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Purpose: Intravesical BCG is the standard treatment of non-muscle invasive bladder cancer. No difference has yet been reported in the safety profiles of the various BCG strains., Methods: A nationwide multidisciplinary retrospective survey was conducted between January 2013 and December 2016 to identify cases of BCG infection and differentiate them based on the type of BCG strain used., Results: Forty patients were identified (BCG RIVM 28; other strains 8; unknown 4). Patients treated with BCG RIVM were less severely ill, with fewer occurrences of septic shock (3.6% vs. 50%, P=0.003) and ICU admission (7.1% vs. 62.5%, P=0.003). A higher frequency of pulmonary miliaries (71.4% vs. 12.5%, P=0.005) but lower transaminase levels (mean AST 65 vs. 264 U/L, P=0.001) were observed in these patients. No difference in terms of recovery was reported., Conclusion: The type of BCG strain could correlate with the frequency and severity of subsequent BCG infections., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Bacillus cereus is a gram-positive rod bacterium that is responsible for food poisoning. It is naturally widely distributed, and thus often contaminates cultures. Although it is rarely considered responsible, it can cause serious infections under certain conditions. However, lethal infections, especially in immunocompetent patients, are rare., Case Presentation: A healthy 60-year-old man developed community-acquired B. cereus pneumonia and alveolar hemorrhage unveiled by abrupt chest pain and hemoptysis with no other advance symptoms. B. cereus induced silent alveolar destruction without any local or systemic inflammatory response. Although the lesion resembled lung anthrax, there was no evidence of Bacillus anthracis toxin., Conclusions: Some isolates of B. cereus can cause anthrax-like fulminant necrotizing pneumonia in immunocompetent patients. If this type of B. cereus were used as a means of bioterrorism, it may be quite difficult to recognize as bioterrorism. We should keep B. cereus in mind as a potential pathogen of fulminant human infectious disease.

An 83-year-old patient suffered a cat bite dorsally to the Achilles tendon. In the further course, he developed an isolated intratendinous abscess of the Achilles tendon, which was surgically revised twice and subsequently healed with antibiotic treatment. In Germany, about 40,000 bite injuries of different origins occur annually. Most of these injuries are cat or dog bites, while human bites are rare. Although the course is often complicated, there are no standard recommendations for treatment. An intratendinous abscess after animal bite injury has not been described in the literature as yet., Competing Interests: Interessenkonflikt: Nein., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: A number of outbreaks caused by Bacillus species have been reported to date. Outbreaks reported in the last decade have predominantly arisen in Japanese hospitals., Aim: To elucidate factors contributing to these real or pseudo outbreaks by Bacillus species, and to evaluate the rate of Bacillus species-positive blood culture samples in Japan., Methods: A systematic review of the literature was performed. Reports including data on outbreaks caused by Bacillus species were searched for in PubMed, Google Scholar and Evidence-based Medicine BMJ from inception through 10 Aug 2014. Japanese nationwide data on bacteriological tests were collected from Japan Nosocomial Infections Surveillance. Regional bacteriological data for Akita prefecture were collected using the Akita Regional Network for Infection Monitoring/Control System., Findings: Contamination of reusable towels was suspected as a cause for the high rate of Bacillus-positive blood cultures in Japan. The rate of Bacillus species in blood cultures was much higher in Japan than in reports from other countries., Conclusions: The high contamination rate of blood culture samples by Bacillus species in Japan is a matter of concern for infection control and medical treatment. Bacteriological investigation of reusable towels should be considered in hospitals with a high frequency of Bacillus-positive blood cultures., (Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

We report a unique case in which a 57-year-old man with an 8-year history of late recurrent post-tympanostomy tube otorrhea (PTTO) was found to harbor Bacillus subtilis, an aerobic endospore-forming bacillus that is typically resistant to chemical and physical agents because of its unique life cycle. Removal of the patient's tympanostomy tube resulted in complete resolution of his long-standing otorrhea. We also review the etiologies of and treatment strategies for early, late, chronic, and recurrent PTTO. We conclude that regardless of the etiology, a patient with persistent or recurrent PTTO should consider undergoing removal of the ventilation tube.

