Background and Importance Bacillus cereus is a spore-forming, gram-positive bacterium that is ubiquitous in the environment. It is frequently dismissed as contaminants, however, in the proper setting these organisms have the potential to be virulent. Clinical infections caused by B. cereus fall into six broad groups: local infections of wounds, burns, bacteraemia, CNS infections, respiratory infections, endocarditis and food poisoning. Despite aggressive treatment with broad-spectrum antibiotics and using them appropriately, the mortality is high.
Aim and Objectives To describe a case of Bacillus cereus central nervous system infection associated with post-surgical meningitis and a patient successfully treated with antibiotics.
Material and Methods Descriptive and retrospective clinical case. Data were obtained by review of electronic medical records.
Results A 72-year-old woman underwent a decompressive laminectomy due to lumbar spinal stenosis. Past medical history included hypertension and dyslipidaemia. She was discharged without complications. One week later, the patient was brought to the emergency room for altered consciousness, dysarthria, hemiplegia and fever. Her vital signs included a blood pressure of 109/82 mmHg, heart rate 125 beats/min, SpO2 92%, and Glasgow Coma Scale score of 7/15. C-reactive protein (CRP) level was 95 mg/l (reference <5 mg/l). Polymerase chain reaction (PCR) testing for SARS-CoV-2 was negative. Blood culture was negative. After a lumbar puncture, Bacillus cereus was isolated. The isolate was found resistant to β-lactam antibiotics (including penicillin, ampicillin and cephalosporin) and trimethoprim/sulfamethoxazole, and showed susceptibility to macrolides, vancomycin, clindamycin, carbapenems and quinolones. Triple antibiotherapy with meropenem, vancomycin and linezolid was initiated. After a few days of clinical stability, absence of fever and negative microbiological cultures, the triple antibiotic therapy was withdrawn and vancomycin and meropenem were continued. With adequate control of the source of infection and after a good evolution of the surgical wound, antibiotic therapy was switched to the oral route with linezolid. The patient was discharged with no evidence of sequelae from the meningeal infection, normal neurologic examination and CRP levels within the normal range.
Conclusion and Relevance This case highlights the clinical challenge to diagnose B. cereus and the importance of the delay between the detection of B. cereus and the establishment of an effective, targeted antibiotic therapy, especially in immunocompromised patients.
Conflict of Interest No conflict of interest
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.