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==Overview==
Bacillus cereus is an [[Endemic (epidemiology)|endemic]], soil-dwelling, [[Gram-positive]], rod shaped, [[beta hemolysis|beta hemolytic]] [[bacterium|bacteria]] that causes [[foodborne illness]].<ref>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill | year = 2004 | id = ISBN 0-8385-8529-9 }}</ref> It is the cause of "[[Fried Rice Syndrome]]".  ''B. cereus'' bacteria are [[facultative aerobe]]s, and like other members of the genus ''[[Bacillus]]'' can produce protective [[endospore]]s.


'''''Bacillus cereus''''' is an [[Endemic (epidemiology)|endemic]], soil-dwelling, [[Gram-positive]], rod shaped, [[beta hemolysis|beta hemolytic]] [[bacterium|bacteria]] that causes [[foodborne illness]].<ref>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill | year = 2004 | id = ISBN 0-8385-8529-9 }}</ref> It is the cause of "[[Fried Rice Syndrome]]". ''B. cereus'' bacteria are [[facultative aerobe]]s, and like other members of the genus ''[[Bacillus]]'' can produce protective [[endospore]]s.
==Pathogenesis==
* B. cereus is responsible for a minority of foodborne illnesses (2&ndash;5%). It is known to create heavy nausea, vomiting, and abdominal periods. <ref>{{cite journal | author=Kotiranta A, Lounatmaa K, Haapasalo M | title=Epidemiology and pathogenesis of ''Bacillus cereus'' infections | journal=Microbes Infect | year=2000 | pages=189-98 | volume=2 | issue=2 | id=PMID 10742691}}</ref> Generally speaking, ''Bacillus'' foodborne illnesses occur due to survival of the bacterial spores when food is improperly cooked.<ref>{{ cite book | author = Turnbull PCB | title = Bacillus. ''In:'' Baron's Medical Microbiology ''(Barron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 | id = [http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.935#939 (via NCBI Bookshelf)] ISBN 0-9631172-1-1 }}</ref> This problem is compounded when food is then improperly refrigerated, allowing the spores to germinate.<ref>{{cite journal | author=McKillip JL | title=Prevalence and expression of enterotoxins in ''Bacillus cereus'' and other ''Bacillus'' spp., a literature review | journal=Antonie Van Leeuwenhoek | year=2000 | pages=393-9 | volume=77 | issue=4 | id=PMID 10959569}}</ref> Bacterial growth results in production of [[enterotoxin]], and ingestion leads to two types of illness, diarrheal and emetic syndrome.<ref>{{cite journal | author=Ehling-Schulz M, Fricker M, Scherer S | title=''Bacillus cereus'', the causative agent of an emetic type of food-borne illness | journal=Mol Nutr Food Res | year=2004 | pages=479-87 | volume=48 | issue=7 | id=PMID 15538709}}</ref>
:* The diarrheal type is associated with a wide-range of foods, has an 8&ndash;16 hour incubation time and is associated with diarrhea and [[gastrointestinal]] pain. Also know as the ''long-incubation'' form of ''B. cereus'' food poisoning, it can be difficult to differentiate from poisoning caused by ''[[Clostridium perfringens]]''.<ref name=Todar>{{cite web | title=''Bacillus cereus'' | work=Todar's Online Textbook of Bacteriology  | url=http://textbookofbacteriology.net/B.cereus.html | accessdate=2006-04-10}}</ref>
:* In the emetic form, cooked rice that is improperly refrigerated is the most common cause, leading to nausea and vomiting 1&ndash;5 hours after consumption. This form can be difficult to distinguish from other short-term bacterial foodborne pathogens (e.g. ''[[Staphylococcus aureus]]'').<ref name=Todar />
* It was previously thought that the timing of the toxin production might be responsible for the two different types, but in fact the emetic syndrome is caused by a toxin called cereulide that is found only in emetic strains and is not part of the 'standard toolbox' of ''B. cereus''. Cereulide a dodecadepsipeptide produced by non-ribosomal peptide synthesis (NRPS), which is somewhat unusual in itself. It was shown independently by two research groups to be encoded on a plasmid, which is called pCERE01 <ref>{{cite journal | author=Hoton FM, Andrup L, Swiecicka I, Mahillon J | title=The cereulide genetic determinants of emetic ''Bacillus cereus'' are