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Non-Invasive Model of Neuropathogenic Escherichia coli Infection in the Neonatal Rat
Published on: October 29, 2014
Neuroinvasive Bacillus cereus Infection in Immunocompromised Hosts: Epidemiologic Investigation of 5 Patients With
Jessica S Little1,2,3, Cassie Coughlin1,2,4, Candace Hsieh1,2,4
1Harvard Medical School, Boston, Massachusetts, USA.
Background:
Bacillus cereus is a ubiquitous gram-positive rod-shaped bacterium that can cause sepsis and neuroinvasive disease in patients with acute leukemia or neutropenia.
Methods:
A single-center retrospective review was conducted to evaluate patients with acute leukemia, positive blood or cerebrospinal fluid test results for B cereus, and abnormal neuroradiographic findings between January 2018 and October 2022. Infection control practices were observed, environmental samples obtained, a dietary case-control study completed, and whole genome sequencing performed on environmental and clinical Bacillus isolates.
Results:
Five patients with B cereus neuroinvasive disease were identified. All patients had acute myeloid leukemia (AML), were receiving induction chemotherapy, and were neutropenic. Neurologic involvement included subarachnoid or intraparenchymal hemorrhage or brain abscess. All patients were treated with ciprofloxacin and survived with limited or no neurologic sequelae. B cereus was identified in 7 of 61 environmental samples and 1 of 19 dietary protein samples-these were unrelated to clinical isolates via sequencing. No point source was identified. Ciprofloxacin was added to the empiric antimicrobial regimen for patients with AML and prolonged or recurrent neutropenic fevers; no new cases were identified in the ensuing year.
Conclusions:
B cereus is ubiquitous in the hospital environment, at times leading to clusters with unrelated isolates. Fastidious infection control practices addressing a range of possible exposures are warranted, but their efficacy is unknown and they may not be sufficient to prevent all infections. Thus, including B cereus coverage in empiric regimens for patients with AML and persistent neutropenic fever may limit the morbidity of this pathogen.
Insights
Bacillus cereus can cause serious infections in neutropenic patients with acute myeloid leukemia (AML). Early ciprofloxacin treatment improved outcomes, and adding it to empiric regimens may prevent future cases.
Area of Science:
- Infectious Diseases
- Hematology
- Neuroscience
Background:
- Bacillus cereus is a common bacterium that can cause severe sepsis and neuroinvasive disease.
- Patients with acute leukemia or neutropenia are particularly vulnerable to B. cereus infections.
Purpose of the Study:
- To evaluate B. cereus neuroinvasive disease in patients with acute leukemia.
- To investigate infection control practices and potential sources of B. cereus in a hospital setting.
- To assess the impact of empiric antimicrobial regimens on B. cereus infections.
Main Methods:
- Retrospective review of patients with acute leukemia and B. cereus infection.
- Analysis of environmental and dietary samples using whole genome sequencing.
- Observation of infection control practices and case-control study.
Main Results:
- Five patients with B. cereus neuroinvasive disease and acute myeloid leukemia (AML) were identified, all neutropenic and undergoing chemotherapy.
- Neurologic involvement included hemorrhage or brain abscess; all patients survived with ciprofloxacin treatment.
- B. cereus was found in environmental and dietary samples, but isolates were unrelated to clinical cases; no point source was identified.
Conclusions:
- Bacillus cereus is prevalent in hospitals, and infections can occur even with unrelated isolates.
- While infection control is important, it may not prevent all cases.
- Empiric ciprofloxacin for AML patients with neutropenic fever may reduce B. cereus-related morbidity.
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