Sarcina ventriculi: Pathogenic or Benign Commensal? A Clinician Should Know

Sarcina ventriculi is an exceptionally rare bacterium, with less than 30 cases reported in literature in association with human infection. Although this bacterium is a well-known pathogen in livestock, cats and horses, it is more frequently an innocent bystander rather than a pathogenic organism and its occurrence in gastric biopsy is an incidental finding, particularly in patients with delayed gastric emptying, gastroparesis, emphysematous gastritis or gastric perforation. Although the pathogenic role of this organism is not entirely certain, its recognition in an endoscopic biopsy raises important diagnostic and therapeutic considerations. The organism can commonly be found in the soil and air, and S. ventriculi has been reported in the faecal matter of healthy humans, particularly those with vegetarian diets. Sarcina organisms are difficult to grow on cultures in general laboratories and molecular methods of confirmation are not available; hence, a histopathological examination for the classic morphologic features remains a key to the diagnosis until specific microbiologic diagnostic methods become available. Since infection may lead to life-threatening complications, it should be treated promptly with proton-pump inhibitor and antibiotics until further understanding are achieved.