plasmid-borne. | journal=Microbiology | year=2005 | pages=2121-4 | volume=151 | issue=7 | id=PMID 16000702}}</ref>  or pBCE4810 <ref>{{cite journal | author=Ehling-Schulz M, Fricker M, Grallert H, Rieck P, Wagner M, Scherer S | title=Cereulide synthetase gene cluster from emetic ''Bacillus cereus'': structure and location on a mega virulence plasmid related to ''Bacillus anthracis'' toxin plasmid pXO1. | journal=BMC Microbiol | year=2006 | volume=6 | issue=20 | id=PMID 16512902}}</ref>. Interestingly, this plasmid shares a common backbone with the virulence plasmid pXO1, which encodes the anthrax toxin genes in ''B. anthracis'', but with a different pathogenicity island. Periodontal isolates of ''B. cereus'' also possess distinct pXO1-like plasmids.==Ecology==
''B. cereus'' competes with other microorganisms such as ''[[Salmonella]]'' and ''[[Campylobacter]]'' in the [[Gut (zoology)|gut]], so its presence reduces the numbers of those microorganisms. In food animals such as [[chickens]],<ref>{{cite journal
  | last = Vilà
  | first = B
  | authorlink = |author2=A. Fontgibell |author3=I. Badiola |author4=E. Esteve-Garcia |author5=G. Jiménez |author6=M. Castillo |author7=J. Brufau
  | title = Reduction of ''Salmonella enterica'' var. ''Enteritidis'' colonization and invasion by ''Bacillus cereus'' var. ''toyoi'' inclusion in poultry feeds
  | journal = Poultry Science
  | volume = 88
  | issue = 55
  | pages = 975–9
  | publisher = HighWire Press
  | location =
  | year = 2009
  | url = http://ps.fass.org/cgi/content/full/88/5/975
  | issn =
  | doi = 10.3382/ps.2008-00483
  | id =
  | accessdate = 14 May 2009
  | pmid = 19359685 | archiveurl= http://web.archive.org/web/20090429043512/http://ps.fass.org/cgi/content/full/88/5/975| archivedate= 29 April 2009 <!--DASHBot-->| deadurl= no}}
</ref> [[rabbit]]s<ref>{{cite journal
  | last = Bories
  | first = Georges
  | authorlink =
  | coauthors = Paul Brantom, Joaquim Brufau de Barberà, Andrew Chesson, Pier Sandro Cocconcelli, Bogdan Debski, Noël Dierick, Jürgen Gropp, Ingrid Halle, Christer Hogstrand, Joop de Knecht, Lubomir Leng, Sven Lindgren, Anne-Katrine Lundebye Haldorsen, Alberto Mantovani, Miklós Mézes, Carlo Nebbia, Walter Rambeck, Guido Rychen, Atte von Wright and Pieter Wester
  | title = Safety and efficacy of the product Toyocerin (Bacillus cereus var. toyoi) as feed additive for rabbit breeding does - Scientific Opinion of the Panel on Additives and Products or Substances used in Animal Feed
  | journal =
  | volume =
  | issue =
  | pages =
  | publisher = European Food Safety Authority
  | location =
  | date = 9 December 2008
  | url = http://www.efsa.europa.eu/cs/BlobServer/Scientific_Opinion/feedap_op_ej913_toyocerin_en,3.pdf?ssbinary=true
  | issn =
  | doi =
  | id = EFSA-Q-2008-287
  | accessdate = 14 May 2009 }}
</ref> and [[pig]]s,<ref>{{cite journal
  | last = Bories
  | first = Georges
  | authorlink =
  | coauthors = Paul Brantom, Joaquim Brufau de Barberà, Andrew Chesson, Pier Sandro Cocconcelli, Bogdan Debski, Noël Dierick, Anders Franklin, Jürgen Gropp, Ingrid Halle, Christer Hogstrand, Joop de Knecht, Lubomir Leng, Anne-Katrine Lundebye Haldorsen, Alberto Mantovani, Miklós Mézes, Carlo Nebbia, Walter Rambeck, Guido Rychen, Atte von Wright and Pieter Wester
  | title = Opinion of the Scientific Panel on Additives and Products or Substances used in Animal Feed on the safety and efficacy of the product Toyocerin (Bacillus cereus var. Toyoi) as a feed additive for sows from service to weaning, in accordance with Regulation (EC) No 1831/2003
  | journal =
  | volume =
  | issue =
  | pages =
  | publisher = European Food Safety Authority
  | location =
  | date = EFSA-Q-2006-037
  | url = http://www.efsa.europa.eu/cs/BlobServer/Scientific_Opinion/feedap_op_ej458_toyocerin_sows_en.pdf?ssbinary=true
  | issn =
  | doi =
  | id =
  | accessdate = 14 May 2009 }}
</ref> some harmless strains of ''B. cereus'' are used as a [[probiotic]] [[feed additive]] to reduce ''Salmonella'' in the [[intestine]]s and [[cecum]]. This improves the animals' growth as well as food safety for humans who eat their meat.
 
