Bacteremia caused by accidental injection of Bacillus licheniformis microbiota modulator through the central venous catheter: A case report.

RATIONALE: Bacillus licheniformis (B licheniformis) is a commonly used microbiota modulator. However, infections are rarely observed in immunocompetent hosts. PATIENT CONCERNS: A 67-year-old woman who underwent esophagectomy experienced accidental injection of B licheniformis and presented with chills followed by hyperpyrexia. DIAGNOSIS: The initial diagnosis was B licheniformis bacteremia. INTERVENTION: Based on our experience, the patient first received levofloxacin and ornidazole. The application of levofloxacin was retained based on the antibiogram results. After discharge, the antibiotics were changed to vancomycin and levofloxacin, based on sensitivity tests, until two consecutive blood cultures were negative. OUTCOMES: The patient recovered without any severe complications. LESSONS: This is a rare report of the successful treatment of B licheniformis bacteremia caused by improper drug administration, which will provide a reference for the treatment of B licheniformis bacteremia.

Recurrent post-tympanostomy tube otorrhea secondary to aerobic endospore-forming bacilli: a case report and brief literature review.

We report a unique case in which a 57-year-old man with an 8-year history of late recurrent post-tympanostomy tube otorrhea (PTTO) was found to harbor Bacillus subtilis, an aerobic endospore-forming bacillus that is typically resistant to chemical and physical agents because of its unique life cycle. Removal of the patient's tympanostomy tube resulted in complete resolution of his long-standing otorrhea. We also review the etiologies of and treatment strategies for early, late, chronic, and recurrent PTTO. We conclude that regardless of the etiology, a patient with persistent or recurrent PTTO should consider undergoing removal of the ventilation tube.

Bacillus cereus septicemia attributed to a matched unrelated bone marrow transplant.

BACKGROUND: Hematopoietic cell transplantation (HCT) is performed in more than 25,000 patients annually. Clinically significant bacterial transmission from HCT products is rare. CASE REPORT: A 36-year-old male of Asian descent with chronic myelogenous leukemia developed sepsis leading to acute renal failure and disseminated intravascular coagulation during infusion of matched unrelated donor bone marrow. This product later tested positive for Bacillus cereus. DISCUSSION: This HCT product traveled 31 hours at room temperature before arriving at the transplant center. Reducing transport times, transporting at 4 °C, and enhancing bacterial surveillance of HCT products may increase the ability to detect bacterial proliferation from transport. CONCLUSION: To prevent a similar case in the future, we will begin Gram staining all HCT products in transit more than 24 hours to alert physicians of the need for prophylactic antibiotic therapy.

Fatal outcome of Bacillus cereus septicaemia.

Bacillus cereus is a ubiquitous environmental micro-organism which is often a contaminant of clinical cultures. Infections due to B. cereus are described, but mostly in immunocompromised patients. We report a fatal outcome of B. cereus septicaemia in an immunocompetent patient with a mechanical mitral valve.

[Bacillus cereus keratitis--case report]. / Bacillus cereus, pôvodca keratitídy--kazuistika.

Bacillus cereus is a gram-positive, rod-shaped, beta hemolytic bacterium which rarely causes eye infections. We present a case of 15 year old boy with unilateral keratitis. He was treated for two months by his ophthalmologist who suspected herpetic keratitis. Patient most probably suffered secondary infection by Bacillus cereus. After bacillus was identified and targeted treatment given clinical picture improved rapidly. Until now there are only few cases of bacillus cereus keratitis published.

Food poisoning associated with emetic-type of Bacillus cereus in Korea.

Bacillus cereus can cause diarrheal and emetic types of food poisoning but little study has been done on emetic type of food poisoning in Korea. The objective of this study was to report on the emetic type of food poisoning associated with B. cereus in Korea. The toxin gene profile, toxin production, and antibiotic resistance of B. cereus isolates were investigated in this study. B. cereus was detected in three out of four samples, while the other food poisoning bacteria were not detected. All isolates (KUGH 10, 11, and 12) presented nhe A, B, and C diarrheal toxin genes (755, 743, and 683 bp), detected using NHA, NHB, and NHC primers, and ces emetic toxin gene (1271 bp), detected using CES primer, and produced nonhemolytic enterotoxin and emetic toxin (cereulide), detected using immunochemical assay and high performance liquid chromotography/mass spectrometry (HPLC/MS) analysis. All emetic-associated isolates were resistant to beta-lactam antibiotics. Most important finding in this study was that the risk of emetic-type B. cereus food poisoning has existed in Korea. This suggested that the food poisoning caused by B. cereus producing emetic and diarrheal toxins should be constantly evaluated to prevent misdiagnosis between emetic and diarrheal types of food poisoning.

