Combined Bacillus licheniformis and Bacillus subtilis infection in a patient with oesophageal perforation

Abstract

Species of the genus Bacillus are a common laboratory contaminant, therefore, isolation of these organisms from blood cultures does not always indicate infection. In fact, except for Bacillus anthracis and Bacillus cereus, most species of the genus Bacillus are not considered human pathogens, especially in immunocompetent individuals. Here, we report an unusual presentation of bacteraemia and mediastinitis due to co-infection with Bacillus subtilis and Bacillus licheniformis, which were identified by 16S RNA gene sequencing, in a patient with an oesophageal perforation. Case ReportA 71-year-old male visited the emergency department with chest pain that was first noticed after swallowing tablets 3 h before admission. The pain progressively worsened and was associated with dyspnoea. On examination, his heart rate was 95 beats min 21 , respiratory rate was 30 breaths min 21 , blood pressure was 130/70 mmHg, body temperature was 36 u C and arterial O 2 saturation was 94 %. His medical history included a mild drinking habit and past pulmonary tuberculosis. He was also taking medicine for chronic obstructive pulmonary disease (COPD). The results of laboratory tests performed on admission were haemoglobin 14.3 g dl 21 , white blood cell (WBC) count 9.76610 9 cells l 21 (73.7 % segmented neutrophils, 15.9 % lymphocytes, 3.1 % monocytes, 6.6 % eosinophils), Creactive protein (CRP) ,0.3 mg dl 21 and creatine kinase myocardial band (CK-MB) 2.2 mmol l 21 . A computed tomography (CT) scan of the chest showed a pleural effusion in the left lower lobe and an oesophageal perforation was suspected. We believe that the tablets were the cause of this. Sputum and blood were cultured and empirical antimicrobial therapy with ceftriaxone, clindamycin, and gentamicin was administered. The next day, the pain continued, the CRP had increased to 12.57 mg dl 21 and his body temperature was 38.4 u C. A chest tube was inserted and blood-tinged fluid was drained. Over time, the CRP increased steadily to 29.53 mg dl 21 . Three sets of blood cultures and culture of the pleural fluid from the chest tube were performed. On day 4, the patient underwent an exploratory thoracotomy. In the mediastinum, pus and inflammatory tissue were observed and the pus was cultured; however, no oesophageal perforation was found. At the end of the operation, a chest tube was inserted and pus-containing fluid was drained.Colonies identified as members of the genus Bacillus were isolated from blood and pleural fluid cultured on days 1 and 2 and subcultures were performed on blood agar. Subsequently, the antimicrobial regimen was changed to moxifloxacin and clindamycin. After hospitalization, the patient had a persistent fever above 38 u C and the CRP remained high at 26.07 mg dl 21 .The subcultures grew various colonies of Gram-positive bacilli and the cultures taken on day 1 grew transparent, spreading colonies (designated colony 1). All three sets of blood cultures taken on day 2 grew two kinds of colonies: transparent, spreading colonies (designated colony 2) and ...

Occurrence and characterization of toxigenic Bacillus cereus in food and infant feces

“…B. licheniformis have been recovered from raw and infant milk powder, and implicated in food poisoning cases [31,32] . B. licheniformis have shown to exhibit pathogenic properties and they may pose a health hazard [33,34] .…”

Morphological transitions of Bacillus subtilis in the presence of food‐grade lipidic nanoemulsions

“…In the year 2012, a case study was reported in South Korea, wherein a 71‐year‐old male patient with esophageal perforation exhibited bacteremia and mediastinitis, which was later ascribed to B. subtilis and Bacillus licheniformis . Blood culture and Pleural fluid isolated from the patient signified B. subtilis as main culprit of this episode, and commented not to ignore the Bacillus , as a possible human contaminant that may cause significant bacteremia infections (Jeon et al., 2012).…”

Scientific Opinion on the maintenance of the list of QPS biological agents intentionally added to food and feed (2013 update)

“…A bacteraemia related to a pacemaker wire infection was caused by Bacillus licheniformis (Idelevich et al, 2012). Bacillus subtilis and Bacillus licheniformis were identified as the cause of a bacteraemia in a patient with an oesophageal perforation (La Jeon et al, 2012). reported a case of bacteraemia caused by Bacillus licheniformis following vertebrotherapy in a patient with a lung cancer.…”

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