Fulminant Necrotizing Soft-tissue Infection in an Extremely Low Gestational Age Infant.

We report a case of rapidly progressive necrotizing skin and soft-tissue infection caused by Bacillus cereus in an extremely low for gestational age infant. This case reminds clinicians to consider this opportunistic pathogen as the etiologic agent in fulminant necrotizing infections in vulnerable hosts, and to institute appropriate therapy in a timely fashion.

Potential role of Demodex mites and bacteria in the induction of rosacea.

Rosacea is a common dermatological condition that predominantly affects the central regions of the face. Rosacea affects up to 3 % of the world's population and a number of subtypes are recognized. Rosacea can be treated with a variety of antibiotics (e.g. tetracycline or metronidazole) yet no role for bacteria or microbes in its aetiology has been conclusively established. The density of Demodex mites in the skin of rosacea patients is higher than in controls, suggesting a possible role for these mites in the induction of this condition. In addition, Bacillus oleronius, known to be sensitive to the antibiotics used to treat rosacea, has been isolated from a Demodex mite from a patient with papulopustular rosacea and a potential role for this bacterium in the induction of rosacea has been proposed. Staphylococcus epidermidis has been isolated predominantly from the pustules of rosacea patients but not from unaffected skin and may be transported around the face by Demodex mites. These findings raise the possibility that rosacea is fundamentally a bacterial disease resulting from the over-proliferation of Demodex mites living in skin damaged as a result of adverse weathering, age or the production of sebum with an altered fatty acid content. This review surveys the literature relating to the role of Demodex mites and their associated bacteria in the induction and persistence of rosacea and highlights possible therapeutic options.

Combined Bacillus licheniformis and Bacillus subtilis infection in a patient with oesophageal perforation.

Species of the genus Bacillus are a common laboratory contaminant, therefore, isolation of these organisms from blood cultures does not always indicate infection. In fact, except for Bacillus anthracis and Bacillus cereus, most species of the genus Bacillus are not considered human pathogens, especially in immunocompetent individuals. Here, we report an unusual presentation of bacteraemia and mediastinitis due to co-infection with Bacillus subtilis and Bacillus licheniformis, which were identified by 16S RNA gene sequencing, in a patient with an oesophageal perforation.

Bacillus cereus meningitis in a term neonate.

A case of Bacillus cereus meningitis in a term neonate without identifiable risk factors or source of the organism is presented. Prompt identification of the organism and treatment resulted in a favourable outcome.

[Bacillus cereus sepsis and subarachnoid hemorrhage following consolidation chemotherapy for acute myelogenous leukemia].

A 64-year-old man with acute myelogenous leukemia (FAB classification, M7) in remission received consolidation chemotherapy with mitoxantrone/cytosine arabinoside. WBC counts decreased to 0/microl on day 14, and fever (39.3 degrees C) and epigastralgia developed on day 15. Cefozopran was instituted for febrile neutropenia; however, on day 16, he was found to be in cardiac arrest. CT scan on day 16 revealed subarachnoid hemorrhage. Gram-positive rods were isolated from blood cultures on day 15, and were later identified as B.cereus. He recovered transiently, but eventually died on day 19. Postmortem examination demonstrated many colonies of B. cereus in the cerebrum, cerebellum, lung, and liver. Hepatocyte necrosis was also observed in the liver. Bacterial aneurysms or septic emboli were not identified in the arachnoid vessels, but necrosis of cerebral vessels was prominent, which was considered to be the cause of subarachnoid hemorrhage. Fatal subarachnoid hemorrhage has been reported to be associated with B. cereus sepsis, which developed at nadir following chemotherapy for leukemia patients. Because of the aggressive clinical course of B. cereus sepsis, including the risk for subarachnoid hemorrhage, early treatment with effective antibiotics for B. cereus sepsis would be important in the management of leukemia patients after chemotherapy.

A patient with acute myeloid leukemia who developed fatal pneumonia caused by carbapenem-resistant Bacillus cereus.