Some strains of ''B. cereus'' produce [[cerein]]s, [[bacteriocin]]s active against different ''B. cereus'' strains or other Gram-positive bacteria.<ref>{{cite journal|last1=Naclerio|first1=G|last2=Ricca|first2=E|last3=Sacco|first3=M|last4=De Felice|first4=M|title=Antimicrobial activity of a newly identified bacteriocin of Bacillus cereus|journal=Appl Environ Microbiol.|date=December 1993|volume=59|issue=12|pages=4313-6|pmid=8285719}}</ref>
== Diagnosis ==
 
In case of [[foodborne illness]], the diagnosis of ''B. cereus'' can be confirmed by the isolation of more than 10<sup>5</sup> ''B. cereus'' organisms per gram from epidemiologically implicated food, but such testing is often not done because the illness is relatively harmless and usually self-limiting.<ref name=cdc>[http://www.cdc.gov/mmwr/pdf/wk/mm4310.pdf Bacillus cereus Food Poisoning Associated with Fried Rice at Two Child Day Care Centers] from Morbidity and Mortality Weekly Report from Centers for Disease Control and Prevention. 18 March 1994 / Vol. 43 / No. 10 U.S.</ref>


==Pathogenesis==
==Prognosis==
''B. cereus'' is responsible for a minority of foodborne illnesses (2&ndash;5%). It is known to create heavy nausea, vomiting, and abdominal periods. <ref>{{cite journal | author=Kotiranta A, Lounatmaa K, Haapasalo M | title=Epidemiology and pathogenesis of ''Bacillus cereus'' infections | journal=Microbes Infect | year=2000 | pages=189-98 | volume=2 | issue=2 | id=PMID 10742691}}</ref> Generally speaking, ''Bacillus'' foodborne illnesses occur due to survival of the bacterial spores when food is improperly cooked.<ref>{{cite book | author = Turnbull PCB | title = Bacillus. ''In:'' Baron's Medical Microbiology ''(Barron S ''et al'', eds.)| edition = 4th ed. | publisher = Univ of Texas Medical Branch | year = 1996 | id = [http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=mmed.section.935#939 (via NCBI Bookshelf)] ISBN 0-9631172-1-1 }} </ref> This problem is compounded when food is then improperly refrigerated, allowing the spores to germinate.<ref>{{cite journal | author=McKillip JL | title=Prevalence and expression of enterotoxins in ''Bacillus cereus'' and other ''Bacillus'' spp., a literature review | journal=Antonie Van Leeuwenhoek | year=2000 | pages=393-9 | volume=77 | issue=4 | id=PMID 10959569}}</ref> Bacterial growth results in production of [[enterotoxin]], and ingestion leads to two types of illness, diarrheal and emetic syndrome.<ref>{{cite journal | author=Ehling-Schulz M, Fricker M, Scherer S | title=''Bacillus cereus'', the causative agent of an emetic type of food-borne illness | journal=Mol Nutr Food Res | year=2004 | pages=479-87 | volume=48 | issue=7 | id=PMID 15538709}}</ref>  
Most emetic patients recover within six to 24 hours, but in some cases, the toxin can be fatal.<ref>{{cite journal | author=Takabe F, Oya M | title=An autopsy case of food poisoning associated with ''Bacillus cereus'' | journal=ForensicSci | year=1976 | pages=97–101 | volume=7 | issue=2}}</ref><ref>{{cite journal | author=Mahler H | title=Fulminant liver failure in association with the emetic toxin of ''Bacillus cereus'' | journal=N Engl J Med | year=1997 | pages=1142–1148 | volume=336 | issue=16 | pmid=9099658 | url=http://www.nejm.org/doi/pdf/10.1056/NEJM199704173361604 | doi=10.1056/NEJM199704173361604|display-authors=etal}}</ref><ref>{{cite journal | author=Dierick K | title=Fatal family outbreak of Bacillus cereus-associated food poisoning | journal=J Clin Microbiol | year=2005 | pages=4277–4279 | volume=43 | issue=8 | doi=10.1128/JCM.43.8.4277-4279.2005 | url=http://jcm.asm.org/content/43/8/4277.full|display-authors=etal}}</ref><ref>{{cite journal | author=Shiota, M | title=Rapid