Abstract
BackgroundBacillus cereus (B. cereus) rarely causes lower respiratory tract infections, although most reported cases of B. cereus pneumonia are fatal despite intensive antibiotic therapy. We present a case of B. cereus pneumonia in an immunocompetent patient.Case presentationAn 81-year-old woman was transferred from a district general hospital to our hospital for treatment of congestive heart failure. The patient presented with a nonproductive cough, dyspnea, edema in both lower extremities, orthopnea, fever, and occult blood in the stool. A chest radiograph indicated bilateral pleural effusion and pulmonary congestion. After diuretic therapy and chest drainage, bilateral pleural effusion and pulmonary congestion improved. On day 2, she experienced severe respiratory distress. B. cereus was isolated from two blood sample cultures. On day 4, her condition had progressed to severe respiratory distress (PaO2/FiO2 ratio = 108). A chest radiograph and computed tomography indicated extensive bilateral infiltrates. She was transferred to the intensive care unit and was intubated. B. cereus was also isolated from five blood sample cultures at that time. After isolating B. cereus, we switched antibiotics to a combination of imipenem and levofloxacin, which were effective. She had no history of immunodeficiency, surgery, ill close contacts, risk factors for HIV or tuberculosis, recent central venous catheter insertion, or anthrax vaccination. She improved and was discharged from the intensive care unit after several days.ConclusionThis is a rare case of B. cereus pneumonia in an immunocompetent patient, who subsequently recovered. Bacillus should be considered as a potential pathogen when immunocompetent patients develop severe pneumonia.
Highlights
Bacillus cereus (B. cereus) rarely causes lower respiratory tract infections, most reported cases of B. cereus pneumonia are fatal despite intensive antibiotic therapy
This is a rare case of B. cereus pneumonia in an immunocompetent patient, who subsequently recovered
Bacillus should be considered as a potential pathogen when immunocompetent patients develop severe pneumonia
Summary
Bacillus cereus (B. cereus) is a Gram-positive, aerobic to facultative, spore-forming rod that is widely distributed in the environment [1]. She had a no drinking and smoking history, and activities of daily living were in the normal range Her temperature was 37.3 °C, pulse rate was 133 beats per min with AF, respiratory rate was 24 breaths per min, and blood pressure was 115/58 mmHg. Laboratory findings were as follows: WBC count, 11,040 cells/mm without a left shift; hematocrit, 34.7%; platelets, 145,000/mm; creatinine, 0.8 mg/dL; alanine. B. cereus was isolated from two blood sample cultures (arterial blood and venous blood) collected at admission (Fig. 3), and intravenous levofloxacin (250– 500 mg/day) therapy was initiated instead of ampicillin/ sulbactam therapy (Fig. 2). A chest radiograph (Fig. 4) and computed tomography (CT) (Fig. 5) indicated extensive bilateral infiltrates Her temperature was 37.5 °C, pulse rate was 139 beats per min with AF, blood pressure was 78/47 mmHg, and oxygen saturation was 93% while receiving 100% oxygen by a rebreather 15-L mask. No further remarkable changes were noted, and she was discharged from the hospital
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