Sudden Death of a Young Adult Associated with Bacillus cereus Food Poisoning

Abstract

A lethal intoxication case, which occurred in Brussels, Belgium, is described. A 20-year-old man died following the ingestion of pasta contaminated with Bacillus cereus. Emetic strains of B. cereus were isolated, and high levels of cereulide (14.8 g/g) were found in the spaghetti meal. CASE REPORTOn 1 October 2008, a 20-year-old man became sick after eating a meal of leftovers of spaghetti with tomato sauce, which had been prepared 5 days before and left in the kitchen at room temperature. After school, he warmed the spaghetti in the microwave oven. Immediately after eating, he left home for his sports activities, but he returned 30 min later because of headache, abdominal pain, and nausea. At his arrival, he vomited profusely for several hours and at midnight had two episodes of watery diarrhea. He did not receive any medication and drank only water. After midnight, he fell asleep. The next morning at 11:00 AM, his parents were worried because he did not get up. When they went to his room, they found him dead.Legal examination determined the time of death, presumably at 4:00 AM, approximately 10 h after ingestion of the suspected meal. An autopsy could not be performed until 5 days later. Macroscopically, brownish and moderately softened liver and ascites (550 ml of citrine liquid) were found. The heart was macroscopically normal. A total lysis of the pancreas was also found, but it could not be excluded that this finding was due to the autopsy delay.Microscopic findings were as follows: moderate centrolobular liver necrosis without inflammatory signs and discrete biliary stasis, significant vascular congestion of the lungs, probably due to acute cardiac insufficiency, significant necrosis from all layers of colon mucosa and submucosa alternating with betterpreserved zones, and mixed intestinal flora but no evidence of invasive bacterial lesions. Significant lysis of the adrenal glands was also reported. The exact cause of death could not be determined by the autopsy because the interpretation of findings was very difficult due to the autopsy delay.Five fecal swabs and two feces samples were taken postmortem, and samples were tested for the presence of Bacillus cereus by growth on mannitol egg yolk polymyxin (MYP) agar. B. cereus was found in only two of the five fecal swabs, and the strains isolated were named ISP321 and ISP322. No B. cereus was cultured from the feces samples. Pasta and tomato sauce samples, the leftovers of the dinner, were also sent for analysis to the National Reference Laboratory for Food-borne Outbreaks (NRLFBO). For enumeration of B. cereus in food samples, the ISO 7932 method (16) was used. Significant B. cereus counts (9.5 ϫ 10 7 CFU/g) were found in the pasta, while B. cereus was absent in the tomato sauce. The strain isolated from the pasta meal was named ISP303.PCR assays that detect the presence of toxin genes were applied to DNA from the pasta isolate (ISP303) and the two human isolates (ISP321 and ISP322), and the results are presented in Table 1. The presence of genes encoding ...

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