Detoxification of Cereulide in ''Bacillus cereus'' Food Poisoning | journal=Pediatrics | year=2010 | pages=e951-e955 | volume=125 | issue=4 | doi=10.1542/peds.2009-2319 | url=http://pediatrics.aappublications.org/content/125/4/e951.full|display-authors=etal}}</ref><ref>{{cite journal | author=Naranjo, M | title=Sudden Death of a Young Adult Associated with ''Bacillus cereus'' Food Poisoning | journal=J Clin Microbiol | year=2011 | pages=4379–4381 | volume=49 | issue=12 | doi=10.1128/JCM.05129-11|display-authors=etal}}</ref> In 2014, 23 neonates receiving total parenteral nutrition contaminated with ''B. cereus'' developed septicaemia, with three of the infants later dying as a result of infection. <ref>https://www.gov.uk/drug-device-alerts/drug-alert-lipid-phase-only-of-parenteral-nutrition-potential-contamination-with-bacillus-cereus</ref><ref>http://www.independent.co.uk/life-style/health-and-families/health-news/third-baby-dies-from-contaminated-total-parenteral-nutrition-drip-feed-9576663.html</ref>
:*The diarrheal type is associated with a wide-range of foods, has an 8&ndash;16 hour incubation time and is associated with diarrhea and [[gastrointestinal]] pain. Also know as the ''long-incubation'' form of ''B. cereus'' food poisoning, it can be difficult to differentiate from poisoning caused by ''[[Clostridium perfringens]]''.<ref name=Todar>{{cite web | title=''Bacillus cereus'' | work=Todar's Online Textbook of Bacteriology  | url=http://textbookofbacteriology.net/B.cereus.html | accessdate=2006-04-10}}</ref>
 
:*In the emetic form, cooked rice that is improperly refrigerated is the most common cause, leading to nausea and vomiting 1&ndash;5 hours after consumption. This form can be difficult to distinguish from other short-term bacterial foodborne pathogens (e.g. ''[[Staphylococcus aureus]]'').<ref name=Todar />
==Reproduction==
It was previously thought that the timing of the toxin production might be responsible for the two different types, but in fact the emetic syndrome is caused by a toxin called cereulide that is found only in emetic strains and is not part of the 'standard toolbox' of ''B. cereus''. Cereulide a dodecadepsipeptide produced by non-ribosomal peptide synthesis (NRPS), which is somewhat unusual in itself. It was shown independently by two research groups to be encoded on a plasmid, which is called pCERE01 <ref>{{cite journal | author=Hoton FM, Andrup L, Swiecicka I, Mahillon J | title=The cereulide genetic determinants of emetic ''Bacillus cereus'' are plasmid-borne. | journal=Microbiology | year=2005 | pages=2121-4 | volume=151 | issue=7 | id=PMID 16000702}}</ref>  or pBCE4810 <ref>{{cite journal | author=Ehling-Schulz M, Fricker M, Grallert H, Rieck P, Wagner M, Scherer S | title=Cereulide synthetase gene cluster from emetic ''Bacillus cereus'': structure and location on a mega virulence plasmid related to ''Bacillus anthracis'' toxin plasmid pXO1. | journal=BMC Microbiol | year=2006 | volume=6 | issue=20 | id=PMID 16512902}}</ref>. Interestingly, this plasmid shares a common backbone with the virulence plasmid pXO1, which encodes the anthrax toxin genes in ''B. anthracis'', but with a different pathogenicity island. Periodontal isolates of ''B. cereus'' also possess distinct pXO1-like plasmids.
At {{convert|30|C|F}}, a population of ''B. cereus'' can double in as little as 20 minutes or as long as 3 hours, depending on the food product.<ref>{{cite book|url=https://helda.helsinki.fi/bitstream/handle/10138/20888/foodandi.pdf?sequence=1|title=Food and Indoor Air Isolated Bacillus Non-Protein Toxins: Structures, Physico-Chemical Properties and Mechanisms of Effects on Eukaryotic Cells|author=Mikkola, Raimo|page=12}}</ref>
 