Background: Hematopoietic cell transplantation (HCT) is performed in more than 25,000 patients annually. Clinically significant bacterial transmission from HCT products is rare., Case Report: A 36-year-old male of Asian descent with chronic myelogenous leukemia developed sepsis leading to acute renal failure and disseminated intravascular coagulation during infusion of matched unrelated donor bone marrow. This product later tested positive for Bacillus cereus., Discussion: This HCT product traveled 31 hours at room temperature before arriving at the transplant center. Reducing transport times, transporting at 4 °C, and enhancing bacterial surveillance of HCT products may increase the ability to detect bacterial proliferation from transport., Conclusion: To prevent a similar case in the future, we will begin Gram staining all HCT products in transit more than 24 hours to alert physicians of the need for prophylactic antibiotic therapy., (© 2012 American Association of Blood Banks.)

Purpose: On 13 December 2007, Merck & Co., Inc. voluntarily recalled 1.2 million doses of Haemophilus influenzae type b (Hib) vaccines that had been distributed since April 2007 for concerns regarding potential Bacillus cereus contamination. Enhanced postrecall surveillance was conducted to detect vaccine-associated B. cereus infections., Methods: We reviewed reports involving recalled Hib vaccines received by the Vaccine Adverse Event Reporting System (VAERS) during 1 April 2007-29 February 2008. For each reported death, autopsy review sought evidence of B. cereus infections. For each specified outcome, the proportional reporting ratios (PRRs) were calculated to compare the recalled Hib vaccines with the manufacturer's nonrecalled Hib vaccines in the VAERS databases. On 20 December 2007, we used the Epidemic Information Exchange (Epi-X) to solicit nongastrointestinal vaccine-associated B. cereus infections, and requested B. cereus isolates for genotyping to compare with the manufacturing facility isolate., Results: VAERS received 75 reports involving recalled Hib vaccines; none described a confirmed B. cereus infection. Comparative analyses did not reveal disproportionate reporting of specified outcomes for recalled Hib vaccines. The Epi-X posting triggered one report of vaccine-associated B. cereus bacteremia from a child who received a nonrecalled Hib vaccine manufactured by Merck; the genotypes of isolates from the patient and the manufacturing facility differed., Conclusions: No evidence of vaccine-associated B. cereus infection had been found in recipients of recalled Hib vaccines. Conducting laboratory surveillance through Epi-X was feasible and may enhance public health response capacities for future vaccine safety emergencies.

We report a 16-year-old woman patient with acute lymphoblastic leukemia (ALL) who developed severe critical illness polyneuropathy (CIP). She developed Bacillus cereus sepsis with multiple brain abscesses after chemotherapy. Although she was successfully treated and her general condition recovered, she could not stand. CIP was diagnosed based on the clinical course and electrophysiological studies. Since vincristine (VCR) was thought to have aggravated neurological symptoms, ALL treatment was continued without VCR. Five months from the onset of CIP, she could walk again with steppage gait. This case suggests that CIP can recover even while continuing ALL treatment, but omitting VCR.

Pyogenic infections of the central nervous system of dental origin are quite uncommon in industrialized countries. We report six cases with intracerebral (n = 4) and intraspinal (n = 2) infections treated in our hospital. The microbial pathogen was successfully isolated in all patients. Fusobacterium nucleatum as well as Streptococcus species were found in three cases. Bacillus species were identified in two patients. Actinomyces was the etiologic agent in one case. All patients suffered from dental pathologies, so that after clinical and radiological exclusion of other sources an oral focus was presumed. Therapeutic management consisted of an operative procedure in order to obtain decompression, as well as evacuation of the pus on the one hand, followed by targeted antibiotics on the other. Clinical improvement was achieved in all patients, with one patient lost to follow-up. On magnetic resonance tomography, the inflammatory changes also disappeared in all cases. We recommend that oral infection with recurrent bacteraemia should always be considered in the pathogenesis of the so-called "cryptic" intracerebral and intraspinal infections.

The authors report a case of a cutaneous infection due to Bacillus licheniformis. It occurred after a wound due to a wicker splinter. The bacteriological identification was easy thanks to the very typical aspects of culture. First intention antibiotherapy given for bacterial dermo-hypodermatitis may be ineffective because Bacillus licheniformis secretes a biofilm and is frequently resistant to Beta-lactams.

