Emphysematous oesophagitis associated with Sarcina organisms in a patient receiving anti-inflammatory therapy

Sarcina Ventriculi infection: a rare but fearsome event. A Systematic Review of the Literature

OBJECTIVES

This study is aimed to report a case of SV-related gastritis and the results of a systematic literature review of SV infections.

METHODS

Following a case presentation, we systematically searched different databases (MEDLINE, PubMed, Scopus, Web of Science, EMBASE, google scholar) for the items "sarcina," "ventriculi," "clostridium" with AND/OR.

RESULTS

A total of 55 articles reporting 65 cases of Sarcina Ventriculi were found. Thus, 66 patients, including our case, were reviewed. The median age was 51 years (IQR: 0-87 years). Females accounted for 51% of cases. 68% of patients had one or more comorbidities. SV was isolated in the gastrointestinal tract (88%), respiratory (5%), urine (4%), and bloodstream (3%) systems. Upper endoscopy was performed in 52 patients (79%). Biopsies were obtained in all 52 cases and were normal in 23%. Surgery was warranted in 15 patients (23%), and specific antimicrobial therapy was delivered in 34 (52%) patients. Mortality was 14%. At follow-up, 88% of patients showed complete eradication of the SV infection.

CONCLUSIONS

Upper gastrointestinal biopsy positive for SV should prompt an evaluation of the clinical conditions, considering the risk of gastric perforation is not negligible. Antibiotic therapy may eradicate the infection and prevent complications. Emergency surgery is required in case of source control.

Sarcina ventriculi a rare pathogen

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.

Concomitant Sarcina-Associated Erosive Esophagitis and Refractory Helicobacter pylori Gastritis

For unclear reasons, there has been an increasing number of reported cases of Sarcina infections in the gastrointestinal tract over the past several years. Associated clinical conditions with the infection most commonly include delayed gastric emptying from diabetes mellitus, a history of previous gastrointestinal surgery, and ulcer disease. The precise pathogenetic role of Sarcina infection in humans remains unclear. Because of the ubiquitous environmental presence of Sarcina and limited previously reported clinical cases, the link between symptoms along with endoscopic findings to Sarcina can be associative at best. When found in the upper GI tract, the decision to treat along with the chosen regimen remains debatable. Sarcina, however, has rarely been seen in the esophagus. We report the third case of Sarcina of the esophagus associated with Helicobacter pylori gastritis.

Sarcina Organisms in the Upper Gastrointestinal Tract: A Report of 3 Cases With Varying Presentations

Sarcina species are anaerobic gram-positive cocci rarely seen in the upper gastrointestinal tract and associated with delayed gastric emptying. We present 3 cases of Sarcina infection with varying clinical presentations including the first reported case of Sarcina in a patient with eosinophilic esophagitis. Although the pathogenesis of Sarcina is unclear, awareness of the bacteria is important as they can usually only be detected on histopathologic examination of upper gastrointestinal biopsies. Treatment in symptomatic patients may prevent severe complications such as emphysematous gastritis and gastric perforation.

Ulcerative Gastritis and Esophagitis in Two Children with Sarcina ventriculi Infection

Sarcina ventriculi is a Gram-positive, obligate anaerobic coccus, with a characteristic morphology. Only 22 cases of human infections by this microorganism, including 7 in children, have been reported in literature so far. Affected subjects usually present with abdominal pain, nausea, vomiting, and delayed gastric emptying. However, life-threatening complications, like emphysematous gastritis and gastric perforation have also been described. Gastroparesis and gastric outlet obstruction have been considered as a potential etiologic factor. All pediatric cases described thus far presented with concomitant gastrointestinal pathology, such as Helicobacter pylori gastritis, celiac disease, infection with Giardia lamblia or Candida spp. Here, we report two children with S. ventriculi infection, in whom the diagnosis was established by typical histological findings in mucosal biopsies. The first child presented with hematemesis due to ulcerative esophagitis and gastritis, the second child with a history of esophageal stricture had ulcerative gastritis. Confirmation of S. ventriculi infection is feasible by molecular microbiota detection methods, since this microorganism cannot be detected by classical culture techniques. Prompt treatment with antibiotics could prevent life-threatening complications.

Pathogenic Sarcina in urine

Sarcina is a Gram-positive anaerobic coccus that has been consistently reported in the upper gastrointestinal tract biopsies of patients with evidence of gastric stasis. The pathogenic role of Sarcina in humans is not entirely known. We describe an infant who was surgically treated for posterior urethral valve and the urine showed pathogenic Sarcina.

The significance of Sarcina in routine surgical pathology practice

Sarcina was first described by Goodsir. The appearance of this bacterium is so characteristic that the diagnosis can be made on light microscopy. Although the original description of Sarcina was made more than 150 years ago, little is known about its role in various human diseases. This study was undertaken with the aim to analyze critically the reason for this sudden recent interest in human Sarcina infection. The results indicate that Sarcina is a histopathological marker of functional or anatomical causes of gastric stasis, and has a possible association with life-threatening emphysematous gastritis. Hence, its documentation in the final report is warranted as the patient might need further work-up.