{|class="wikitable" style="text-align:center;"
!Food!!style="width:10em"|Minutes to double, {{convert|30|C|F}}!!style="width:10em"|Hours to multiply by 1,000,000
|-
|Milk||20-36||{{n-life|n=2|t=20|t2=36|end=10^6|scale=60|dec=1}}
|-
|Cooked rice||26-31||{{n-life|n=2|t=26|t2=31|end=10^6|scale=60|dec=1}}
|-
|Infant formula||56||{{n-life|n=2|t=56|end=10^6|scale=60|dec=1}}
|}


==Gallery==
==Gallery==
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</gallery>
</gallery>


==Treatment==
==Treatment==


==Antimicrobial therapy==
===Antimicrobial Regimen===
 
:* 1. '''Food poisoning'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
*Bacillus cereus {{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}
::* Preferred regimen: Food poisoning is usually self-limited and requires no antibiotic therapy.
 
:* 2. '''Bacteremia'''
:* (1) Food poisoning
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
::* Preferred treatment: Food poisoning is self-limited, no antibiotics necessary. Treatment is Supportive therapy, hydration, and anti-emetics. Prevention is by fried/boiled rice should be maintained >60° C or rapidly cooled <8 ° C to avoid room temperature germination of spores and toxin.
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
:: Note (1): Bacillus cereus with two forms.(a) Emetic phase: 1-6 hrs after ingestion contaminated usually starchy food, e.g., fried rice. (b) Diarrheal phase: 10-12 hrs after eating e.g. tainted meats, milk, vegetables, etc. with watery diarrhea, tenesmus lasting <2-10 days.
::* Note (1): Bacillus cereus is commonly resistant to beta-lactams.
 
::* Note (2): Pseudobacteremia is transient and usually results from contaminated blood cultures, gloves, or syringes.
:* (2) Bacteremia
:* 3. '''Meningitis or brain abscess'''
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
::* Note: Blood culture isolates are mostly contaminates until proven otherwise, especially in intravenous drug user population.
:* 4. '''Endophthalmitis'''
::* Preferred regimen: [[Clindamycin]] 450 μg intravitreal {{and}} [[Gentamicin]] 400 μg intravitreal {{or}} [[Dexamethasone]] intravitreal {{and}} [[Vancomycin]] 15 mg/kg IV q12h
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
::* Note: Ophthalmological consultation, culture ocular fluids, early vitrectomy, and intravitreal antibiotics are necessary.
:* 5. '''Endocarditis'''
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
::* Note: Most blood cultures in intravenous drug users are contaminates or represent transient bacteremia.
:* 6. ''' Soft tissue infection'''
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
::: Note (1): Bacillus cereus often resistant to beta-lactams.
:* 7. '''Pneumonia'''
::: Note (2): Uncommon, may complicate mixed infections including surgical wounds or infected necrotic tumors.
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
::: Note (3): Source of pseudobacteremia is contaminated blood cultures, gloves, syringes, etc. Often transient bacteremia of no significance in intravenous drug user population.
 
:* (3) Meningitis, brain abscess
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h.
::: Note (1): Blood culture isolates are mostly contaminates until proven otherwise, especially in intravenous drug user population.
::: Note(2):  Uncommon presentations, may complicate otitis, mastoiditis, neurosurgical procedures, and shunts.
 
