Bacillus cereus - Clinicals, Diagnosis, and Management

Infectious diseases

Clinicals - History

Fact Explanation
Symptoms of food poisoning (i.e. diarrhea and vomiting) Bacillus cereus is a Gram-positive aerobic or facultatively anaerobic, motile, spore-forming, rod-shaped bacterium. The main manifestation is food poisoning, which is frequently associated with the consumption of rice-based dishes. The multiplying bacteria produce emetic and diarrheal exotoxins. (i.e. exotoxins cereulide and the tripartite hemolysin BL ). The food poisoning can present as an outbreak, when many people consumed the same contaminated food item. Nausea and abdominal cramps can also be associated with diarrhea and vomiting. Symptoms of food poisoning (i.e. diarrhea and vomiting)
Bacillus cereus is a Gram-positive aerobic or facultatively anaerobic, motile, spore-forming, rod-shaped bacterium. The main manifestation is food poisoning, which is frequently associated with the consumption of rice-based dishes. The multiplying bacteria produce emetic and diarrheal exotoxins. (i.e. exotoxins cereulide and the tripartite hemolysin BL ). The food poisoning can present as an outbreak, when many people consumed the same contaminated food item. Nausea and abdominal cramps can also be associated with diarrhea and vomiting.
Symptoms of eye infection. i.e. Eye pain following trauma to the eye Bacillus cereus is known to cause endophthalmitis, panophthalmitis, and keratitis following eye trauma. i.e. contact lens abrasions, blunt trauma. Symptoms of eye infection. i.e. Eye pain following trauma to the eye
Bacillus cereus is known to cause endophthalmitis, panophthalmitis, and keratitis following eye trauma. i.e. contact lens abrasions, blunt trauma.
Symptoms of septicemia i.e. High fever, dizziness and yellow discoloration of eyes Due to B.cereus septicemia and associated hemolysis. Symptoms of septicemia i.e. High fever, dizziness and yellow discoloration of eyes
Due to B.cereus septicemia and associated hemolysis.
Symptoms of lung infections i.e. Productive cough, chest pain and difficulty in breathing Due to B. cereus pneumonia, which can be necrotizing and fulminant, often yielding fatal outcomes. Symptoms of lung infections i.e. Productive cough, chest pain and difficulty in breathing
Due to B. cereus pneumonia, which can be necrotizing and fulminant, often yielding fatal outcomes.
Symptoms of meningitis i.e. Headache, seizures, visual disturbances, vomiting, fever and behavioral changes Due to B. cereus meningitis. Commoner in immunocompromised individuals and neonates. Symptoms of meningitis i.e. Headache, seizures, visual disturbances, vomiting, fever and behavioral changes
Due to B. cereus meningitis. Commoner in immunocompromised individuals and neonates.

Clinicals - Examination

Fact Explanation
Features of dehydration. (i.e. dry mucus membranes, absence of sweating, sunken eyes.) Due to vomiting and diarrhea. Features of dehydration. (i.e. dry mucus membranes, absence of sweating, sunken eyes.)
Due to vomiting and diarrhea.
Red eye Due to eye infections. i.e. endophthalmitis, panophthalmitis, and keratitis. Red eye
Due to eye infections. i.e. endophthalmitis, panophthalmitis, and keratitis.
High fever Due to inflammatory response in B. cereus septicemia. High fever
Due to inflammatory response in B. cereus septicemia.
Low blood pressure and tachycardia Due to septic shock. Low blood pressure and tachycardia
Due to septic shock.
Signs of pulmonary consolidation i.e. reduced air entry, reduced lung expansion, coarse crepitations Due to B. cereus pneumonia. Signs of pulmonary consolidation i.e. reduced air entry, reduced lung expansion, coarse crepitations
Due to B. cereus pneumonia.

