A Cluster of CNS Infections Due to B. cereus in the Setting of Acute Myeloid Leukemia. Issue 10 (October 2015)

• Record Type: Journal Article
• Authors: Vodopivec, Ivana; Rinehart, Elizabeth M.; Griffin, Gabriel K.; Johncilla, Melanie E.; Pecora, Nicole; Yokoe, Deborah S.; Feske, Steven K.; Milner, Danny A.; Folkerth, Rebecca D.
• Is Part Of: Journal of neuropathology and experimental neurology. Volume 74:Issue 10(2015:Oct.)
• Publication Date: 2015-10
• Subjects: Neurology -- Diseases -- Periodicals; Neurology -- Diseases -- Physiopathology -- Periodicals; 616.8047
• DOI: 10.1097/NEN.0000000000000244
• Languages: English
• ISSNs: 0022-3069

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>Abstract</title> <p> <italic>Bacillus cereus</italic> typically causes a self-limited foodborne gastrointestinal (GI) illness. Severe invasive infection occurs rarely, mainly among immunocompromised hosts. We describe a cluster of <italic>B. cereus</italic> infections among 5 patients with acute myeloid leukemia and chemotherapy-induced neutropenia. The initial case presented with occipital lobe abscess and was found on biopsy to have organisms consistent with <italic>Bacillus</italic> species. Within 1 week, a second patient died of fulminant brain swelling and hemorrhage. Neuropathologic autopsy and culture revealed <italic>B. cereus</italic>; hospital infection control and public health officials were notified. Three more patients died within the subsequent 9 months (2 patients had rapid massive hemorrhage and many bacilli reminiscent of <italic>Bacillus anthracis</italic> infection, and 1 patient had sparse bacilli, petechial hemorrhages, and border zone infarcts). Blood cultures yielded positive results in 3 of 5 cases. A possible route of infection was hematogenous dissemination via GI mucosal breaches (GI symptoms occurred in 3 of 5 cases, and postmortem GI ulceration was found in 3 of 4 cases). Bacilli were seen in 2 of 3 GI ulcerations. Epidemiologic work-up, including a site visit conducted by the Centers for Disease Control and Prevention, did not identify a clear common source but suggested the possibility of bananas as a food source. <italic>Bacillus cereus</italic> causes a rapidly progressive, hemorrhagic meningoencephalitis with high mortality among patients with neutropenia. Neuropathologists can play a key role in the detection of outbreaks.</p> </sec> </abstract>