:* (4) Endophthalmitis
::* Preferred regimen: [[Clindamycin]] 450 mcg intravitreal {{and}} [[Gentamicin]] 400 mcg intravitreal {{or}} [[Dexamethasone]] intravitreal {{and}} [[Vancomycin]] 15 mg/kg IV q12h.
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
::: Note (1): Prognosis for sight retention poor.
::: Note (2): Rapid, massive destruction of vitreous/retina in intravenous drug user or posttraumatic with ringabscess within 48 hrs. Pathognomic Bacillus cereus panophthalmitis.
::: Note (3): Early ophthalmological consultation, culture ocular fluids. Early vitrectomy and intravitreal antibiotics is advocated.
::: Note (4): Ocular infections devastating and require quick intervention.
::: Note (5): primary pathogen of post-traumatic , risk factor also intravenous drug use. May also cause keratitis, orbital abscess, conjunctivitis, dacryocystitis.
:* (5) Endocarditis
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h.
::: Note (1):  Well-described but rare complication seen in intravenous drug user . Most blood cultures in intravenous drug user positive for bacillus are contaminates or represent transient bacteremia.
::: Note (2): Evidence of valvular involvement should be sought by echocardiography to prove endocarditis. Tricuspid valve involvement most common. Course indolent.
::: Note (3): Tricuspid valve endocarditis mostly indolent in nature.
:* (6) Soft tissue
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h.
::: note:  rare reports of fasciitis.
:* (7) Pneumonia
::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h.
::: Note: rare pathogen of compromised host. May mimic Bacillus anthracis-type presentation.
==References==
==References==
{{reflist|2}}
{{reflist|2}}
==References==
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Latest revision as of 13:28, 4 February 2016

Bacillus cereus
B. cereus on sheep blood agar plate.
B. cereus on sheep blood agar plate.
Scientific classification
Kingdom: Bacteria
Phylum: Firmicutes
Class: Bacilli
Order: Bacillales
Family: Bacillaceae
Genus: Bacillus
Species: cereus
Binomial name
Bacillus cereus
Frankland & Frankland 1887

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Overview

Bacillus cereus is an endemic, soil-dwelling, Gram-positive, rod shaped, beta hemolytic bacteria that causes foodborne illness.[1] It is the cause of "Fried Rice Syndrome". B. cereus bacteria are facultative aerobes, and like other members of the genus Bacillus can produce protective endospores.

Pathogenesis

  • B. cereus is responsible for a minority of foodborne illnesses (2–5%). It is known to create heavy nausea, vomiting, and abdominal periods. [2] Generally speaking, Bacillus foodborne illnesses occur due to survival of the bacterial spores when food is improperly cooked.[3] This problem is compounded when food is then improperly refrigerated, allowing the spores to germinate.[4] Bacterial growth results in production of enterotoxin, and ingestion leads to two types of illness, diarrheal and emetic syndrome.[5]
  • The diarrheal type is associated with a wide-range of foods, has an 8–16 hour incubation time and is associated with diarrhea and gastrointestinal pain. Also know as the long-incubation form of B. cereus food poisoning, it can be difficult to differentiate from poisoning caused by Clostridium perfringens.[6]
  • In the emetic form, cooked rice that is improperly refrigerated is the most common cause, leading to nausea and vomiting 1–5 hours after consumption. This form can be difficult to distinguish from other short-term bacterial foodborne pathogens (e.g. Staphylococcus aureus).[6]
  • It was previously thought that the timing of the toxin production might be responsible for the two different types, but in fact the emetic syndrome is caused by a toxin called cereulide that is found only in emetic strains and is not part of the 'standard toolbox' of B. cereus. Cereulide a dodecadepsipeptide produced by non-ribosomal peptide synthesis (NRPS), which is somewhat unusual in itself. It was shown independently by two research groups to be encoded on a plasmid, which is called pCERE01 [7] or pBCE4810 [8]. Interestingly, this plasmid shares a common backbone with the virulence plasmid pXO1, which encodes the anthrax toxin genes in B. anthracis, but with a different pathogenicity island. Periodontal isolates of B. cereus also possess distinct pXO1-like plasmids.==Ecology==

B. cereus competes with other microorganisms such as Salmonella and Campylobacter in the gut, so its presence reduces the numbers of those microorganisms. In food animals such as chickens,[9] rabbits[10] and pigs,[11] some harmless strains of B. cereus are used as a probiotic feed additive to reduce Salmonella in the intestines and cecum. This improves the animals' growth as well as food safety for humans who eat their meat.