Investigations - Diagnosis

Fact Explanation
Microbiological culture of swabs Culture under aerobic conditions on 5% sheep blood agar at 37°C, skin gangrenes yield B. cereus colonies that are dull gray and opaque with a rough matted surface. Colony perimeters are irregular and represent the configuration of swarming from the site of initial inoculation, perhaps due to B. cereus swarming motility. There are zones of discontinuous beta-hemolysis surround and conform to the colony morphology. Microbiological culture of swabs
Culture under aerobic conditions on 5% sheep blood agar at 37°C, skin gangrenes yield B. cereus colonies that are dull gray and opaque with a rough matted surface. Colony perimeters are irregular and represent the configuration of swarming from the site of initial inoculation, perhaps due to B. cereus swarming motility. There are zones of discontinuous beta-hemolysis surround and conform to the colony morphology.
Gram stain Swabs, aspirates can be used for Gram staining as well as culture colonies. B. cereus are straight or slightly curved slender bacilli with square ends singly or in short chains. There are distinct junctions separating members of the chain. Gram-stained smears prepared from agar growth will show more uniform bacillary morphology with oval,The spores if present, are centrally situated and do not distort the bacillary form. Gram stain
Swabs, aspirates can be used for Gram staining as well as culture colonies. B. cereus are straight or slightly curved slender bacilli with square ends singly or in short chains. There are distinct junctions separating members of the chain. Gram-stained smears prepared from agar growth will show more uniform bacillary morphology with oval,The spores if present, are centrally situated and do not distort the bacillary form.
Antibiotic Sensitivity Becasue most of the B. cereus strains are resistant to penillins and cephalosporins since they produce beta-lactamases, and erythromycin, tetracycline, carbapenem has also been reported. Antibiotic Sensitivity
Becasue most of the B. cereus strains are resistant to penillins and cephalosporins since they produce beta-lactamases, and erythromycin, tetracycline, carbapenem has also been reported.

Management - Supportive

Fact Explanation
Empirical antibiotic therapy With Clindamycin plus gentamicin or vancomycin before the results of ABST arrives, because in cases of eye infection and systemic infection, the outcome will be disastrous unless treated aggressively. Imipenum can also be used. The empirical treatment should be used in whatever the route needed, topical, oral, intravenous, even intrathecal. Empirical antibiotic therapy
With Clindamycin plus gentamicin or vancomycin before the results of ABST arrives, because in cases of eye infection and systemic infection, the outcome will be disastrous unless treated aggressively. Imipenum can also be used. The empirical treatment should be used in whatever the route needed, topical, oral, intravenous, even intrathecal.
Specific antibiotic thereapy Once the ABST results arrive, the antibiotics can be changed according to the results. Pulmonary infections with bronchiectasis has been treated successfully with Ciprofloxacin. The usual antibiotics that B. cereus is sussceptible to are imipenem, vancomycin, chloramphenicol, gentamicin and ciprofloxacin. Specific antibiotic thereapy
Once the ABST results arrive, the antibiotics can be changed according to the results. Pulmonary infections with bronchiectasis has been treated successfully with Ciprofloxacin. The usual antibiotics that B. cereus is sussceptible to are imipenem, vancomycin, chloramphenicol, gentamicin and ciprofloxacin.

Concise, fact-based medical articles to refresh your knowledge

Access a wealth of content and skim through a smartly presented catalog of diseases and conditions.