We describe a 72-year-old Chinese man who developed fulminant Bacillus cereus endophthalmitis 36 h after an uneventful surgery for cataract extraction. Clinical progression of disease was extremely rapid, in spite of early vitrectomy and intravitreal injection of antibiotics. Results of Gram staining showed gram-positive bacilli, and the culture was positive for B. cereus. Endophthalmitis is rare after cataract surgery (cumulative probability within 1 year, approximately 0.08%), and cases caused by B. cereus are even less common. The prognosis and plan of treatment are discussed.

As part of the follow-up investigations associated with an outbreak of severe illness and death among illegal injecting drug users during 2000, 43 cultures of Clostridium novyi type A, 40 C. perfringens type A and 6 isolates of Bacillus cereus were characterised by amplified fragment length polymorphism (AFLP) analysis. Among the 43 C. novyi isolates, 23 different AFLP profiles were detected. The same AFLP profile was detected in isolates from 18 drug users investigated during 2000 from Scotland, England, the Republic of Ireland and Norway and a wound from a patient in 2000 who was not identified as a drug user. Unique AFLP profiles were obtained from four drug users from England and the Republic of Ireland, 10 historical isolates from culture collections, an isolate from food (1989) and three isolates from wounds (1995, 1991, 1988). The 40 C. perfringens isolates were from 13 drug users, the contents of one syringe and two samples of heroin. Sixteen AFLP types of C. perfringens were distinguished and there was little evidence for commonality among the isolates. The AFLP types of C. perfringens from heroin differed and were unique. Six isolates of B. cereus were from four drug users and two samples of heroin. Four different AFLP patterns were distinguished. Three AFLP types were isolated from four drug users. B. cereus isolates from an aspirate and a heroin sample collected from the same drug user were identical, and were also indistinguishable from an isolate from a groin infection in a second drug user. The AFLP type of the isolate from a second and unrelated heroin sample was unique. The AFLP results showed no or very limited evidence for commonality between the different isolates of B. cereus and C. perfringens. In marked contrast, the C. novyi isolates from the majority of the drug users during 2000 were homogeneous, suggesting a common source or clonal selection of a C. novyi type, or both, which either had an adaptive advantage in spore germination, survival or growth following the drug preparation and the injection procedure, or produced a more severe clinical presentation.

Membrane-damaging toxins are thought to be responsible for the explosive clinical course of Bacillus endophthalmitis. This study analyzed the contribution of phosphatidylinositol-specific phospholipase C (PI-PLC) and phosphatidylcholine-specific phospholipase C (PC-PLC) to the pathogenesis of experimental Bacillus endophthalmitis. Isogenic mutants were constructed by insertion of lacZ into Bacillus thuringiensis genes encoding PI-PLC (plcA) and PC-PLC (plcB). Rabbit eyes were injected intravitreally with 2 log(10) CFU of strain BT407 (wild type), the PI-PLC mutant (BTplcA::lacZ), or the PC-PLC mutant (BTplcB::lacZ). The rates of decrease in retinal responses of eyes infected with the isogenic mutants were similar to that of wild type, with all infections resulting in elimination of retinal function by 18 h. Strain BT407 caused a significant increase in the latency of retinal responses at 6 h, but strains BTplcA::lacZ and BTplcB::lacZ did not. All strains elicited significant inflammatory cell influx into the anterior chamber by 12 h. Histologically, eyes infected with each strain were indistinguishable throughout the infection course. In this model, neither PI-PLC nor PC-PLC had an effect on the course or severity of experimental Bacillus endophthalmitis. Alterations in retinal responses early in infection may mark the beginnings of specific photoreceptor or glial cell dysfunction.