Bacillus cereus is known as a serious bacterial pathogen in neutropenic patients. B. cereus is often resistant to beta-lactams, including penicillins and cephalosporins. We report a case of fatal pneumonia caused by B. cereus in a patient with newly diagnosed acute myeloid leukemia (AML) during remission induction therapy. Cefepime was started for febrile neutropenia (FN) initially and was switched to panipem/betamipron, when fulminant pneumonia supervened. The isolated strain was resistant not only to cefepime but also to panipenem/betamipron. This is the first report of fulminant infection caused by carbapenem-resistant B. cereus in a neutropenic patient. B. cereus should be kept in mind as a target of empirical treatment when neutropenic patients develop pneumonia.

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.

Bacillus species sepsis in the neonatal intensive care unit.

OBJECTIVES: In 2002 there was an increase in the incidence of Bacillus species sepsis in our NICU that was almost completely resolved in 2003-2004 after the NICU was relocated. Our aims were to identify the source, the risk factors, and to characterize the clinical features of these infections. METHODS: The epidemiological investigation commenced during the outbreak and thereafter. The patient's data were collected retrospectively and a case control study was used to analyze the risk factors. RESULTS: There were eight cases of Bacillus species sepsis: five during 2002, two in 2003, and one in 2004. All infants recovered and salvaging percutaneous central venous catheter (PCVC) was successful in 4/6 of the cases. A case control study identified necrotizing enterocolitis (NEC) and PCVC as risk factors in univariate analysis but only NEC in multivariate analysis. No focal source of Bacillus bacteria was identified, but a high load of bacteria was found in the NICU's air before it was relocated. CONCLUSION: The risk factors for Bacillus species sepsis in our NICU were NEC and PCVC. The clinical course was milder than previously described, and PCVC was successfully salvaged in most cases. The increase in the incidence could be related to the construction work connected with NICU's relocation.

[Pathogenetic mechanisms of bacterial cholangitis in mechanical jaundice (experimental histological study)]. / Patogeneticheskie mekhanizmy bakterial'nogo kholangita pri mekhanicheskoi zheltukhe (éksperimental'no-gistologicheskoe issledovanie).

In 89 rats with experimentally induced mechanical jaundice the infectious process was modeled by intragastric administration of E. coli and B. subtilis. The study included the investigation of the main routes and time intervals of dissemination, organ content of microbes labeled with 3H-thymidine, as well as of structural and functional peculiarities of the interaction of animal tissues with the microbes in cholestasis development dynamics and under the condition of biliary tract decompression. It was established that under the condition of mechanical jaundice viable bacteria from the alimentary tract penetrated the organs of peritoneal cavity through the blood and lymph flow. In the liver, the endogenous agents of surgical infections, and E. coli, in particular, were found to aggravate the inflammatory and necrobiotic processes. B. subtilis did not cause any inflammatory or other pathologic process in the tissue of liver.

Successful non-surgical treatment of brain abscess and necrotizing fasciitis caused by Bacillus cereus.

Musculoskeletal and central nervous system infections caused by Bacillus cereus are very rare. Only a few cases have been reported, whose clinical courses strongly suggested that surgical procedures combined with appropriate antimicrobial therapy are necessary to cure these infections. A 60-year-old man with severe neutropenia due to myelodysplastic syndrome, developing necrotizing fasciitis and brain abscess caused by Bacillus cereus is reported. Without performing any surgical procedures, the patient was successfully treated with systemic antimicrobial therapy combined with granulocyte colony stimulating factor, which contributed to the increase in the neutrophil count.

Super-infection by Bacillus thuringiensis H34 or 3a3b can lead to death in mice infected with the influenza A virus.

Bacterial super-infections are the main cause of complication and mortality after influenza virus (IAV) infection. Since Bacillus thuringiensis (Bt) is considered non-pathogenic for humans and is widely sprayed in urban areas, the aim of this work was to evaluate the potential pathogenicity of a combined infection Bt-IAV in a mouse model of pneumonia. Bacteria used for super-infections were Bt serotype H34 isolated from human infection and the insecticidal strain 3a3b obtained from a commercial source. Virus strain was A/Scotland/20/74 (H3N2) adapted to BALB/c mice by serial lung passage. Combined infection with 4% of the viral lethal dose 50% (LD(50)) and 10(2) spores of Bt H34 killed 40% of the mice. Mortality rates increased up to 55% and 100% when combined infections were done with respectively 10(4) and 10(7) spores. The insecticidal strain Bt 3a3b was less pathogenic than Bt H34. A dose of 10(4) spores associated with 4% of IAV LD(50) killed 50% of the mice. This inoculum must be compared with the doses usually sprayed in agriculture: 10(11) spores m(-2). Total protection against super-infection was obtained when mice were treated with amantadine. Even if only a few cases of Bt human infection have been reported, these results suggest a possible risk for workers spraying Bt-based biopesticides during flu outbreaks.