  1. ABUSIN SALAHELDIN, BHIMARAJ ARVIND, KHADRA SUHAIL. Bacillus Cereus Endocarditis in a permanent pacemaker: a case report. Array [online] 2008 December [viewed 07 September 2014] Available from: doi:10.1186/1757-1626-1-95
  2. AVASHIA SB, RIGGINS WS, LINDLEY C, HOFFMASTER A, DRUMGOOLE R, NEKOMOTO T, JACKSON PJ, HILL KK, WILLIAMS K, LEHMAN L, LIBAL MC, WILKINS PP, ALEXANDER J, TVARYANAS A, BETZ T. Fatal pneumonia among metalworkers due to inhalation exposure to Bacillus cereus Containing Bacillus anthracis toxin genes. Clin Infect Dis [online] 2007 Feb 1, 44(3):414-6 [viewed 05 September 2014] Available from: doi:10.1086/510429
  3. BACILLUS CEREUS AS A SYSTEMIC PATHOGEN. The Lancet [online] 1983 December [viewed 05 September 2014] Available from: doi:10.1016/S0140-6736(83)90812-7
  4. BARRIE D., WILSON J.A., HOFFMAN P.N., KRAMER J.M.. Bacillus cereus meningitis in two neuro surgical patients: An investigation into the source of the organism. Journal of Infection [online] 1992 November, 25(3):291-297 [viewed 05 September 2014] Available from: doi:10.1016/0163-4453(92)91579-Z
  5. BOTTONE EJ. Bacillus cereus, a Volatile Human Pathogen Clin Microbiol Rev [online] 2010 Apr, 23(2):382-398 [viewed 07 September 2014] Available from: doi:10.1128/CMR.00073-09
  6. CALLEGAN MC, JETT BD, HANCOCK LE, GILMORE MS. Role of hemolysin BL in the pathogenesis of extraintestinal Bacillus cereus infection assessed in an endophthalmitis model. Infect Immun [online] 1999 Jul, 67(7):3357-66 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/10377113
  7. DE MEDEIROS CR, FAORO LN, FRIEDRICH ML, PEREIRA N, CUNHA CA, PASQUINI R. Unrelated bone marrow as a source of Bacillus cereus causing septic shock. Bone Marrow Transplant [online] 2000 Dec, 26(11):1259-60 [viewed 06 September 2014] Available from: doi:10.1038/sj.bmt.1702704
  8. DIB ELIE G., DIB SAMAR A., KORKMAZ DANY A., MOBARAKAI NEVILLE K., GLASER JORDAN B.. Nonhemolytic, Nonmotile Gram-Positive Rods Indicative of . Emerg. Infect. Dis. [online] 2003 August, 9(8):1013-1015 [viewed 07 September 2014] Available from: doi:10.3201/eid0908.030205
  9. DIERICK K, VAN COILLIE E, SWIECICKA I, MEYFROIDT G, DEVLIEGER H, MEULEMANS A, HOEDEMAEKERS G, FOURIE L, HEYNDRICKX M, MAHILLON J. Fatal Family Outbreak of Bacillus cereus-Associated Food Poisoning J Clin Microbiol [online] 2005 Aug, 43(8):4277-4279 [viewed 05 September 2014] Available from: doi:10.1128/JCM.43.8.4277-4279.2005
  10. DROBNIEWSKI FA. Bacillus cereus and related species. Clin Microbiol Rev [online] 1993 Oct, 6(4):324-338 [viewed 07 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC358292
  11. DROBNIEWSKI FA. Bacillus cereus and related species. Clin Microbiol Rev [online] 1993 Oct, 6(4):324-38 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/8269390
  12. Dehydration and diarrhea Paediatr Child Health [online] 2003 Sep, 8(7):459-460 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791660
  13. Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years: Assessing dehydration and shock. [web] [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/books/NBK63845/
  14. FRANKARD J., LI R., TACCONE F., STRUELENS M.J., JACOBS F., KENTOS A.. Bacillus cereus pneumonia in a patient with acute lymphoblastic leukemia. Eur J Clin Microbiol Infect Dis [online] December [viewed 07 September 2014] Available from: doi:10.1007/s10096-004-1180-y
  15. GASCOIGNE AD, RICHARDS J, GOULD K, GIBSON GJ. Successful treatment of Bacillus cereus infection with ciprofloxacin. Thorax [online] 1991 Mar, 46(3):220-221 [viewed 07 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC463053
  16. GINSBURG AMY S., SALAZAR LUPE G., TRUE LAWRENCE D., DISIS MARY L.. FatalBacillus cereus sepsis following resolving neutropenic enterocolitis during the treatment of acute leukemia. Am. J. Hematol. [online] December, 72(3):204-208 [viewed 06 September 2014] Available from: doi:10.1002/ajh.10272
  17. GUINEBRETIèRE MH, BROUSSOLLE V, NGUYEN-THE C. Enterotoxigenic Profiles of Food-Poisoning and Food-Borne Bacillus cereus Strains J Clin Microbiol [online] 2002 Aug, 40(8):3053-3056 [viewed 05 September 2014] Available from: doi:10.1128/JCM.40.8.3053-3056.2002
