Abstract
Bacillus cereus foodborne intoxications and toxicoinfections are on a rise. Usually, symptoms are self-limiting but occasionally hospitalization is necessary. Severe intoxications with the emetic Bacillus cereus toxin cereulide, which is notably resistant heat and acid during cooking, can cause acute liver failure and encephalopathy. We here present a case series of food poisonings in five immunocompetent adults after ingestion of fried rice balls, which were massively contaminated with Bacillus cereus. The patients developed a broad clinical spectrum, ranging from emesis and diarrhoea to life-threatening acute liver failure and acute tubular necrosis of the kidney in the index patient. In the left-over rice ball, we detected 8 × 106 Bacillus cereus colony-forming units/g foodstuff, and cereulide in a concentration of 37 μg/g foodstuff, which is one of the highest cereulide toxin contaminations reported so far from foodborne outbreaks. This report emphasizes the potential biological hazard of contaminated rice meals that are not freshly prepared. It exemplifies the necessity of a multidisciplinary approach in cases of Bacillus cereus associated food poisonings to rapidly establish the diagnosis, to closely monitor critically ill patients, and to provide supportive measures for acute liver failure and—whenever necessary—urgent liver transplantation.
Highlights
The spore-forming facultatively anaerobic, Gram-positive bacterium Bacillus cereus is well known for its food poisoning potential in humans [1]
Upon arrival in the tertiary care centre and 13 h after the putative food poisoning, liver transaminases were rising, the factor V was as low as 12%, and lactic acid was elevated to 9.9 mmol/L
We here report a case with acute liver failure after exposure to Bacillus cereus toxins that emphasizes the potential biological hazard of contaminated rice meals that are not freshly prepared and were refrigerated for several days
Summary
The spore-forming facultatively anaerobic, Gram-positive bacterium Bacillus cereus is well known for its food poisoning potential in humans [1]. There are only supportive treatments available for these food poisonings, which are attributable to various toxins. The non-haemolytic enterotoxin (Nhe), the haemolytic enterotoxin (Hbl) and the cytotoxin K (CytK), have been linked to the diarrhoeal form of food poisoning, while the small cyclic dodecadepsipeptide toxin cereulide and its isoforms are responsible for the emetic syndrome [2,3]. Among the toxins produced by Bacillus cereus, cereulide is the most critical, and is notably resistant to heat and acid during cooking [4]. We here report a case series of food poisonings in five young and previously healthy adults after ingestion of fried rice balls that were massively contaminated with Bacillus cereus
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