi: 10.1080/mmy.38.s1.225.236 [MEDLINE]
• Saccharomyces cerevisiae fungemia: an emerging infectious disease. Clin Infect Dis. 2005 Jun 1;40(11):1625-34. doi: 10.1086/429916 [MEDLINE]
• New trends in emerging pathogens. Int J Food Microbiol. 2007 Dec 15;120(3):217-24. doi: 10.1016/j.ijfoodmicro.2007.07.046 [MEDLINE]
• Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010 May 14;16(18):2202-22. doi: 10.3748/wjg.v16.i18.2202 [MEDLINE]
• Review of current methods for characterizing virulence and pathogenicity potential of industrial Saccharomyces cerevisiae strains towards humans. FEMS Yeast Res. 2015 Sep;15(6):fov057. doi: 10.1093/femsyr/fov057 [MEDLINE]
• Opportunistic Strains of Saccharomyces cerevisiae: A Potential Risk Sold in Food Products. Front Microbiol. 2016 Jan 8;6:1522. doi: 10.3389/fmicb.2015.01522. eCollection 2015 [MEDLINE]
• Review of Saccharomyces boulardii as a treatment option in IBD. Immunopharmacol Immunotoxicol. 2018 Dec;40(6):465-475. doi: 10.1080/08923973.2018.1469143 [MEDLINE]

Clinical Manifestations

• Fever of unknown origin secondary to brewer’s yeast ingestion. Arch. Intern. Med 1976. 136, 332–333. doi: 10.1001/archinte.1976.03630030064011 [MEDLINE]
• Saccharomyces cerevisiae fungemia: case report and review of the literature. Diagn Microbiol Infect Dis. 1987 Oct;8(2):113-7. doi: 10.1016/0732-8893(87)90158-1 [MEDLINE]
• Saccharomyces cerevisiae pneumonia in a patient with acquired immune deficiency syndrome. J Clin Microbiol. 1989 Jul;27(7):1689-91. doi: 10.1128/jcm.27.7.1689-1691.1989 [MEDLINE]
• Invasive infection with Saccharomyces cerevisiae: report of three cases and review. Rev Infect Dis. 1990 May-Jun;12(3):406-11. doi: 10.1093/clinids/12.3.406 [MEDLINE]
• Fatal Saccharomyces cerevisiae aortic graft infection. J Clin Microbiol. 2002 Jul;40(7):2691-2. doi: 10.1128/JCM.40.7.2691-2692.2002 [MEDLINE]
• Saccharomyces cerevisiae fungemia in a head and neck cancer patient: a case report and review of the literature. Acta Clin Belg. 2004 Jul-Aug;59(4):220-2. doi: 10.1179/acb.2004.032 [MEDLINE]
• Allergic bronchopulmonary mycosis due to fungi other than Aspergillus: a global overview . Crit Rev Microbiol. 2014 Feb;40(1):30-48. doi: 10.3109/1040841X.2012.754401 [MEDLINE]
• Invasive Saccharomyces cerevisiae in a liver transplant patient: case report and review of infection in transplant recipients. Transpl Infect Dis. 2015 Jun;17(3):435-41. doi: 10.1111/tid.12384 [MEDLINE]
• Vulvovaginal Candidiasis: A Review of the Evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines. Clin Infect Dis. 2022 Apr 13;74(Suppl_2):S162-S168. doi: 10.1093/cid/ciab1057 [MEDLINE]