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Bacillus cereus-induced Myonecrosis
Abstract
A patient with an incomplete amputation due to a crush injury to his arm developed a myonecrosis with Gram-positive rods noted on muscle and wound aspirates. The patient was treated for a probable Clostridium perfringens infection but culture results proved the organism to be Bacillus cereus. In light of the reported resistance of Bacillus cereus to penicillin, this case serves to emphasize the importance of expanded empiric coverage with high-dose penicillin and an aminoglycoside pending the return of culture and sensitivity results.
... Bu olgu B. cereus'un sebep olduğu yara enfeksiyonunun doku için oldukça tahrip edici olduğunu ve enfeksiyonun yayılımını önlemek için geniş eksizyonel debridman yapılmasını veya etkilenen ekstremitenin ampütasyonunu gerektirebileceğini göstermiştir (11). Başka bir çalışmada kaza sonrası kolunda kırık oluşan bir hastanın yara yerinde Gram-pozitif basil görülmesi üzerine klostridyal miyonekroz düşünülen bir hastaya ampütasyon yapılarak, penisilin ve hiperbarik oksijen tedavisine başlanılmış ancak kültürde B. cereus üremesi üzerine oksijen tedavisi kesilerek antimikrobiyal tedavi değiştirilmiştir (12). Bu raporda klinik, klostridyal gazlı gangrene benzetilmiş ve B. cereus'un, fulminan seyirli yumuşak doku enfeksiyonuna yol açabileceği gösterilmiştir (12). ...
... Başka bir çalışmada kaza sonrası kolunda kırık oluşan bir hastanın yara yerinde Gram-pozitif basil görülmesi üzerine klostridyal miyonekroz düşünülen bir hastaya ampütasyon yapılarak, penisilin ve hiperbarik oksijen tedavisine başlanılmış ancak kültürde B. cereus üremesi üzerine oksijen tedavisi kesilerek antimikrobiyal tedavi değiştirilmiştir (12). Bu raporda klinik, klostridyal gazlı gangrene benzetilmiş ve B. cereus'un, fulminan seyirli yumuşak doku enfeksiyonuna yol açabileceği gösterilmiştir (12). ...
Bacillus cereus is an aerobic, endospore-forming Gram-positive rod found widely in nature, including soil, dust and mud, rotting organic matter, fresh and salt water, vegetables and fomites. When isolated from clinical specimens it is often interpreted as a “contaminant”. However, it may present as an etiological agent in both gastrointestinal and extraintestinal infections. In this case report, we have presented a post-traumatic wound infection due to B. cereus in a 35 year-old, diabetic patient who have applied to hospital with gunshot injury and operated due to tibia and fibula fractures. B. cereus should not always be considered as a contaminant when cultured in the laboratory and should be kept in mind as a pathogen especially post-operative and post-traumatic wound infections.
... Vascular gangrene is due to compromise in the arterial blood supply, post-injury or in diabetics. Several organisms (mixed infection that includes Proteus spp., Bacteroides spp., and anaerobic streptococci) may be involved (34). Gas formation and foul-smelling exudate are commonly seen. ...
Myositis is inflammation especially of the voluntary muscles, characterized by localized or diffuse pain, tenderness on movement or palpation, swelling, and/or weakness. The two main categories of myositis include non-infectious and infectious. Infective myositis may be due to a wide variety of pathogens, including bacteria, fungi, viruses, and parasites. A brief account of the various pathogens causing infective myositis is discussed.
... This exotoxin is shown to exhibit a proteolytic activity (Ouled-Haddar et al. 2010;Saleem et al. 2012). It has been observed that most of the earlier reports on B. cereus fall under the aspect of clinical manifestations of the toxins (Johnson et al. 1984;Rusul and Yaacob 1995;Henriques and Moran 2007;Sánchez et al. 2009). Among these studies, the present work is the first report on the public health importance on the isolation of a marine B. cereus (VCRC-B540) for the control of mosquito vectors. ...
A marine bacterium with mosquitocidal effect was isolated from the gut region of the marine red snapper fish (Lutjanus sanguineous). The 16S rRNA gene sequence alignment showed that this isolate belonged to the strain Bacillus cereus VCRC-B540 (NCBI: JN377787). Biochemical studies showed that the strain could be useful in mosquito control. It showed an increasing pattern of toxicity for Culex quinquefasciatus, Anopheles stephensi, and Aedes aegypti, without negative effects for the non-targeted organisms Chironomus riparius, Daphnia cephalata and Notonecta glauca. A qualitative analysis of B. cereus showed that a polypeptide (M.wt: 90 kDa) was associated with the toxicity observed. Consequently, the peptide sequence is identified to be a surface layer protein. A phylogenetic analysis of 16S rDNA gene sequence of B. cereus revealed shared homology with the Bacillus species. Hence, it is concluded that the marine bacterium (B. cereus) can be useful in the biological control of mosquito vectors.