Objective: We report the first case of contact lens-related Bacillus cereus keratitis and ulcer associated with B. cereus contamination of the contact lens case. This is also the first study to investigate and establish the genetic identity of an organism isolated from the cornea and contact lens case in a patient with contact lens-associated keratitis., Design: Case report., Intervention and Testing: Conjunctival swabs and corneal scrapings from the left eye were inoculated for culture. The contact lens case was also cultured. Antibiotic susceptibility testing was determined by agar disk diffusion method. Initial treatment with topical ciprofloxacin and fortified tobramycin was given. Genetic analysis of the bacterial isolates was performed using polymerase chain reaction (PCR) with enterobacterial repetitive intergenic consensus primers (ERIC; ERIC-PCR). Susceptibility of B. cereus to heat and contact lens disinfecting solutions containing hydrogen peroxide, hydrogen peroxide-catalase, polyquaternium-1, and polyaminopropyl biguanide (PAPB) was tested., Main Outcome Measures: Clinical features, culture results, and antibiotic susceptibility testing were analyzed. The ERIC-PCR amplification products were visualized in ethidium bromide-stained agarose gel. Bacterial growth after exposure to heat and contact lens disinfecting solutions was assessed on blood agar plates., Results: B. cereus was grown from the conjunctiva, corneal ulcer, and contact lens case. All isolates were sensitive to gentamicin, tobramycin, ciprofloxacin, clindamycin, and vancomycin. The corneal ulcer gradually healed over the next 6 days. Results of ERIC-PCR showed that the isolates from the cornea and contact lens case were indistinguishable, thus demonstrating the source of infecting organism to be the contaminated contact lens case. Exposure to a temperature of 80 degrees C for 20 minutes and incubation with hydrogen peroxide-catalase, polyquaternium-1, and PAPB for the minimum recommended time failed to kill B. cereus. Only exposure to hydrogen peroxide for 4 hours eradicated the organism., Conclusions: B. cereus should be considered a possible etiologic agent of contact lens-associated keratitis. Heat and many types of contact lens disinfecting solutions may be ineffective in eradicating B. cereus from contaminated contact lens cases. Only prolonged exposure to hydrogen peroxide appeared to be sporicidal to B. cereus in this study.

In the period 1989-1999, Bacillus sphaericus was demonstrated to cause 12 out of 469 (2%) episodes of bacteraemia in children with cancer or receiving bone marrow transplant at G. Gaslini Children's Hospital, Genoa, Italy. Neutropenia was present in five episodes, six episodes, (all without neutropenia) were related to the presence of a central venous catheter, and one episode occurred in a patient with intestinal graft vs. host disease and gut colonization. All patients survived. Ciprofloxacin was the only drug active against all the isolated strains.Bacillus sphaericus represents a new cause of infection in the immunocompromised host, with low aggressiveness, but a peculiar pattern of antibiotic susceptibility., (Copyright 2001 The Hospital Infection Society.)

Paenibacillus species are gram-positive, rod-shaped, spore-forming aerobes that are abundant in nature and closely related to Bacillus. Between June 24 and June 30, 1999, 8 neonates in our neonatal intensive care unit had positive blood cultures for Paenibacillus macerans. This cluster of positive blood cultures with an unusual pathogen suggested a pseudoepidemic. Investigation revealed that the most likely etiology of the pseudobacteremia was environmental contamination of the rubber stoppers in blood culture bottles. This was confirmed by environmental sampling and simulated inoculation studies. This pseudobacteremia outbreak highlights the importance of adhering to well-established methods for blood culture collection and ongoing infection control surveillance.

Non-anthrax Bacillus species are rare, but serious causes of bacterial meningitis in those either immunocompromised or treated with CSF diversion. Although resistant to first-line antibiotics, they usually respond to chloramphenicol. We report a case of fulminant Bacillus cereus meningitis that complicated lumbar spinal drainage which proved resistant to all first-line antibiotics including chloramphenicol.

Bacillus thuringiensis has been widely used for 40 years as a safe biopesticide for controlling agricultural pests and mosquitoes because it produces insecticidal crystal proteins. However, spores have also been shown to contribute to overall entomopathogenicity. Here, the opportunistic properties of acrystalliferous B. thuringiensis Cry(-) and Bacillus cereus strains were investigated in an insect species, Galleria mellonella, and in a mammal, BALB/c mice. In both animal models, the pathogenicity of the two bacterial species was similar. Mutant strains were constructed in which the plcR gene, encoding a pleiotropic regulator of extracellular factors, was disrupted. In larvae, co-ingestion of 10(6) spores of the parental strain with a sublethal concentration of Cry1C toxin caused 70% mortality whereas only 7% mortality was recorded if spores of the DeltaplcR mutant strain were used. In mice, nasal instillation of 10(8) spores of the parental strain caused 100% mortality whereas instillation with the same number of DeltaplcR strain spores caused much lower or no mortality. Similar effects were obtained if vegetative cells were used instead of spores. The cause of death is unknown and is unlikely to be due to actual growth of the bacteria in mice. The lesions caused by B. thuringiensis supernatant in infected mice suggested that haemolytic toxins were involved. The cytolytic properties of strains of B. thuringiensis and B. cereus, using sheep, horse and human erythrocytes and G. mellonella haemocytes, were therefore investigated. The level of cytolytic activity is highly reduced in DeltaplcR strains. Together, the results indicate that the pathogenicity of B. thuringiensis strain 407 and B. cereus strain ATCC 14579 is controlled by PlcR.

