Auto brewery syndrome overview- emerging infectious disease.

• By

• Dr.Ashok laddha• Occupational Health

Physician

• MBBS, PGDC ,PGDD, PGDEM, AFIH

• Diploma in Workplace Health and safety. MBA-HA(In –Progress)

Auto brewery Syndrome

• Auto-brewery syndrome, also known as gut fermentation syndrome,

• a rare medical condition• intoxicating quantities of alcohol are produced

through endogenous fermentation within the digestive system

• Numerous cases have been documented in the medical literature.

History

• Auto-brewery syndrome was not unknown• previously been described in Japan, where it is

called “meitei-sho.”• people of East Asian descent possess a

mutation in their liver enzymes which does not allow them to properly process alcohol.

• relatively unknown phenomenon in modern medicine

definition

• Gut Fermentation Syndrome is described as a syndrome whereby patients become intoxicated without ingesting alcohol.

• syndrome has also been called Drunkenness Disease and Endogenous Ethanol Fermentation.

• The underlying mechanism is thought to be an overgrowth of yeast in the gut whereby the yeast ferments carbohydrates into ethanol

Contributing factors

• heavy consumption of carbohydrate-rich food like rice

• gastrointestinal surgery, • taking antibiotics, • All above factrors can wipe out the bacteria in

the stomach and make room for infestations of yeast.

Causative agent

• yeast called Saccharomyces cerevisiae • Candida albicans, Candida krusei, Candida

glabrata• yeast caused starch to ferment sugar --

ultimately producing ethanol.

Risk factor

• Treatment with a probiotic containing Saccharomyces boulardii

• immunosuppressed or critically ill patients.• probiotic is used for the treatment and

prevention of Clostridium difficile-associated diarrhea

Saccharomyces cerevisiae• Saccharomyces cerevisiae, also known as brewer’s yeast, has a

very well known history and life cycle because of the brewing industry.

• More recently the entire genome of S. cerevisiae has been identified due to its important use in fermenting corn into ethanol for fuel consumption. Very little is known, however, about the role of S. cerevisiae in humans. In fact, S. cerevisiae has been described only recently as an “emerging infectious disease”

• S. cerevisiae has mostly been identified as a pathogen in critically ill patients who are immunocompromised and in infants Not one single article could be found on an S. cerevisiae infection in an otherwise healthy, immuno-competent adult .

Uses-Saccharomyces cerevisiae

• Saccharomyces cerevisiae is well known in the baking and brewing industry

• also used as a probiotic in humans. • However, it is a very uncommon cause of

infection in humans.

Symptoms

• Those of alcohol intoxication

Diagnostic tests

• Gulcose and carbohydrate challenge• Fructose and lactose intolerance• Stool culture• BAC• Blood gulcose level• Blood ethanol level• Complete gastroenterology workup

treatment

• Antifungal – fluconazole 100 mg a day for three weeks

• Followed by Nystatin 500,000 IU 4 times a day-3 weeks

• Restricted carbohydrate diet• No sugar• No alcohol• Treatment for H.pylori--Tetracycline

Importance

• This is a rare syndrome but should be recognized because of the social implications such as loss of job

• relationship difficulties• stigma • possible arrest and• incarceration.

Implication

• Listen—careful and meticulos history can clinch the diagnosis

• Occupational history• Additional investigations• Research on overgrowth of microbes• Additional research on microbe

Take home message

• Meticulous clinical and occupational history can clinch the diagnosis