... The levels of susceptibility to methicillin and penicillin G, ampicillin, methicillin and cephalothin with streptomycin varied widely for different strains other species of Bacillus having varying levels of considerable interspecific differences in susceptibility sensitivity [52]. Bacillus cereus isolates are highly could be detected with oleandomy-cinacillin, resistant to lincomycin, polymyxin B, penicillin G, chloramphenicol, ampicillin, carbenicillin, ristomycin, cephalosporin and are susceptible to streptomycin, tetracycline and benzyl penicillin [55]. ...
Abstract: Twenty five samples of baby powder and ten samples of solution lenses have been used to determine
their bacterial contamination. Sixteen samples (64.0%) of baby powder out of 25 is contaminated (bacterial
growth), their count is in the range from 1.0 x 101 CFU/ml to 9.0x102 CFU/ml. Eight samples out of 10 of solution
lenses are contaminated (80%). Their count is in the range from 2.0 CFU/ml to 1.5 x 102 CFU/ml. The microscopic
examination revealed that out of 32 isolated bacterial strains, 24 isolates (75%) are Gram positive spore forming
bacilli. However 15 out of 16 samples (93.7%) are contaminated with Bacillus spp. However, 8 out of 8 (100%)
of solution lenses are contaminated with Bacillus spp. The results revealed that 19 out of 24 (79.1%) Bacillus
spp isolated from baby powder are hemolysin producers, while 3 out of 10 (30%) of Bacillus spp. isolated from
solution lenses produced high levels of hemolysins. The most virulent Bacillus spp. isolated from baby powder
and solution lenses are gamma and antibiotic resistant. Four kGy reduced the viable count of bacterial
contaminated baby powder. Imipenem is found to be the most effective antibiotic against the most Bacillus
isolates of baby powder and solution lenses.
... B. cereus was recorded to be the third most common cause of the food-poisoning outbreaks in Hungary (117 outbreaks) between 1960 and 1968, followed by Finland (50 outbreaks), Netherlands (11 outbreaks) and Canada (9 outbreaks) (Gilbert 1979;Shinagawa 1990). Besides these, there are many reports of food-borne outbreaks of B. cereus from a large variety of foods in many countries including the USA (Bean and Griffin 1990), UK, Scandinavia, Japan (Johnson et al. 1984) and Norway (Kotiranta et al. 2000). Although Norway is almost free of Salmonella and Campylobacter food poisoning, B. cereus is most commonly reported in food-poisoning syndromes (Blackburn and McClure 2005). ...
Food borne illnesses result from eating food or
drinking beverages that are contaminated with chemical matter,
heavy metals, parasites, fungi, viruses and Bacteria.
Bacillus cereus is one of the food-borne disease causing
Bacteria. Species of Bacillus and related genera have long
been troublesome to food producers on account of their resistant
endospores. Their spores may be present on various types
of raw and cooked foods, and their ability to survive high
cooking temperatures requires that cooked foods be served hot
or cooled rapidly to prevent the growth of this bacteria.
Bacillus cereus is well known as a cause of food poisoning,
and much more is now known about the toxins produced by
various strains of this species, so that its significance in such
episodes are clearer. However, it is still unclear why such
cases are so rarely reported worldwide.
... This exotoxin is shown to exhibit a proteolytic activity (Haddar et al. 2010; Saleem et al. 2012). It has been observed that most of the earlier reports on B. cereus fall under the aspect of clinical manifestations of the toxins (Johnson et al. 1984; Rusul and Yaacob 1995; Henriques and Moran 2007; Sánchez et al. 2009). Among these studies, the present work is the first report on the public health importance on the isolation of a marine B. cereus (VCRC-B540) for the control of mosquito vectors. ...