Periorbital cellulitis caused by Bacillus thuringiensis.

PURPOSE: Periorbital cellulitis is an inflammation of the lids and periorbital tissues without signs of true involvement such as proptosis or limitation of eye movement. METHODS: Bacillus thuringiensis is a Gram-positive, spore-forming soil bacterium with the ability to produce insecticidal crystal proteins. B thuringiensis is an extremely rare causative organism of orbital and periorbital infections. However, it was rarely seen isolated in pediatric cases with preseptal cellulites. Ocular infections of this bacteria quickly progress, within 12-48 hours from inoculation, leading to endophthalmitis or panophthalmitis and irreversible vision loss. RESULTS: Periorbital cellulitis should be recognized promptly and treated carefully. Hospitalization, prompt systemic antibiotic therapy, and careful monitoring for signs of sepsis and local invasion are critical. CONCLUSIONS: We report a rare presentation of periorbital cellulitis caused by B thuringiensis.

Liver abscess and sepsis with Bacillus pantothenticus in an immunocompetent patient: a first case report.

Bacillus species are aerobic, gram-positive, spore forming rods that are usually found in the soil, dust, streams, and other environmental sources. Except for Bacillus. anthracis (B. anthracis), most species display low virulence, and only rarely cause infections in hosts with weak or damaged immune systems. There are two case reports of B. cereus as a potentially serious bacterial pathogen causing a liver abscess in an immunologically competent patient. We herein report a case of liver abscess and sepsis caused by B. pantothenticus in an immunocompetent patient. Until now, no case of liver abscess due to B. pantothenticus has been reported.

Management of Bacillus bacteremia: the need for catheter removal.

Bacillus species are biofilm-forming organisms that are associated with Bacillus catheter-related bloodstream infections (CRBSIs). The optimal treatment of Bacillus CRBSIs is not known. Therefore, in the current study, we determined the role of long-term central venous catheter (CVC) removal and treatment with vancomycin compared with other agents in Bacillus CRBSIs by retrospectively reviewing the medical records of cancer patients with Bacillus bacteremia who had been treated at our institution from December 1990 to March 2008. True bacteremia was defined as a positive blood culture (>15 colony-forming units/mL) with signs and symptoms of infection (such as fever and chills). Bacillus CRBSI was defined in accordance with the Infectious Diseases Society of America guidelines as probable or definite. There were 94 Bacillus bacteremia episodes, 93 of which (99%) were Bacillus CRBSIs (28% definite and 71% probable). Neutropenia during bacteremia occurred in 29%. Almost all bacteremia patients (99%) had been treated with antibiotics; 63% had received vancomycin. Sepsis with hypotension occurred in 6%, and endocarditis in 1%. Bacillus isolates were susceptible to linezolid (100%), vancomycin (98%), tetracycline (77%), and rifampin (67%). All 4 recurrences occurred in patients in whom the CVC had not been removed (12%), whereas no recurrences occurred in patients whose CVC had been removed (p = 0.028). Patient outcome, in terms of fever and hospitalization duration after the infection, was similar in patients who had received < or =10 days of systemic antibiotics compared with patients who had received >10 days. In conclusion, catheter retention in patients with Bacillus CRBSIs is associated with a significantly higher recurrence rate. If the CVC is retained, treatment with non-vancomycin antibiotics is associated with significantly shorter hospitalization duration after the infection, which may be because glycopeptide antibiotics have poor activity against bacilli embedded in biofilm.

Necrotizing fasciitis and myonecrosis "synergistic necrotizing cellulitis" caused by Bacillus cereus.

