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Bacillus cereus meningoencephalitis in an immunocompetent patient
Pichaya Tao Worapongsatitaya1, Jakrapun Pupaibool2
1Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.
Insights
Bacillus cereus meningoencephalitis is a rare CNS infection, even in immunocompetent patients. Early detection and vancomycin treatment are crucial for better outcomes in this serious bacterial infection.
Area of Science:
- Neuroscience
- Infectious Diseases
- Microbiology
Background:
- Central nervous system (CNS) infections caused by Bacillus cereus (B. cereus) are infrequent.
- Typically, B. cereus CNS infections occur in immunocompromised individuals or those with invasive CNS devices.
Observation:
- This report details a rare case of B. cereus meningoencephalitis and bacteremia in an immunocompetent elderly patient without CNS devices.
- The patient experienced preceding gastrointestinal symptoms and had undergone trans-sphenoidal hypophysectomy, potentially acting as precipitating factors.
Findings:
- A positive blood culture for B. cereus requires careful consideration and repeat testing to rule out contamination.
- The case highlights the importance of not dismissing positive blood cultures as mere contamination.
Implications:
- Prompt recognition and management of B. cereus meningoencephalitis are vital due to its rapid progression and high mortality rate.
- Empirical treatment with intravenous vancomycin is recommended pending susceptibility results.
- Clinicians should maintain a high index of suspicion for this rare but severe infection.
Abstract:
Central nervous system (CNS) infection from Bacillus cereus (B. cereus) is rare and usually occurs in immunosuppressed patients or in a presence of invasive CNS devices. Our case reported here is a very rare case of an immunocompetent elderly patient without any CNS devices who was diagnosed with B. cereus meningoencephalitis and bacteremia. According to our patient, preceding gastrointestinal (GI) symptoms and trans-sphenoidal hypophysectomy could be the precipitating factors. A positive blood culture should not be concluded as a contamination but prompt repeating another set of blood culture for a better clinical judgment. Given its abrupt clinical course and high mortality rate, high index of suspicion for rapid detection and management is needed for a preferable clinical outcome. Empiric treatment with intravenous vancomycin is reasonable before a susceptibility result becomes available.