Some strains of B. cereus produce cereins, bacteriocins active against different B. cereus strains or other Gram-positive bacteria.[12]

Diagnosis

In case of foodborne illness, the diagnosis of B. cereus can be confirmed by the isolation of more than 105 B. cereus organisms per gram from epidemiologically implicated food, but such testing is often not done because the illness is relatively harmless and usually self-limiting.[13]

Prognosis

Most emetic patients recover within six to 24 hours, but in some cases, the toxin can be fatal.[14][15][16][17][18] In 2014, 23 neonates receiving total parenteral nutrition contaminated with B. cereus developed septicaemia, with three of the infants later dying as a result of infection. [19][20]

Reproduction

At 30 °C (86 °F), a population of B. cereus can double in as little as 20 minutes or as long as 3 hours, depending on the food product.[21]

Food Minutes to double, 30 °C (86 °F) Hours to multiply by 1,000,000
Milk 20-36 Template:N-life
Cooked rice 26-31 Template:N-life
Infant formula 56 Template:N-life

Gallery

Treatment

Antimicrobial Regimen

  • 1. Food poisoning[23]
  • Preferred regimen: Food poisoning is usually self-limited and requires no antibiotic therapy.
  • 2. Bacteremia
  • Preferred regimen: Vancomycin 15 mg/kg IV q12h
  • Alternative regimen: Clindamycin 600 mg IV q8h
  • Note (1): Bacillus cereus is commonly resistant to beta-lactams.
  • Note (2): Pseudobacteremia is transient and usually results from contaminated blood cultures, gloves, or syringes.
  • 3. Meningitis or brain abscess
  • Preferred regimen: Vancomycin 15 mg/kg IV q12h
  • Alternative regimen: Clindamycin 600 mg IV q8h
  • Note: Blood culture isolates are mostly contaminates until proven otherwise, especially in intravenous drug user population.
  • 4. Endophthalmitis
  • Preferred regimen: Clindamycin 450 μg intravitreal AND Gentamicin 400 μg intravitreal OR Dexamethasone intravitreal AND Vancomycin 15 mg/kg IV q12h
  • Alternative regimen: Clindamycin 600 mg IV q8h
  • Note: Ophthalmological consultation, culture ocular fluids, early vitrectomy, and intravitreal antibiotics are necessary.
  • 5. Endocarditis
  • Preferred regimen: Vancomycin 15 mg/kg IV q12h
  • Note: Most blood cultures in intravenous drug users are contaminates or represent transient bacteremia.
  • 6. Soft tissue infection
  • 7. Pneumonia

