Spontaneous fermentation constitutes the basis of the chief natural method of processing of table olives, where autochthonous strains of lactic acid bacteria (LAB) play a dominant role. A thorough literature search has unfolded 197 reports worldwide, published in the last two decades, that indicate an increasing interest in table olive-borne LAB, especially in Mediterranean countries. This review attempted to extract extra information from such a large body of work, namely, in terms of correlations between LAB strains isolated, manufacture processes, olive types, and geographical regions. Spain produces mostly green olives by Spanish-style treatment, whereas Italy and Greece produce mainly green and black olives, respectively, by both natural and Spanish-style. More than 40 species belonging to nine genera of LAB have been described; the genus most often cited is Lactobacillus, with L. plantarum and L. pentosus as most frequent species-irrespective of country, processing method, or olive type. Certain LAB species are typically associated with cultivar, e.g., Lactobacillus parafarraginis with Spanish Manzanilla, or L. paraplantarum with Greek Kalamata and Conservolea, Portuguese Galega, and Italian Tonda di Cagliari. Despite the potential of native LAB to serve as starter cultures, extensive research and development efforts are still needed before this becomes a commercial reality in table olive fermentation.

A three week old extremely low birth weight (ELBW) infant infected by vancomycin-resistant Leuconostoc spp is presented. Treatment with appropriate antibiotics was successful after the percutaneous inserted central catheter (PICC) was removed. The infection with Leuconostoc spp is rare but should be suspected when vancomycin-resistant organisms resembling streptococci are isolated. Previous pediatric case reports are also summarized and reviewed.

We report the case of a 26-day-old premature infant born at 24 weeks\' gestation who developed septicemia while receiving vancomycin therapy. The blood isolate initially identified as a vancomycin-resistant Streptococcous viridans was found to be Leuconostoc spp. Her condition improved with parenteral ampicillin and gentamicin therapy and removal of the intravenous central catheter. Prematurity is a recognized risk factor for Leuconostoc disease. Clinicians need to consider Leuconostoc spp. when vancomycin-resistant pathogens are identified and provide appropriate therapy.

BACKGROUND: Infections caused by Leuconostoc species are rare with most reported cases occurring in immunocompromised patients. This article presents 6 new cases of pediatric patients with short bowel syndrome who developed Leuconostoc bacteremia, and compares these cases with those previously reported in the literature.
METHODS: This is a retrospective, descriptive study (January 2001 to May 2007) performed in a tertiary care teaching center. Hospitalized patients younger than 18 years of age, with multiple positive blood cultures for Leuconostoc spp. were evaluated. The collected data were compared with 10 similar previously reported cases.
RESULTS: Six new cases of pediatric patients with short bowel syndrome who developed Leuconostoc bacteremia were identified. All 6 patients had received total parenteral nutrition and had central venous access, while 3 of these patients also received enteral nutrition. These results are similar to those reported in the literature. Only one of the newly reported patients had received vancomycin therapy before detection of Leuconostoc in the blood, whereas all prior reported cases had previously received this antimicrobial agent. Molecular analysis identified Leuconostoc mesenteroides as the most common species (4 cases) detected.
CONCLUSIONS: This report expands on the number of cases of Leuconostoc bacteremia in pediatric patients with short bowel syndrome and shows that prior vancomycin is not a required risk factor for the development of this infection. As previously reported in the literature, the presence of a central venous catheter and disrupted bowel mucosa are risk factors for Leuconostoc bacteremia.

In this article, we report a case of Leuconostoc bacteremia in a 7-month-old infant who had short-gut syndrome after a gastroschisis repair and who was dependent on total parenteral nutrition through a central venous catheter. The organism was initially misidentified as viridans group streptococcus. Detection of vancomycin resistance led to the correct diagnosis of Leuconostoc species. The patient was successfully treated with ampicillin and an aminoglycoside. A review of the literature revealed prematurity, short-gut syndrome, prior vancomycin use, and central venous catheters as important predisposing factors. Leuconostoc species is an emerging pathogen that should be considered in the differential diagnosis of vancomycin-resistant gram-positive bacteremia, particularly in these clinical settings.

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Leuconostocs, members of the family Streptococcacae, have only recently been recognized as potential pathogens. We describe six cases of leuconostoc bacteremia and review 11 additional cases of infection reported in the literature. Fifteen patients with bacteremia ranged from neonates to persons aged 78 years. Almost all were hospitalized with significant underlying diseases, had received previous antibiotic therapy, and had undergone procedures that interrupted the normal integumentary defense. Leuconostoc bacteremia was associated with fever, leukocytosis, and gastrointestinal complaints. Eight of 15 patients had polymicrobial bacteremia, seven of these eight with staphylococcal species. Clinical isolates of Leuconostoc were frequently misidentified, usually as viridans streptococci. All clinical isolates identified to date--and most agricultural isolates--demonstrate a high level of resistance to vancomycin. Successful regimens for treatment of Leuconostoc include high-dose penicillin, clindamycin, and where appropriate, removal of infected intravascular catheters. Susceptibility testing of all gram-positive bacteria isolated from normally sterile body sites is recommended.

Two new cases of significant bacteremia caused by Leuconostoc spp. are reported and five others described in the literature are reviewed. Four of the seven patients were under one year old and presented with prolonged diarrhea related to gastrointestinal disorders. The remaining three patients were over 50 years of age and being treated in intensive care units. Six patients had nosocomially acquired catheter-related bacteremia. Leuconostoc spp. are naturally resistant to vancomycin, and five patients had received this antibiotic for prior bacteremia caused by methicillin-resistant staphylococci. The majority of patients presented with fever without severe complications. Penicillin is the treatment of choice and there is no report of any death directly attributable to infection by these microorganisms. Infection with Leuconostoc spp. should be suspected if \"vancomycin-resistant streptococci\" are isolated from the blood, and recorded as a potential cause of bacteremia in patients with indwelling intravenous catheters.