A 59-year-old woman who had been undergoing chemotherapy for B-cell acute lymphoblastic leukaemia suffered from an episode of neutropenic sepsis on day 12 post-chemotherapy. Bacillus cereus (B. cereus) was isolated from two sets of blood cultures collected consecutively. The patient was treated with meropenem, colistin and teicoplanin. Although on the ventilator for three days, she recovered and could be discharged in 12 days. She continued to be on chemotherapy as per schedule. Bacillus spp. are usually considered contaminants in blood cultures but have been known to cause sepsis in immunocompromised patients. This case report aimed to highlight the possible pathogenic role of B. cereus when isolated from blood. Clinical correlation and routine practice of a minimum of two sets of blood cultures from two different sites will help us determine the significance of uncommon pathogens. The source of infection in this case is likely to be the gut, secondary to the mucosal barrier injury due to the chemotherapy.
Doern GV, Carroll KC, Diekema DJ, Garey KW, Rupp ME, Weinstein MP, et al. Practical guidance for clinical microbiology laboratories: A comprehensive update on the problem of blood culture contamination and a discussion of methods for addressing the problem. Clin Microbiol Rev 2019;33:e00009-19.
Ramarao N, Lereclus D, Sorokin A. The Bacillus cereus group. In: Molecular Medical Microbiology. 2nd ed., Vol. III. Amsterdam, Netherlands: Elsevier; 2015. p. 1041-78.
Glasset B, Herbin S, Granier SA, Cavalié L, Lafeuille E, Guérin C, et al. Bacillus cereus, a serious cause of nosocomial infections: Epidemiologic and genetic survey. PLoS One 2018;13:e0194346.
Riedel S, Morse SA, Mietzner TA, Miller S. Jawetz Melnick and Adelbergs Medical Microbiology. 28th ed., Kindle edition. Amsterdam, Netherlands: Elsevier; 2019. p. 183.
Uchino Y, Iriyama N, Matsumoto K, Hirabayashi Y, Miura K, Kurita D, et al. A case series of Bacillus cereus septicemia in patients with hematological disease. Intern Med 2012;51:2733-8.
Ikeda M, Yagihara Y, Tatsuno K, Okazaki M, Okugawa S, Moriya K. Clinical characteristics and antimicrobial susceptibility of Bacillus cereus blood stream infections. Ann Clin Microbiol Antimicrob 2015;14:43.
Arora S, Thakkar D, Upasana K, Yadav A, Rastogi N, Yadav SP. Bacillus cereus infection in pediatric oncology patients: A case report and review of literature. IDCases 2021;26:e01302.
Nath SR, Gangadharan SS, Kusumakumary P, Narayanan G. The spectrum of Bacillus cereus infections in patients with haematological malignancy. J Acad Clin Microbiol 2017;19:27-31.
Jayapal P, Raman N, Soundran V, Selvarajan D. Fatal pneumonia in an immunocompetent individual: Role of Bacillus cereus. Int J Health Sci 2022;6:9243-9.
Saikia L, Gogoi N, Das PP, Sarmah A, Punam K, Mahanta B, et al. Bacillus cereus-attributable primary cutaneous anthrax-like infection in newborn infants, India. Emerg Infect Dis 2019;25:1261-70.
Saigal K, Gautam V, Singh G, Ray P. Bacillus cereus causing intratumoral brain abscess. Indian J Pathol Microbiol 2016;59:554-6.
Gopinathan A, Kumar A, Sen AC, Sudha S, Varma P, Gs S, et al. A case series and review of Bacillus cereus endocarditis from India. Open Microbiol J 2018;12:28-33.
Dhaliwal M, Daneman N. Utility of differential time to positivity in diagnosing central line-associated bloodstream infections: A systematic review and meta-analysis. Clin Infect Dis 2023;77:428-37.
Turnbull PC, Kramer JM. Intestinal carriage of Bacillus cereus: Faecal isolation studies in three population groups. J Hyg (Lond) 1985;95:629-38.
Hueso T, Ekpe K, Mayeur C, Gatse A, Joncquel-Chevallier Curt M, Gricourt G, et al. Impact and consequences of intensive chemotherapy on intestinal barrier and microbiota in acute myeloid leukemia: The role of mucosal strengthening. Gut Microbes 2020;12:1800897.
Peterson DE, Boers-Doets CB, Bensadoun RJ, Herrstedt J, ESMO Guidelines Committee. Management of oral and gastrointestinal mucosal injury: ESMO clinical practice guidelines for diagnosis, treatment, and follow-up. Ann Oncol 2015;26 Suppl 5:v139-51.
Hogan WJ, Letendre L, Litzow MR, Tefferi A, Hoagland HC, Pruthi RK, et al. Neutropenic colitis after treatment of acute myelogenous leukemia with idarubicin and cytosine arabinoside. Mayo Clin Proc 2002;77:760-2.
Rahnama H, Azari R, Yousefi MH, Berizi E, Mazloomi SM, Hosseinzadeh S, et al. A systematic review and meta-analysis of the prevalence of Bacillus cereus in foods. Food Control 2023;143:109250.
Tusgul S, Prod'hom G, Senn L, Meuli R, Bochud PY, Giulieri SG. Bacillus cereus bacteraemia: Comparison between haematologic and nonhaematologic patients. New Microbes New Infect 2017;15:65-71.
