UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

Bacillus cereus and other non-anthracis Bacillus species

Authors
Lisa Noonan, MSc, MBChB, DTMH, FRACP
Joshua Freeman, MBChB, FRCPA
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH

INTRODUCTION

The Bacillus cereus group is comprised of seven closely related species: B. cereus, B. mycoides, B. pseudomycoides, B. thuringiensis, B. weihenstephanensis, B. toyonensis, and B. anthracis [1-5]. Most human non-anthracis Bacillus spp infections are caused by B. cereus, although infections with other species within the B. cereus group have also been described [1,2]. Not all isolates are associated with invasive disease. B. cereus is associated with nosocomial and opportunistic infections, particularly in immunocompromised patients, intravenous drug users, and patients with indwelling or implanted devices. B cereus is also associated with syndromes such as food poisoning due to toxin production.

Issues related to B. cereus and other non-anthracis Bacillus species will be reviewed here. Issues related to B. anthracis are discussed separately. (See "Microbiology, pathogenesis, and epidemiology of anthrax" and "Clinical manifestations and diagnosis of anthrax" and "Treatment of anthrax".)

MICROBIOLOGY

Members of the B. cereus group are catalase-positive, aerobic (or facultatively anaerobic), spore-forming gram-positive bacilli [6]. Occasionally, B. cereus may appear gram variable or even gram negative with age. In Gram stains of body fluids, B. cereus appears straight or slightly curved with square ends arranged either alone or in short chains. Junctions between members of the chain are clearly visible. Gram staining of B. cereus taken from agar colonies tends to have a more uniform bacillary appearance ranging in size from 3 by 0.4 microns up to 9 by 2 microns. B. cereus present in tissue sections may appear long and filamentous. Spores are not always visible on Gram stain but, when apparent, they are located centrally, do not distort the bacillary shape, and are clear in appearance. Spores can be stained using specific dyes (eg, malachite green) that are absorbed by spores in the presence of heat.

Bacillus species are easily recovered on blood and chocolate agars and grow optimally at environmental temperatures (25 to 37°C). All species except B. anthracis are motile and beta-hemolytic on blood agar. Colonies have an irregular perimeter and appear dull gray and opaque on sheep blood agar. On egg yolk agar, members of the B. cereus group produce a zone of opacification due to lecithinase production.

Individual species within the B. cereus group cannot usually be differentiated by diagnostic laboratories (with the exception of B. anthracis, which is nonmotile and nonhemolytic). Newer methods for identifying microorganisms such as matrix-assisted light desorption/ionization–time of flight mass spectrometry (MALDI-TOF MS) can reportedly differentiate between some members of the B. cereus group (eg, between B. cereus sensu stricto and B. thuringiensis), but this may not be achievable using standard databases and identification algorithms [7]. Therefore, distinguishing individual species within the B. cereus group usually requires specialized molecular testing by a reference laboratory [8].

