A Cluster of CNS Infections Due to B. cereus in the Setting of Acute Myeloid Leukemia: Neuropathology in 5 Patients.
Bacillus cereus typically causes a self-limited foodborne gastrointestinal (GI) illness. Severe invasive infection occurs rarely, mainly among immunocompromised hosts. We describe a cluster of B. cereus 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 Bacillus species. Within 1 week, a second patient died of fulminant brain swelling and hemorrhage. Neuropathologic autopsy and culture revealed B. cereus; 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 Bacillus anthracis 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. Bacillus cereus causes a rapidly progressive, hemorrhagic meningoencephalitis with high mortality among patients with neutropenia. Neuropathologists can play a key role in the detection of outbreaks.
From the Department of Neurology, Massachusetts General Hospital (IV); Department of Neurology (IV, SKF), Department of Pathology (GKG, EMR, MEJ, NP, DAMJ, RDF), and Division of Infectious Disease, Department of Medicine (DSY), Brigham and Women's Hospital, Boston, Massachusetts.
Ivana
I
Vodopivec
Elizabeth M
EM
Rinehart
Gabriel K
GK
Griffin
Melanie E
ME
Johncilla
Nicole
N
Pecora
Deborah S
DS
Yokoe
Steven K
SK
Feske
Danny A
DA
Milner
Rebecca D
RD
Folkerth
D000328:Adult; D001409:Bacillus cereus; D003428:Cross Infection / Q000276:immunology* / Q000473:pathology*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000276:immunology* / Q000473:pathology*; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D008297:Male; D008590:Meningoencephalitis / Q000382:microbiology*; D008875:Middle Aged