References

  1. ↑ Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed. ed.). McGraw Hill. ISBN 0-8385-8529-9.
  2. ↑ Kotiranta A, Lounatmaa K, Haapasalo M (2000). "Epidemiology and pathogenesis of Bacillus cereus infections". Microbes Infect. 2 (2): 189–98. PMID 10742691.
  3. ↑ Turnbull PCB (1996). Bacillus. In: Baron's Medical Microbiology (Barron S et al, eds.) (4th ed. ed.). Univ of Texas Medical Branch. (via NCBI Bookshelf) ISBN 0-9631172-1-1.
  4. ↑ McKillip JL (2000). "Prevalence and expression of enterotoxins in Bacillus cereus and other Bacillus spp., a literature review". Antonie Van Leeuwenhoek. 77 (4): 393–9. PMID 10959569.
  5. ↑ Ehling-Schulz M, Fricker M, Scherer S (2004). "Bacillus cereus, the causative agent of an emetic type of food-borne illness". Mol Nutr Food Res. 48 (7): 479–87. PMID 15538709.
  6. ↑ 6.0 6.1 "Bacillus cereus". Todar's Online Textbook of Bacteriology. Retrieved 2006-04-10.
  7. ↑ Hoton FM, Andrup L, Swiecicka I, Mahillon J (2005). "The cereulide genetic determinants of emetic Bacillus cereus are plasmid-borne". Microbiology. 151 (7): 2121–4. PMID 16000702.
  8. ↑ Ehling-Schulz M, Fricker M, Grallert H, Rieck P, Wagner M, Scherer S (2006). "Cereulide synthetase gene cluster from emetic Bacillus cereus: structure and location on a mega virulence plasmid related to Bacillus anthracis toxin plasmid pXO1". BMC Microbiol. 6 (20). PMID 16512902.
  9. ↑ Vilà, B; A. Fontgibell; I. Badiola; E. Esteve-Garcia; G. Jiménez; M. Castillo; J. Brufau (2009). "Reduction of Salmonella enterica var. Enteritidis colonization and invasion by Bacillus cereus var. toyoi inclusion in poultry feeds". Poultry Science. HighWire Press. 88 (55): 975–9. doi:10.3382/ps.2008-00483. PMID 19359685. Archived from the original on 29 April 2009. Retrieved 14 May 2009.
  10. ↑ Bories, Georges (9 December 2008). "Safety and efficacy of the product Toyocerin (Bacillus cereus var. toyoi) as feed additive for rabbit breeding does - Scientific Opinion of the Panel on Additives and Products or Substances used in Animal Feed" (PDF). European Food Safety Authority. EFSA-Q-2008-287. Retrieved 14 May 2009. Unknown parameter |coauthors= ignored (help)
  11. ↑ Bories, Georges (EFSA-Q-2006-037). "Opinion of the Scientific Panel on Additives and Products or Substances used in Animal Feed on the safety and efficacy of the product Toyocerin (Bacillus cereus var. Toyoi) as a feed additive for sows from service to weaning, in accordance with Regulation (EC) No 1831/2003" (PDF). European Food Safety Authority. Retrieved 14 May 2009. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)
  12. ↑ Naclerio, G; Ricca, E; Sacco, M; De Felice, M (December 1993). "Antimicrobial activity of a newly identified bacteriocin of Bacillus cereus". Appl Environ Microbiol. 59 (12): 4313–6. PMID 8285719.
  13. ↑ Bacillus cereus Food Poisoning Associated with Fried Rice at Two Child Day Care Centers from Morbidity and Mortality Weekly Report from Centers for Disease Control and Prevention. 18 March 1994 / Vol. 43 / No. 10 U.S.
  14. ↑ Takabe F, Oya M (1976). "An autopsy case of food poisoning associated with Bacillus cereus". ForensicSci. 7 (2): 97–101.
  15. ↑ Mahler H; et al. (1997). "Fulminant liver failure in association with the emetic toxin of Bacillus cereus". N Engl J Med. 336 (16): 1142–1148. doi:10.1056/NEJM199704173361604. PMID 9099658.
  16. ↑ Dierick K; et al. (2005). "Fatal family outbreak of Bacillus cereus-associated food poisoning". J Clin Microbiol. 43 (8): 4277–4279. doi:10.1128/JCM.43.8.4277-4279.2005.
  17. ↑ Shiota, M; et al. (2010). "Rapid Detoxification of Cereulide in Bacillus cereus Food Poisoning". Pediatrics. 125 (4): e951–e955. doi:10.1542/peds.2009-2319.
  18. ↑ Naranjo, M; et al. (2011). "Sudden Death of a Young Adult Associated with Bacillus cereus Food Poisoning". J Clin Microbiol. 49 (12): 4379–4381. doi:10.1128/JCM.05129-11.
  19. ↑ https://www.gov.uk/drug-device-alerts/drug-alert-lipid-phase-only-of-parenteral-nutrition-potential-contamination-with-bacillus-cereus
  20. ↑ http://www.independent.co.uk/life-style/health-and-families/health-news/third-baby-dies-from-contaminated-total-parenteral-nutrition-drip-feed-9576663.html
  21. ↑ Mikkola, Raimo. Food and Indoor Air Isolated Bacillus Non-Protein Toxins: Structures, Physico-Chemical Properties and Mechanisms of Effects on Eukaryotic Cells (PDF). p. 12.
  22. ↑ 22.0 22.1 22.2 22.3 22.4 22.5 22.6 22.7 "Public Health Image Library (PHIL)".
  23. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
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