Objective: To report the clinical outcome of chronic Bacillus endophthalmitis after cataract surgery., Design: Retrospective, noncomparative case series., Participants: Five eyes of five patients with late-onset or recurrent inflammation after exposure to bacteria-contaminated viscoelastic material were studied., Intervention: Repeated vitrectomies, wide excision of the remnant posterior capsule, and intravitreal injections of antibiotics in five patients. Eventual explantation of the intraocular lens in four patients., Main Outcome Measures: Final visual acuities and results of microbiologic studies of aqueous and vitreous specimens as well as pathologic studies using hematoxylin-eosin, Gram, and periodic acid-Schiff (PAS) stain of explanted capsular remnants were obtained., Results: Final visual acuity of 20/40 or better was obtained in three patients. Bacillus species were grown from two cases. PAS- and Gram-positive microorganisms were identified in the capsular tissue in three of four patients who had explantation of the intraocular lens., Conclusions: A chronic form of Bacillus endophthalmitis is described for the first time. The clinical outcome is similar to chronic endophthalmitis caused by other organisms.

In recent years manufacturers have developed several products containing saprophytic bacteria, previously believed to be of minimal pathogenicity. We describe the first case of persistent Bacillus licheniformis bacteremia occurring after intentional injection of a consumer product that includes B. licheniformis spores. We postulate that these spores remained in the tissue, unaffected by antimicrobials, ultimately necessitating soft-tissue debridement of the area surrounding the injection site. On the basis of this case and a review of the literature, we submit that some consumer products contain bacteria with demonstrated pathogenicity. Manufacturers should study these bacteria in detail in order to rapidly provide information such as bacteriologic data and antimicrobial susceptibility data to clinicians.

Purpose: Bacillary endophthalmitis occurring after penetrating ocular trauma with an intraocular foreign body is always associated with poor visual outcome. Bacilli cause fulminant infection associated with tissue damage in the intraocular structures., Case Reports: Our series consisted of four patients with penetrating ocular trauma and endophthalmitis caused by B. cereus or B. licheniformis. Three eyes ultimately developed phtisis. Only on eye recovered good vision (2.5/10 P4)., Discussion: Recommended early treatment includes topical, subconjunctival, parenteral antibiotics. A review of the literature indicates that intravitreal antibiotic infusion is crucial for sufficient concentration to control infection. Early vitrectomy is recommended in the management of endophthalmitis. Vitreous and intraocular foreign bodies should be cultured to identify pathogens and ascertain antibiotic susceptibilities.

Bacillus species were recovered from the blood cultures of 39 oncology patients over 14 weeks. A matched case-control study showed a strong association of Bacillus species bacteremia with use of calcium gluconate solution (odds ratio=25.0) and of central venous lines (odds ratio=8.8). Stopping use of the implicated calcium gluconate vials controlled the outbreak.

Non-anthrax Bacillus species are usually considered to be contaminants if found in clinical specimens. Only a few patients with systemic infections due to Bacillus cereus are reported. We present the case of a 18-month old boy with a primitive neuroectodermal tumor (PNET) in the brainstem and obstructive hydrocephalus that required an outlying and subsequently a ventriculoperitoneal drain. Following contamination at the site of entry of the external drain, shunt infection and meningitis with Bacillus cereus developed. Antibiotic treatment with vancomycin failed to eliminate the bacterium from the cerebrospinal fluid, so the shunt system had to be removed. Explantation of the shunt and addition of fosfomycin to the antibiotic regimen resulted in a complete cure of the infection.