Our patient was a 37-year-old man with diabetes mellitus and hepatopathy as underlying diseases. Swelling, erythema and pain appeared in the left upper limb on the day before the initial examination. On examination, diffuse purpura was noted on the left upper limb, and, as it rapidly extended to the left upper trunk, emergency surgery was performed. Intraoperatively, gas-producing necrosis was observed not only in subcutaneous tissues but also from the fascia to muscle tissues, and the condition resembled clostridial gas gangrene. However, as the culturing of samples from the lesion yielded Bacillus cereus, a diagnosis of necrotizing fasciitis and myonecrosis (synergistic necrotizing cellulitis) due to B. cereus was made. While the patient developed a serious condition due to sepsis and disseminated intravascular coagulation, he could be saved by early debridement and intensive treatment with an appropriate selection of antibiotics.

Bacillus circulans paracardiac infection in non-hodgkin lymphoma--a case report.

A case report is presented concerning Bacillus circulans paracardiac infection in a 27 year old woman with non-hodgkin lymphoma.

Molecular identification of Exiguobacterium acetylicum as the aetiological agent of bacteraemia.

A case of catheter-related bacteraemia caused by Exiguobacterium acetylicum is reported in an elderly patient. The availability of sequence-based methods facilitated rapid identification and expanded the spectrum of diseases attributed to coryneform bacteria and specifically to the genus Exiguobacterium.

Probable occupational endophthalmitis from Bacillus cereus.

Endophthalmitis is a severe infection produced by the introduction of microorganisms into the eye after penetrating injury, surgery, or hematogenous spread from a distant primary site of infection. The case presented is a 44-year-old man who worked as a machine operator with exposure to substantial metalworking fluid aerosols from a high-speed grinder generating fine particles.

Pyogenic infections of the central nervous system secondary to dental affections--a report of six cases.

Pyogenic infections of the central nervous system of dental origin are quite uncommon in industrialized countries. We report six cases with intracerebral (n = 4) and intraspinal (n = 2) infections treated in our hospital. The microbial pathogen was successfully isolated in all patients. Fusobacterium nucleatum as well as Streptococcus species were found in three cases. Bacillus species were identified in two patients. Actinomyces was the etiologic agent in one case. All patients suffered from dental pathologies, so that after clinical and radiological exclusion of other sources an oral focus was presumed. Therapeutic management consisted of an operative procedure in order to obtain decompression, as well as evacuation of the pus on the one hand, followed by targeted antibiotics on the other. Clinical improvement was achieved in all patients, with one patient lost to follow-up. On magnetic resonance tomography, the inflammatory changes also disappeared in all cases. We recommend that oral infection with recurrent bacteraemia should always be considered in the pathogenesis of the so-called "cryptic" intracerebral and intraspinal infections.

Bacillus cereus pneumonia in a patient with acute lymphoblastic leukemia.

Reported here is a case of Bacillus cereus pneumonia that occurred in a patient with acute lymphoblastic leukemia. The presentation was severe, essentially marked by respiratory distress and pleuritic chest pain. Classic empirical treatment initiated for febrile neutropenia did not cover this rare pathogen and appropriate therapy was therefore delayed. B. cereus is most often a culture contaminant, but it can also be responsible for self-limited gastrointestinal intoxication and, more rarely, severe systemic diseases. Virulence in the case of systemic disease is attributed to tissue necrosis mediated by toxin release. B. cereus pneumonia, as described in the English-language literature, mainly affects immunocompromised patients and most often has a fatal outcome. Thus, the identification of B. cereus in clinical specimens of severely ill immunocompromised patients should lead physicians to question its clinical significance.

Intestinal perforations in a premature infant caused by Bacillus cereus.

Although Bacillus cereus is a ubiquitous bacterium, the incidence of neonatal infections is very low with only a few cases of B. cereus infections in neonates reported in the literature. We report the case of a premature infant with multiple intestinal perforations and an abdominal B. cereus infection. The initial course was characterized by severe cardiovascular shock, anemia, thrombocytopenia and disseminated intravascular coagulation, leading to periventricular leukomalacia, alopecia capitis and toxic epidermal necrolysis. The possible role of B. cereus-associated enterotoxins for the clinical manifestations are discussed. Our case confirms previous reports of severe clinical symptoms in B. cereus infection in premature neonates. We speculate that the systemic complications of B. cereus infection are at least partly related to the effect of B. cereus-associated enterotoxins.