                       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2017. | This topic last updated: Feb 09, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Fekete T. Bacillus species and related genera other than Bacillus anthracis. In: Principles and Practice of Infectious Diseases, Mandell GL, Bennett JE, Dolin RM (Eds), Churchill Livingston, New York City 2010. p.2727.
  2. Drobniewski FA. Bacillus cereus and related species. Clin Microbiol Rev 1993; 6:324.
  3. Bottone EJ. Bacillus cereus, a volatile human pathogen. Clin Microbiol Rev 2010; 23:382.
  4. Tuazon CU. Bacillus species. In: Antimicrobial therapy and vaccines I, Yu VL, Weber R, Raoult D (Eds), Apple Trees Production, New York City 2002. p.73.
  5. Jiménez G, Urdiain M, Cifuentes A, et al. Description of Bacillus toyonensis sp. nov., a novel species of the Bacillus cereus group, and pairwise genome comparisons of the species of the group by means of ANI calculations. Syst Appl Microbiol 2013; 36:383.
  6. Logan NA, Popovic T, Hoffmaster A. Bacillus and other aerobic endospore forming bacteria. In: Manual of Clinical Microbiology, Murray PR, Baron EJ, Jorgensen JH, et al (Eds), American Society for Microbiology Press, Washington, DC 2007. p.455.
  7. Fernández-No IC, Böhme K, Díaz-Bao M, et al. Characterisation and profiling of Bacillus subtilis, Bacillus cereus and Bacillus licheniformis by MALDI-TOF mass fingerprinting. Food Microbiol 2013; 33:235.
  8. Turenne CY, Snyder JW, Alexander DC. Bacillus and other aerobic endospore forming bacteria. In: Manual of Clinical Microbiology, Jorgensen JH, Pfaller MA, Carroll KC, et al. (Eds), American Society for Microbiology Press, Washington, DC 2015. p.441.
  9. Guinebretière MH, Thompson FL, Sorokin A, et al. Ecological diversification in the Bacillus cereus Group. Environ Microbiol 2008; 10:851.
  10. Rasko DA, Altherr MR, Han CS, Ravel J. Genomics of the Bacillus cereus group of organisms. FEMS Microbiol Rev 2005; 29:303.
  11. Helgason E, Okstad OA, Caugant DA, et al. Bacillus anthracis, Bacillus cereus, and Bacillus thuringiensis--one species on the basis of genetic evidence. Appl Environ Microbiol 2000; 66:2627.
  12. Brézillon C, Haustant M, Dupke S, et al. Capsules, toxins and AtxA as virulence factors of emerging Bacillus cereus biovar anthracis. PLoS Negl Trop Dis 2015; 9:e0003455.
  13. Klee SR, Ozel M, Appel B, et al. Characterization of Bacillus anthracis-like bacteria isolated from wild great apes from Cote d'Ivoire and Cameroon. J Bacteriol 2006; 188:5333.
  14. Marston CK, Ibrahim H, Lee P, et al. Anthrax Toxin-Expressing Bacillus cereus Isolated from an Anthrax-Like Eschar. PLoS One 2016; 11:e0156987.
  15. Hoffmaster AR, Ravel J, Rasko DA, et al. Identification of anthrax toxin genes in a Bacillus cereus associated with an illness resembling inhalation anthrax. Proc Natl Acad Sci U S A 2004; 101:8449.
  16. Hoffmaster AR, Hill KK, Gee JE, et al. Characterization of Bacillus cereus isolates associated with fatal pneumonias: strains are closely related to Bacillus anthracis and harbor B. anthracis virulence genes. J Clin Microbiol 2006; 44:3352.
  17. Avashia SB, Riggins WS, Lindley C, et al. Fatal pneumonia among metalworkers due to inhalation exposure to Bacillus cereus Containing Bacillus anthracis toxin genes. Clin Infect Dis 2007; 44:414.
  18. Turnbull PC, Sirianni NM, LeBron CI, et al. MICs of selected antibiotics for Bacillus anthracis, Bacillus cereus, Bacillus thuringiensis, and Bacillus mycoides from a range of clinical and environmental sources as determined by the Etest. J Clin Microbiol 2004; 42:3626.
  19. Luna VA, King DS, Gulledge J, et al. Susceptibility of Bacillus anthracis, Bacillus cereus, Bacillus mycoides, Bacillus pseudomycoides and Bacillus thuringiensis to 24 antimicrobials using Sensititre automated microbroth dilution and Etest agar gradient diffusion methods. J Antimicrob Chemother 2007; 60:555.
  20. Weber DJ, Saviteer SM, Rutala WA, Thomann CA. In vitro susceptibility of Bacillus spp. to selected antimicrobial agents. Antimicrob Agents Chemother 1988; 32:642.
