1999 Resident Poster Competition
Paul K. Crane M.D.
Washington University
Bacillus Cereus Food Poisoning as a Cause for Sepsis: A Case Report
Bacillus cereus was only recently recognized as a cause of human disease. It is a ubiquitous gram-positive aerobic spore-forming rod which causes six different clinical syndromes: local infections, bacteremia and septicemia, central nervous system infections, respiratory infections, endocarditis and pericarditis, and food poisoning. We describe the first reported case of a patient with Bacillus cereus food poisoning thought to have led to bacteremia and septicemia.
The patient is a 53 year old woman with a history of osteomyelitis of her right femoral head, leading to chronic intravenous antibiotics through a Hickman line. She did well until two nights prior to admission when she went with her mother to Chinese food. Both women ate the fried rice. Both women noted the onset of crampy diarrhea several hours later. The diarrhea was self-limited in the mother. The patient noted increasing malaise, fevers, chills, and weakness, and presented to the emergency department.
There, she was found to be in moderate distress, febrile to 38.4, hypotensive to 90/58, and tachycardic at 110. Respirations were normal. Exam was marked in the poor hygiene around the patient's Hickman line; dressings were changed in the emergency department. The patient responded well to intravenous fluids. On the second hospital day, multiple sets of blood cultures grew a gram positive rod, which was identified on the third hospital day as Bacillus cereus. The patient responded well to antibiotics and was sent home. Three months following the admission there were no long-term sequelae.
Most cases of Bacillus cereus bacteremia have been linked to immunocompromised states or to intravenous drug use. No case of bacteremia had been described in patients who developed food poisoning initially. As patients are increasingly being cared for in outpatient settings with indwelling lines, cases similar to this one may be expected. Certainly hygiene of the line site is essential, and better education of patients will be required to prevent the risk of serious complications from sepsis.
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