Objective: The purpose of the study is to report the clinical outcome of acute Bacillus endophthalmitis after cataract surgery., Design: The study design is a cohort study., Participants: Fourteen eyes of 14 patients with epidemic acute postoperative inflammation after exposure to bacteria-contaminated viscoelastic material were studied., Intervention: Three patients with milder clinical presentations were treated without vitrectomy or antibiotics. Eleven patients with more severe infection were treated with vitrectomy as well as intravitreous and topical fortified antibiotics., Main Outcome Measures: Final visual acuities were obtained in all 14 study patients. Results of microbiologic studies of aqueous and vitreous specimens from 11 vitrectomized eyes also were analyzed., Results: One patient with late presentation had severe inflammation and had phthisis bulbi develop with no light perception. The remaining 13 patients had successful resolution of inflammation after treatment by 1 month of follow-up. Twelve of these 13 patients, including 1 nonvitrectomized patient, had final visual acuities of 20/100 or better at 6 months' follow-up. Six patients, including two patients with nonvitrectomized eyes, had outcomes of 20/40 or better visual acuity. Bacillus species were grown from all 11 (100%) vitreous and 7 (88%) of 8 aqueous specimens obtained from vitrectomized patients, as well as from the contaminated viscoelastic material remaining in the operating room., Conclusions: Postoperative Bacillus endophthalmitis need not result in poor outcome. Results depend on factors including bacterial load, specific bacterial species, timing of treatment, and immune status of the patient.

Endophthalmitis is the syndrome of inflammation or infection of the ocular cavity and its adjacent structures and can result in severe sequelae, such as visual loss. Although most postoperative endophthalmitis following intraocular surgery is caused by infection with normal skin flora, cases associated with the intraoperative use of contaminated eye solutions or materials have been reported. This report summarizes outbreaks of postoperative bacterial (Pseudomonas aeruginosa or Bacillus spp.) endophthalmitis in Thailand and Canada; the outbreaks were associated with the intraoperative use of intrinsically contaminated basal salt solution (BSS) and hyaluronic acid.

Laboratory and field studies were conducted to determine the effectiveness of the antibiotic tylosin in preventing and controlling infections of American foulbrood disease (AFB) of honey bees. Studies conducted on immature worker bees maintained in the laboratory revealed that honey bee larvae could tolerate quite a range of doses of antibiotic in their diet. Intermediate doses of tylosin protected very young larvae from becoming infected by Bacillus larvae at a concentration of 1.5 x 10(8) spores/ml of diet. Antibiotic treatment had no measurable effects on larval or pupal developmental rates until the dose reached a lethal level. Bees in field colonies readily consumed tylosin in powered sugar, up to a level of 800 mg/7 g sugar. No negative colony effects were noted at any dosage rates. Protection against infection by American foulbrood was compared to results obtained with 200 mg Terramycin, the standard dose of the only substance currently registered for foulbrood control. Both 200 mg Terramycin and 100 mg tylosin protected the colonies for up to 3 weeks. A 200-mg dose of tylosin protected the colony for an additional week. Doses of 100 mg or more of tylosin were adequate to eliminate signs of AFB infection in overtly diseased colonies.

Purpose: The authors compare the intravitreal efficacy of ciprofloxacin, vancomycin and imipenem, in treating experimental Bacillus cereus endophthalmitis., Methods: Thirty-three Yorkshire pigs received a surgically induced injury to the right eye, which was then repaired and injected with 8400 colony forming units of live B. cereus. Nine pigs received no therapy and served as a natural history group. Twenty-four other pigs then were randomized into a treatment group with ciprofloxacin (n = 6), vancomycin (n = 6), imipenem (n = 6), or normal saline (n = 6). Eyes were examined clinically 1, 2, 3, 4, 5, 6, 8, 12, and 24 hours after inoculation. After 24 hours, the eyes were enucleated for histologic study., Results: Experimental disease was characterized by an aggressively developing endophthalmitis, with retinitis and vitritis developing at 4 hours. Histologic examination showed vitreous abscess and retinal necrosis. Both vancomycin- and imipenem-treated group had less inflammation and tissue destruction than control animals, based on the Wilcoxon rank sum test (P < 0.05). Ciprofloxacin-treated animals showed significantly more intraocular destruction and were indistinguishable from controls., Conclusion: Vancomycin and imipenem appear to limit inflammation and tissue destruction when given early in the course of experimental posttraumatic endophthalmitis caused by B. cereus. Results with ciprofloxacin are less conclusive and warrant further investigation.