  18. GURLER N, OKSUZ L, MUFTUOGLU M, SARGIN F, BESISIK S. Bacillus Cereus Catheter Related Bloodstream Infection in a Patient with Acute Lymphoblastic Leukemia Mediterr J Hematol Infect Dis [online] , 4(1):e2012004 [viewed 06 September 2014] Available from: doi:10.4084/MJHID.2012.004
  19. HAASE ROLAND, SAUER HARALD, DAGWADORDSCH URANTSCHIMEG, FOELL JüRGEN, LIESER ULLA. Successful treatment of meningitis following allogenic stem cell transplantation . [online] 2005 June, 9(3):338-341 [viewed 07 September 2014] Available from: doi:10.1111/j.1399-3046.2004.00286.x
  20. HILLIARD N. J., SCHELONKA R. L., WAITES K. B.. Bacillus cereus Bacteremia in a Preterm Neonate. Journal of Clinical Microbiology [online] 2003 July, 41(7):3441-3444 [viewed 07 September 2014] Available from: doi:10.1128/JCM.41.7.3441-3444.2003
  21. HIRABAYASHI K, SHIOHARA M, SUZUKI T, SAITO S, TANAKA M, YANAGISAWA R, TSURUTA G, FUKUYAMA T, HIDAKA Y, NAKAZAWA Y, SHIMIZU T, SAKASHITA K, KOIKE K. Critical illness polyneuropathy and myopathy caused by Bacillus cereus sepsis in acute lymphoblastic leukemia. J Pediatr Hematol Oncol [online] 2012 Apr, 34(3):e110-3 [viewed 06 September 2014] Available from: doi:10.1097/MPH.0b013e318234620b
  22. HOLMES J. RICHARD. Emetic Food Poisoning Caused by Bacillus cereus. Arch Intern Med [online] 1981 May [viewed 05 September 2014] Available from: doi:10.1001/archinte.1981.00340060074016
  23. INOUE D, NAGAI Y, MORI M, NAGANO S, TAKIUCHI Y, ARIMA H, KIMURA T, SHIMOJI S, TOGAMI K, TABATA S, YANAGITA S, MATSUSHITA A, NAGAI K, IMAI Y, TAKEGAWA H, TAKAHASHI T. Fulminant sepsis caused by Bacillus cereus in patients with hematologic malignancies: analysis of its prognosis and risk factors. Leuk Lymphoma [online] 2010 May, 51(5):860-9 [viewed 06 September 2014] Available from: doi:10.3109/10428191003713976
  24. KEMMERLY S. A., PANKEY G. A.. Oral Ciprofloxacin Therapy for Bacillus cereus Wound Infection and Bacteremia. Clinical Infectious Diseases [online] 1993 January, 16(1):189-189 [viewed 07 September 2014] Available from: doi:10.1093/clinids/16.1.189
  25. KIM JUNG-BEOM, JEONG HONG-RAE, PARK YONG-BAE, KIM JAE-MOUNG, OH DEOG-HWAN. Food Poisoning Associated with Emetic-Type of in Korea . Foodborne Pathogens and Disease [online] 2010 May, 7(5):555-563 [viewed 05 September 2014] Available from: doi:10.1089/fpd.2009.0443
  26. KIYOMIZU K, YAGI T, YOSHIDA H, MINAMI R, TANIMURA A, KARASUNO T, HIRAOKA A. Fulminant septicemia of Bacillus cereus resistant to carbapenem in a patient with biphenotypic acute leukemia. J Infect Chemother [online] 2008 Oct, 14(5):361-7 [viewed 05 September 2014] Available from: doi:10.1007/s10156-008-0627-y
  27. KOTIRANTA ANJA K., ITO HITOSHI, HAAPASALO MARKUS P.P., LOUNATMAA KARI. Radiation sensitivity of with and without a crystalline surface protein layer . [online] 1999 October, 179(2):275-280 [viewed 07 September 2014] Available from: doi:10.1111/j.1574-6968.1999.tb08738.x
  28. LEBESSI EVANGELIA, DELLAGRAMMATICAS HERACLES D., ANTONAKI GEORGIA, FOUSTOUKOU MARIA, IACOVIDOU NICOLETTA. Array. J Matern Fetal Neonatal Med [online] 2009 January, 22(5):458-461 [viewed 05 September 2014] Available from: doi:10.1080/14767050802610336
  29. MILLER JM, HAIR JG, HEBERT M, HEBERT L, ROBERTS FJ JR, WEYANT RS. Fulminating bacteremia and pneumonia due to Bacillus cereus. J Clin Microbiol [online] 1997 Feb, 35(2):504-507 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC229612
  30. MILLER JM, HAIR JG, HEBERT M, HEBERT L, ROBERTS FJ JR, WEYANT RS. Fulminating bacteremia and pneumonia due to Bacillus cereus. J Clin Microbiol [online] 1997 Feb, 35(2):504-7 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9003628
  31. MIYATA J, TASAKA S, MIYAZAKI M, YOSHIDA S, NAOKI K, SAYAMA K, ASANO K, FUJIWARA H, OHKUSU K, HASEGAWA N, BETSUYAKU T. Bacillus cereus necrotizing pneumonia in a patient with nephrotic syndrome. Intern Med [online] 2013, 52(1):101-4 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23291682
  32. MUSA M.O., AL DOURI M., KHAN S., SHAFI T., AL HUMAIDH A., AL RASHEED A.M.. Fulminant Septicaemic Syndrome of Bacillus cereus: Three case reports. Journal of Infection [online] 1999 September, 39(2):154-156 [viewed 05 September 2014] Available from: doi:10.1016/S0163-4453(99)90009-9