Entomopathogenic bacteria to control mosquitoes are a promising environmentally friendly alternative to synthetic pesticides. In the present study, a novel mosquitocidal bacterium was isolated from marine soil collected from east coastal areas at Pondicherry (India). 16S rRNA gene sequence alignment depicted that this isolate belonged to Bacillus cereus VCRC-B520 (NCBI: KC-119192). Biochemical studies on bacterial growth, biomass, and toxin production have revealed that this strain could possibly be helpful in the production of a biopesticide in mosquito control. Toxicity assay with B. cereus against mosquito larvae has shown that the filariasis vector, Culex quinquefasciatus, is more susceptible than the other two species (Anopheles stephensi and Aedes aegypti). The LC50 and LC90 values for C. quinquefasciatus were 0.30 and 2.21 mg/L, respectively. No effect of B. cereus was found on nontargeted organisms. SDS-PAGE analysis and protein purification result from the cell mass of B. cereus have shown that a well-perceptible polypeptide was the dependable factor (85 kDa) for mosquitocidal action. Protein characterization (M/S MALDI-TOF) has shown that it is an endotoxin-specific insecticidal protein, namely "Cry4Aa". Phylogenetic analyses of 16S rDNA gene sequence from this marine isolate have revealed the presence of homology among closely related Bacillus strains. Therefore, considerable interest has been shown on the identification of a potential mosquitocidal bacterium from marine environment (B. cereus), which was not reported earlier in view of the current scenario of the rapid development of resistance to Bacillus sphaericus in mosquito vector control program.
... Bacillus infections (probably Bacillus cereus in most cases) have been documented since the beginning of this century and probably earlier (8, 42, 47, 81, 107, 110, 132, 136, 180). Clinical infections caused by B. cereus fall into six broad groups: (i) local infections, particularly of burns, traumatic or postsurgical wounds, and the eye (1, 2, 7, 14, 25, 29, 38, 39, 56, 69, 73, 79, 84, 88, 92, 105, 131, 133, 137, their properties, mode of action, and contribution to the spectrum of disease caused will be discussed. TAXONOMY The genus Bacillus is divided into three broad groups, depending on the morphology of the spore and sporangium, a scheme that was originally proposed by Smith et al. (147) and developed further in 1973 (66). ...
Bacillus cereus is a gram-positive aerobic or facultatively anaerobic spore-forming rod. It is a cause of food poisoning, which is frequently associated with the consumption of rice-based dishes. The organism produces an emetic or diarrheal syndrome induced by an emetic toxin and enterotoxin, respectively. Other toxins are produced during growth, including phospholipases, proteases, and hemolysins, one of which, cereolysin, is a thiol-activated hemolysin. These toxins may contribute to the pathogenicity of B. cereus in nongastrointestinal disease. B. cereus isolated from clinical material other than feces or vomitus was commonly dismissed as a contaminant, but increasingly it is being recognized as a species with pathogenic potential. It is now recognized as an infrequent cause of serious nongastrointestinal infection, particularly in drug addicts, the immunosuppressed, neonates, and postsurgical patients, especially when prosthetic implants such as ventricular shunts are inserted. Ocular infections are the commonest types of severe infection, including endophthalmitis, panophthalmitis, and keratitis, usually with the characteristic formation of corneal ring abscesses. Even with prompt surgical and antimicrobial agent treatment, enucleation of the eye and blindness are common sequelae. Septicemia, meningitis, endocarditis, osteomyelitis, and surgical and traumatic wound infections are other manifestations of severe disease. B. cereus produces beta-lactamases, unlike Bacillus anthracis, and so is resistant to beta-lactam antibiotics; it is usually susceptible to treatment with clindamycin, vancomycin, gentamicin, chloramphenicol, and erythromycin. Simultaneous therapy via multiple routes may be required.
Infectious myositis, an infection of the skeletal muscle(s), is uncommon. This clinical entity may be caused by viral, bacterial, fungal, and parasitic pathogens. Viral etiologies typically cause diffuse myalgias and/or myositis, whereas bacteria and fungi usually lead to a local myositis which may be associated with sites compromised by trauma or surgery and are more common among immunocompromised patients. Localized collections within the muscles are referred to as pyomyositis. Other pyogenic causes of myositis include gas gangrene, group A streptococcal myonecrosis, and other types of non-clostridial myonecrosis. Early recognition and treatment of these conditions are necessary as they may rapidly become life-threatening.
An 8-year-old boy presented with fulminant necrotizing infection resembling gas gangrene following penetrating trauma from a tree branch. Bacillus cereus was isolated from tissue specimens, showing that unexpected pathogens can be isolated. It is essential to submit specimens for culture, as this organism is typically resistant to beta-lactam antibiotics and metronidazole, the empiric choice for gas gangrene.