A 73-year old man developed an acute prosthetic aortic valve dehiscence for which emergent operation was undertaken. The intraoperative evidence of an aortic annular disruption and of a subannular abscess led to the hypothesis that an endocarditis process was involved. The aortic valve was replaced with a stentless porcine bioprosthesis. Cultures taken intraoperatively from the aortic area had a pure growth of aerobic, spore-forming, gram-positive bacilli identified as Bacillus licheniformis. The patient responded to specific antibiotic therapy with no relapse at a 20-month follow-up. The potentiality of B. licheniformis as a pathogen should be reconsidered.

We report a case of a brain abscess due to Bacillus macerans and Clostridium sp. following a penetrating periorbital injury by a wooden branch. Intracranial penetration by and retention of a foreign body were not suspected initially, and neurological symptoms developed only 2.5 months later. Previously reported cases of brain abscesses due to Bacillus species are reviewed.

A 13-fold increase (0.08 to 1.05%) in the isolation rate of Bacillus species from in-patient blood cultures led to the investigation of pseudobacteremia over a four-month period. Data on blood isolates (BACTEC NR 660, bottle types 6A and PEDS) of Bacillus species were compiled between July and October 1993. BACTEC bottles, as well as their plastic lids and rubber septa (representing 20% of stored bottles), and alcohol swabs, iodine preparation pads and butterfly collection systems were cultured. Air plates inside the BACTEC 660 instrument were cultured, as well as swabs of both the BACTEC needles and the interior of the BACTEC handling area. To investigate carry-over contamination, sterile BACTEC bottles were tested immediately following bottles containing Bacillus species. Growth of Bacillus species was obtained from 16% of the plastic lids and 1.3% of the rubber septa. No growth was obtained from other cultures. The outbreak coincide with construction on a driveway of the hospital over the area where BACTEC bottles were stored. Upon completion of construction in November 1993, the isolation of Bacillus species returned to baseline. No pseudobacteremia isolates occurred in areas where the trained intravenous team was assigned. In conclusion, hospital construction leading to airborne spread of Bacillus species may cause Bacillus species pseudobacteremia, and failure to disinfect blood culture bottles adequately may predispose to such an outcome.

Non-anthracis Bacillus species associated with clinical infections are usually dismissed as contaminants or nonpathogens. As opportunists, however, Bacillus organisms can cause significant systemic infections including bacteremia, endophthalmitis, and pneumonia. Osteomyelitis with non-anthracis Bacillus organisms has been described in adults, although to our knowledge it has been described only once in a child. We report a case of chronic osteomyelitis due to Staphylococcus aureus and superinfection with Bacillus cereus in a 13-year-old adolescent. A Bacillus isolate should be considered a true pathogen in children with chronic osteomyelitis who have a poor clinical response to antistaphylococcal therapy.

Bacillus cereus, an infectious cause of foodborne illness, accounted for 2% of outbreaks with confirmed etiology that were reported to CDC during 1973-1987 (1). On July 21, 1993, the Lord Fairfax (Virginia) Health District received reports of acute gastrointestinal illness that occurred among children and staff at two jointly owned child day care centers following a catered lunch. This report summarizes the investigation of this outbreak.

A rare case of prosthetic valve endocarditis by Bacillus cereus was reported. The patient was 43-year-old Japanese man, who had mitral valve replacement 5 months prior to this admission. Remitral valve replacement was immediately done successfully. His postoperative course was uneventful for 8 months.

Non-anthracis Bacillus species are ubiquitous gram-positive spore-forming organisms that were once believed to be nonpathogenic but are now recognized as causing a variety of infections. We report a new aspect of trauma associated with bacillus infection: clinically significant infection by Bacillus species in patients who are involved in motor vehicle accidents and sustain injury related to road contact. Cases were evaluated retrospectively from May 1990 through December 1991. Four patients who had documented infections with Bacillus species and who were involved in motor vehicle accidents associated with road trauma were identified during this period. The antibiotic susceptibility profile of the Bacillus species consistently demonstrated resistance to beta-lactam antibiotics. This series of cases illustrates an additional aspect of disease associated with bacteria of the Bacillus species that should be considered for patients who have sustained injuries from motor vehicle accidents associated with road trauma.