  21. Andrews JM, Wise R. Susceptibility testing of Bacillus species. J Antimicrob Chemother 2002; 49:1040.
  22. Veysseyre F, Fourcade C, Lavigne JP, Sotto A. Bacillus cereus infection: 57 case patients and a literature review. Med Mal Infect 2015; 45:436.
  23. Duport C, Jobin M, Schmitt P. Adaptation in Bacillus cereus: From Stress to Disease. Front Microbiol 2016; 7:1550.
  24. Stenfors Arnesen LP, Fagerlund A, Granum PE. From soil to gut: Bacillus cereus and its food poisoning toxins. FEMS Microbiol Rev 2008; 32:579.
  25. Gohar M, Faegri K, Perchat S, et al. The PlcR virulence regulon of Bacillus cereus. PLoS One 2008; 3:e2793.
  26. Senesi S, Ghelardi E. Production, secretion and biological activity of Bacillus cereus enterotoxins. Toxins (Basel) 2010; 2:1690.
  27. Turnbull PC, Kramer JM. Intestinal carriage of Bacillus cereus: faecal isolation studies in three population groups. J Hyg (Lond) 1985; 95:629.
  28. Shamsuddin D, Tuazon CU, Levy C, Curtin J. Bacillus cereus panophthalmitis: source of the organism. Rev Infect Dis 1982; 4:97.
  29. Tuazon CU, Hill R, Sheagren JN. Microbiologic study of street heroin and injection paraphernalia. J Infect Dis 1974; 129:327.
  30. Tuazon CU, Murray HW, Levy C, et al. Serious infections from Bacillus sp. JAMA 1979; 241:1137.
  31. Centers for Disease Control and Prevention (CDC). Notes from the field: Contamination of alcohol prep pads with Bacillus cereus group and Bacillus species--Colorado, 2010. MMWR Morb Mortal Wkly Rep 2011; 60:347.
  32. Pearson HE. Human infections caused by organisms of the bacillus species. Am J Clin Pathol 1970; 53:506.
  33. Cunha BA, Schoch PE, Bonoan JT. Bacillus species pseudomeningitis. Heart Lung 1997; 26:249.
  34. Ashkenazi-Hoffnung L, Kaufman Z, Bromberg M, et al. Seasonality of Bacillus species isolated from blood cultures and its potential implications. Am J Infect Control 2009; 37:495.
  35. Hsueh PR, Teng LJ, Yang PC, et al. Nosocomial pseudoepidemic caused by Bacillus cereus traced to contaminated ethyl alcohol from a liquor factory. J Clin Microbiol 1999; 37:2280.
  36. Barrie D, Hoffman PN, Wilson JA, Kramer JM. Contamination of hospital linen by Bacillus cereus. Epidemiol Infect 1994; 113:297.
  37. Noble RC, Reeves SA. Bacillus species pseudosepsis caused by contaminated commercial blood culture media. JAMA 1974; 230:1002.
  38. York MK. Bacillus species pseudobacteremia traced to contaminated gloves used in collection of blood from patients with acquired immunodeficiency syndrome. J Clin Microbiol 1990; 28:2114.
  39. Loeb M, Wilcox L, Thornley D, et al. Bacillus species pseudobacteremia following hospital construction. Can J Infect Control 1995; 10:37.
  40. Bryce EA, Smith JA, Tweeddale M, et al. Dissemination of Bacillus cereus in an intensive care unit. Infect Control Hosp Epidemiol 1993; 14:459.
  41. Curtis JR, Wing AJ, Coleman JC. Bacillus cereus bacteraemia. A complication of intermittent haemodialysis. Lancet 1967; 1:136.
  42. Sasahara T, Hayashi S, Hosoda K, et al. Comparison of hand hygiene procedures for removing Bacillus cereus spores. Biocontrol Sci 2014; 19:129.
  43. Weber DJ, Sickbert-Bennett E, Gergen MF, Rutala WA. Efficacy of selected hand hygiene agents used to remove Bacillus atrophaeus (a surrogate of Bacillus anthracis) from contaminated hands. JAMA 2003; 289:1274.
  44. Centers for Disease Control and Prevention (CDC). Bacillus cereus food poisoning associated with fried rice at two child day care centers--Virginia, 1993. MMWR Morb Mortal Wkly Rep 1994; 43:177.
  45. Ankolekar C, Labbé RG. Survival during cooking and growth from spores of diarrheal and emetic types of Bacillus cereus in rice. J Food Prot 2009; 72:2386.
  46. Ehling-Schulz M, Fricker M, Scherer S. Bacillus cereus, the causative agent of an emetic type of food-borne illness. Mol Nutr Food Res 2004; 48:479.
  47. Weber DJ, Saviteer SM, Rutala WA, Thomann CA. Clinical significance of Bacillus species isolated from blood cultures. South Med J 1989; 82:705.