  33. Manual for the Health Care of Children in Humanitarian Emergencies: 3 Diarrhoea and dehydration. [web] [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/books/NBK143745/
  34. PHELPS RJ, MCKILLIP JL. Enterotoxin Production in Natural Isolates of Bacillaceae outside the Bacillus cereus Group Appl Environ Microbiol [online] 2002 Jun, 68(6):3147-3151 [viewed 07 September 2014] Available from: doi:10.1128/AEM.68.6.3147-3151.2002
  35. PINNA ANTONIO, SECHI LEONARDO A, ZANETTI STEFANIA, USAI DONATELLA, DELOGU GIOVANNI, CAPPUCCINELLI PIERO, CARTA FRANCESCO. Bacillus cereus keratitis associated with contact lens wear1 1The authors have no financial interest in any material used in this study.. Ophthalmology [online] 2001 October, 108(10):1830-1834 [viewed 05 September 2014] Available from: doi:10.1016/S0161-6420(01)00723-0
  36. PRüß BM, DIETRICH R, NIBLER B, MäRTLBAUER E, SCHERER S. The Hemolytic Enterotoxin HBL Is Broadly Distributed among Species of the Bacillus cereus Group Appl Environ Microbiol [online] 1999 Dec, 65(12):5436-5442 [viewed 07 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC91741
  37. RISHI EKTA, RISHI PUKHRAJ, SENGUPTA SABYASACHI, JAMBULINGAM MALATHI, MADHAVAN HAJIB N., GOPAL LINGAM, THERESE K. LILY. Acute Postoperative Bacillus cereus Endophthalmitis Mimicking Toxic Anterior Segment Syndrome. Ophthalmology [online] 2013 January, 120(1):181-185 [viewed 07 September 2014] Available from: doi:10.1016/j.ophtha.2012.07.009
  38. SANKARARAMAN S., VELAYUTHAN S.. Bacillus Cereus. Pediatrics in Review [online] December, 34(4):196-197 [viewed 07 September 2014] Available from: doi:10.1542/pir.34-4-196
  39. SCHEMMER G. B., DRIEBE W. T.. Posttraumatic Bacillus cereus Endophthalmitis. Archives of Ophthalmology [online] 1987 March, 105(3):342-344 [viewed 05 September 2014] Available from: doi:10.1001/archopht.1987.01060030062026
  40. SENESI S, CELANDRONI F, SALVETTI S, BEECHER DJ, WONG AC, GHELARDI E. Swarming motility in Bacillus cereus and characterization of a fliY mutant impaired in swarm cell differentiation. Microbiology [online] 2002 Jun, 148(Pt 6):1785-94 [viewed 07 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/12055298
  41. SLATEN DD, OROPEZA RI, WERNER SB. An outbreak of Bacillus cereus food poisoning--are caterers supervised sufficiently. Public Health Rep [online] 1992, 107(4):477-480 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403681
  42. SPEROTTO G, CARRAZZA FR, MARCONDES E. Treatment of diarrheal dehydration. Am J Clin Nutr [online] 1977 Sep, 30(9):1447-56 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/331933
  43. STENFORS ARNESEN LOTTE P., FAGERLUND ANNETTE, GRANUM PER EINAR. From soil to gut: and its food poisoning toxins . [online] 2008 July, 32(4):579-606 [viewed 05 September 2014] Available from: doi:10.1111/j.1574-6976.2008.00112.x
  44. STEVENS MP, ELAM K, BEARMAN G. Meningitis due to Bacillus cereus: A case report and review of the literature Can J Infect Dis Med Microbiol [online] 2012, 23(1):e16-e19 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3374474
  45. TOKIEDA K, MORIKAWA Y, MAEYAMA K, MORI K, IKEDA K. Clinical manifestations of meningitis in newborn infants . [online] December, 35(6):582-584 [viewed 05 September 2014] Available from: doi:10.1046/j.1440-1754.1999.00405.x
  46. TUAZON C.U. Bacillus species. [web] [viewed 07 September 2014] Available from: http://www.antimicrobe.org/new/b82.asp
  47. UCHINO Y, IRIYAMA N, MATSUMOTO K, HIRABAYASHI Y, MIURA K, KURITA D, KOBAYASHI Y, YAGI M, KODAIRA H, HOJO A, KOBAYASHI S, HATTA Y, TAKEUCHI J. A case series of Bacillus cereus septicemia in patients with hematological disease. Intern Med [online] 2012, 51(19):2733-8 [viewed 05 September 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23037464
  48. YANG CS, LU CK, LEE FL, HSU WM, LEE YF, LEE SM. Treatment and outcome of traumatic endophthalmitis in open globe injury with retained intraocular foreign body. Ophthalmologica [online] 2010, 224(2):79-85 [viewed 05 September 2014] Available from: doi:10.1159/000235725