Concern exists over recent unexplained deaths among intravenous drug users. This report describes a patient with crepitant cellulitis who was admitted complaining of severe pain in the right forearm. Ultrasonography demonstrated gas in the tissues and he was referred for early surgical debridement of the arm. He was treated with intravenous benzyl penicillin, gentamicin and metronidazole and made a full recovery. Aspirate samples grew Bacillus cereus, morphologically similar to the isolate obtained from a sample of the patient's own heroin. Antibiogram and API 50CHB profiles were also similar. Further typing included 'H' flagellar serotyping, which found both blood and heroin strains to be non-typable, and amplified fragment polymorphism analysis, which showed that the strains were indistinguishable. Genotyping of two selected genes from B. cereus confirmed almost certain identity between the two strains. This case illustrates the potential virulence of B. cereus when inoculated into tissues, and to our knowledge, is the first report to demonstrate a conclusive microbiological link between contaminated heroin and serious sepsis in a drug user due to B. cereus.
We describe a case of rapidly progressive necrotizing cellulitis in an immunocompromised farmer caused by Bacillus cereus, and review 15 additional cases of serious soft tissue infection due to this organism reported in the English language literature. These cases illustrate the potential for B. cereus to cause fulminant soft tissue disease indistinguishable from that caused by clostridia.
Bacillus cereus is a Gram-positive aerobic or facultatively anaerobic, motile, spore-forming, rod-shaped bacterium that is widely distributed environmentally. While B. cereus is associated mainly with food poisoning, it is being increasingly reported to be a cause of serious and potentially fatal non-gastrointestinal-tract infections. The pathogenicity of B. cereus, whether intestinal or nonintestinal, is intimately associated with the production of tissue-destructive exoenzymes. Among these secreted toxins are four hemolysins, three distinct phospholipases, an emesis-inducing toxin, and proteases. The major hurdle in evaluating B. cereus when isolated from a clinical specimen is overcoming its stigma as an insignificant contaminant. Outside its notoriety in association with food poisoning and severe eye infections, this bacterium has been incriminated in a multitude of other clinical conditions such as anthrax-like progressive pneumonia, fulminant sepsis, and devastating central nervous system infections, particularly in immunosuppressed individuals, intravenous drug abusers, and neonates. Its role in nosocomial acquired bacteremia and wound infections in postsurgical patients has also been well defined, especially when intravascular devices such as catheters are inserted. Primary cutaneous infections mimicking clostridial gas gangrene induced subsequent to trauma have also been well documented. B. cereus produces a potent beta-lactamase conferring marked resistance to beta-lactam antibiotics. Antimicrobials noted to be effective in the empirical management of a B. cereus infection while awaiting antimicrobial susceptibility results for the isolate include ciprofloxacin and vancomycin.
It has become increasingly apparent that Bacillus cereus can cause a severe and devastating form of endophthalmitis following penetrating trauma by a metallic object. B. cereus is an uncommon aetiological agent in non-clostridial gas-forming infections. The patient studied in this single case report showed evidence of intraocular gas mimicking gas gangrene infection. The physiology of non-clostridial bacteria producing gas from anaerobic metabolic conditions is reviewed. Further intraocular and systemic complications which may be avoided by accurate and early diagnosis and the use of recommended treatment with antibiotics such as clindamycin.
Over a period of 19 months, Bacillus species, most frequently B. cereus, were isolated from postoperative and post-traumatic wounds in 24 patients on orthopaedic wards in a Swedish hospital. Clinical signs of infection were found in all but 3 patients: in 9 patients, mild signs with increased secretion from the wounds; in 10 patients, moderate signs with fever and/or significant local reaction around the wounds; and in 2 patients, severe signs with necrotic infections. Bacillus spp. were isolated from one-fourth of all patients with wound complications following total hip arthroplasty. Their hospitalization was significantly prolonged, compared with a control group (p = 0.0042). Isolates of B. cereus from wounds should not be dismissed as contaminants or as non-pathogenic, but must be assessed in the light of the clinical situation.
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 cereus is an aerobic, spore-forming, Gram-positive bacteria, that is widely distributed in nature and is commonly found in soil, milk, cereals and other dried foodstuffs. His multiplication has been observed chiefly in foods and may lead to food poisonning. His potential for causing unusually severe eye infection (post-traumatic endophtalmitis) has been recognized increasingly over the past several years. We present a case of a presumed clostridial myonecrosis which proved to be a gangrene infection with Bacillus cereus as the etiologic agent.
A 43-year-old man with incomplete amputation due to a crush injury to his hand developed necrotizing soft tissue infection. Culture results proved the organism to be bacillus cereus. The clinical picture resembled infection by clostridial myonecrosis. But bacillus cereus is resistant to beta-lactam antibioties which is the empiric choice for clostridial myonecrosis. The treatment of necrotizing soft tissue infection includes surgical debridement and appropriate antibiotic therapy. Contaminated foreign bodies can harbor a wide range of organisms. Recognition of unusual and rare organisms such as Bacillus cereus is impossible in the absence of culture results.