Experimental infection of pregnant cows with Bacillus licheniformis bacteria.

To study the abortifacient potential and fetoplacental tropism of Bacillus licheniformis bacteria, eight cows in the sixth to eighth month of gestation were inoculated intravenously either once (n = 4) or on four successive days (n = 4) with B. licheniformis at doses ranging from 10(9) to 10(12) colony-forming units. Cows were euthanatized and necropsied prior to abortion (n = 2), at the time of abortion (n = 2), or at calving (n = 4). Live-born calves (n = 5) were euthanatized immediately after delivery and necropsied. B. licheniformis was reisolated from placentomes/endometrium in six of eight (75%) cows and from one fetus aborted 43 days after inoculation. Lesions associated with B. licheniformis were restricted to the pregnant uterus, with the exception of one cow, which developed pneumonia. Necrosis in the fetal compartment of the placenta were present in three of four (75%) cows of both inoculation groups. Lesions were mainly restricted to fetal membranes and especially to the fetal side of the placentomes. Necrosis and diffuse neutrophil infiltrations of both villi and intervillous areas occurred in the fetal part of the placenta, and the placentomal interface was distended by bacteria, neutrophils, erythrocytes, and debris. Within trophoblasts, bacteria were located both free in the cytoplasm and in cytoplasmatic vesicles. Inflammation was present in three of eight (38%) calves. Placental and fetal lesions were similar to those found in cases of spontaneous abortions associated with B. licheniformis. The abortifacient potential of B. licheniformis and the tropism for the bovine placenta is demonstrated here for the first time.

Experimental Bacillus cereus post-traumatic endophthalmitis and treatment with ciprofloxacin.

BACKGROUND: Bacillus species remain an important cause of post-traumatic endophthalmitis, often causing permanent visual loss. METHODS: Twenty two rabbits were used to evaluate the clinical and histological findings of Bacillus cereus experimental post-traumatic endophthalmitis. Eyes that had received a scleral laceration and surgical repair were inoculated with Bacillus cereus. Thirty four other rabbits were used to evaluate the efficacy of intravitreal ciprofloxacin in treating experimental disease. RESULTS: Animals developed a post-traumatic endophthalmitis that closely mimicked human disease, characterised by a rapidly progressive and destructive endophthalmitis. Histological evaluation revealed retinal detachment, retinal necrosis, and the infiltration of inflammatory cells into the subretinal space. Intravitreal ciprofloxacin (100 micrograms) prevented the development of disease when given 1 hour and 6 hours after trauma and inoculation. CONCLUSIONS: Clinical and histological examination of experimental Bacillus cereus post-traumatic endophthalmitis suggests that retinal detachment and retinal necrosis play important roles in visual loss. Ciprofloxacin may be of benefit in the management of certain intraocular infections following penetrating injury.

Fatal Bacillus cereus meningoencephalitis in an adult with acute myelogenous leukemia.

Bacillus cereus, a ubiquitous, endospore-forming, aerobic gram-positive bacillus, is primarily associated with toxin-mediated food poisoning. Frequently, isolates of Bacillus species from clinical specimens are discussed as contaminants. We report a rapidly fatal case of disseminated infection due to B cereus in a patient receiving induction chemotherapy for M0 acute leukemia. A short clinical syndrome of nausea and vomiting preceded neurologic symptoms. Autopsy showed extensive meningoencephalitis with subarachnoid hemorrhage and multiple liver abscesses. Areas of necrosis were devoid of any inflammatory response consistent with a severely immunocompromised state. The organism was isolated from immediate premortem and autopsy blood specimens. This case illustrates the possibility and severity of true B cereus infections in immunocompromised patients, the clinicopathologic features of which are as yet not well defined.