Objective: The aim of this study was to classify the unusual gram-positive rod isolated from a patient with multiple bacterial synergistic gangrene. Methods: The 16S rRNA fragment cloning, sequencing, 16S rRNA similarity searching, bacterial morphological and biochemical tests were used. Results: YP strain was facultative aerobic, spore-forming on LB agar in the presence of oxygen. Catalase positive, no motility, nitrate reduced. The end products in PYG broth were mainly acetic acid, lactic acid and small amount of succinate acid. The YP strain could not be identified by routine method. The 1457 base pair 16S rRNA of YP strain was synthesized by PCR and sequenced. Comparative 16S rRNA sequence analyses revealed that stain YP is most closely related to several species and some unnamed strains of Bacillus. The highest similarity value between Y6 strain and members of Bacillus could reach up to 96%. However, the most closed is a nonspore-forming species. Conclusion: Based on the biological and genetic results obtained, we named YP strain genus Bacillus, which has the potential to be a new species pathogenic to human being.
Bacillus cereus is a Gram-positive, spore-forming rod, which is part of the Bacillus genus. Although, most commonly known to cause gastrointestinal infections, B. cereus infections can also result in osteomyelitis, meningitis, pneumonia, and endophthalmitis. Deep soft tissue infections caused by Bacillus cereus are uncommon and hence, rarely reported in the literature. Here we describe the case of young lady who presented with persistent soft tissue infection of her forearm following a traumatic injury despite treatment with empirical antibiotics. Soft tissue samples taken intra-operatively grew Bacillus cereus, which was treated successfully with intravenous vancomycin and oral ciprofloxacin. Bacillus cereus soft tissue infections should be considered as differential diagnosis for persistent inflammation following limb trauma. Soft tissue biopsies could play a vital role in accurate diagnosis and prompt management of such infections.
Infectious myositis may be caused by a broad range of bacterial, fungal, parasitic, and viral agents. Infectious myositis is overall uncommon given the relative resistance of the musculature to infection. For example, inciting events, including trauma, surgery, or the presence of foreign bodies or devitalized tissue, are often present in cases of bacterial myositis. Bacterial causes are categorized by clinical presentation, anatomic location, and causative organisms into the categories of pyomyositis, psoas abscess, Staphylococcus aureus myositis, group A streptococcal necrotizing myositis, group B streptococcal myositis, clostridial gas gangrene, and nonclostridial myositis. Fungal myositis is rare and usually occurs among immunocompromised hosts. Parasitic myositis is most commonly a result of trichinosis or cystericercosis, but other protozoa or helminths may be involved. A parasitic cause of myositis is suggested by the travel history and presence of eosinophilia. Viruses may cause diffuse muscle involvement with clinical manifestations, such as benign acute myositis (most commonly due to influenza virus), pleurodynia (coxsackievirus B), acute rhabdomyolysis, or an immune-mediated polymyositis. The diagnosis of myositis is suggested by the clinical picture and radiologic imaging, and the etiologic agent is confirmed by microbiologic or serologic testing. Therapy is based on the clinical presentation and the underlying pathogen.
A patient with a diffuse histiocytic lymphoma developed an infection caused by Bacillus cereus during a period of induced granulocytopenia. A fulminant process resembling gas gangrene developed shortly after the accidental penetration by a small piece of metal into his right hand. Incision and drainage as well as antimicrobial therapy did not prevent the loss of the third, fourth and fifth fingers; however, localization and subsequent control of the infection was achieved concomitant with bone marrow recovery.
In contrast to gas gangrene, there is confusion regarding the nature, proper classification, and virulent potential of other gas forming infections. Experience with seven cases in a brief period of time confirmed the authors' impression that these infections are associated with high morbidity and mortality rates. Since the presence of gas results from anaerobic metabolic conditions, it is an ominous clinical sign indicating the need for immediate, radical debridement.
A rapidly progressing panophthalmitis due to Bacillus cereus developed in three patients. Infection was associated with intravenous drug abuse in two patients and was traced to contaminated injection paraphernalia in one. In the third patient, infection was associated with a foreign-body injury to the eye. Anterior chamber aspiration revealed the organism on Gram's stain in one case and isolation of the bacteria in all three. Despite intravenous and intraocular antibiotic therapy, the infection progressed rapidly and resulted in enucleation in all cases. Bacillus cereus isolates were sensitive to clindamycin hydrochloride hydrate and aminoglycosides but resistant to penicillins and cephalosporins.