  48. Cotton DJ, Gill VJ, Marshall DJ, et al. Clinical features and therapeutic interventions in 17 cases of Bacillus bacteremia in an immunosuppressed patient population. J Clin Microbiol 1987; 25:672.
  49. Kuroki R, Kawakami K, Qin L, et al. Nosocomial bacteremia caused by biofilm-forming Bacillus cereus and Bacillus thuringiensis. Intern Med 2009; 48:791.
  50. Ikeda M, Yagihara Y, Tatsuno K, et al. Clinical characteristics and antimicrobial susceptibility of Bacillus cereus blood stream infections. Ann Clin Microbiol Antimicrob 2015; 14:43.
  51. Cone LA, Dreisbach L, Potts BE, et al. Fatal Bacillus cereus endocarditis masquerading as an anthrax-like infection in a patient with acute lymphoblastic leukemia: case report. J Heart Valve Dis 2005; 14:37.
  52. Sliman R, Rehm S, Shlaes DM. Serious infections caused by Bacillus species. Medicine (Baltimore) 1987; 66:218.
  53. Kelley JM, Onderdonk AB, Kao G. Bacillus cereus septicemia attributed to a matched unrelated bone marrow transplant. Transfusion 2013; 53:394.
  54. Sanfructuoso C, Caballero MD, Vázquez L, et al. Rhabdomyolysis associated with septicemia after autologous bone marrow transplantation. Bone Marrow Transplant 1997; 19:95.
  55. Kato K, Matsumura Y, Yamamoto M, et al. Seasonal trend and clinical presentation of Bacillus cereus bloodstream infection: association with summer and indwelling catheter. Eur J Clin Microbiol Infect Dis 2014; 33:1371.
  56. Hilliard NJ, Schelonka RL, Waites KB. Bacillus cereus bacteremia in a preterm neonate. J Clin Microbiol 2003; 41:3441.
  57. Tomomasa T, Itoh K, Matsui A, et al. An infant with ulcerative colitis complicated by endocarditis and cerebral infarction. J Pediatr Gastroenterol Nutr 1993; 17:323.
  58. Torjesen I. Parenteral nutrition product is suspected as cause of 18 cases of septicaemia in neonates. BMJ 2014; 348:g3763.
  59. Shah M, Patnaik S, Wongrakpanich S, et al. Infective endocarditis due to Bacillus cereus in a pregnant female: A case report and literature review. IDCases 2015; 2:120.
  60. Craig CP, Lee WS, Ho M. Letter: Bacillus cereus endocarditis in an addict. Ann Intern Med 1974; 80:418.
  61. Stevens MP, Elam K, Bearman G. Meningitis due to Bacillus cereus: A case report and review of the literature. Can J Infect Dis Med Microbiol 2012; 23:e16.
  62. Wright WF. Central Venous Access Device-Related Bacillus Cereus Endocarditis: A Case Report and Review of the Literature. Clin Med Res 2016; 14:109.
  63. Steen MK, Bruno-Murtha LA, Chaux G, et al. Bacillus cereus endocarditis: report of a case and review. Clin Infect Dis 1992; 14:945.
  64. Oster HA, Kong TQ. Bacillus cereus endocarditis involving a prosthetic valve. South Med J 1982; 75:508.
  65. Abusin S, Bhimaraj A, Khadra S. Bacillus Cereus Endocarditis in a permanent pacemaker: a case report. Cases J 2008; 1:95.
  66. Wanvarie S, Rochanawatanon M. Bacillus cereus endocarditis. J Med Assoc Thai 1979; 62:34.
  67. Castedo E, Castro A, Martin P, et al. Bacillus cereus prosthetic valve endocarditis. Ann Thorac Surg 1999; 68:2351.
  68. Krause A, Freeman R, Sisson PR, Murphy OM. Infection with Bacillus cereus after close-range gunshot injuries. J Trauma 1996; 41:546.
  69. Dryden MS, Kramer JM. Toxigenic Bacillus cereus as a cause of wound infections in the tropics. J Infect 1987; 15:207.
  70. Dubouix A, Bonnet E, Alvarez M, et al. Bacillus cereus infections in Traumatology-Orthopaedics Department: retrospective investigation and improvement of healthcare practices. J Infect 2005; 50:22.
  71. Akesson A, Hedström SA, Ripa T. Bacillus cereus: a significant pathogen in postoperative and post-traumatic wounds on orthopaedic wards. Scand J Infect Dis 1991; 23:71.
  72. Kunimoto D, Rennie R, Citron DM, Goldstein EJ. Bacteriology of a bear bite wound to a human: case report. J Clin Microbiol 2004; 42:3374.
  73. Rutala WA, Saviteer SM, Thomann CA, Wilson MB. Plaster-associated Bacillus cereus wound infection. A case report. Orthopedics 1986; 9:575.
  74. Ribeiro NF, Heath CH, Kierath J, et al. Burn wounds infected by contaminated water: case reports, review of the literature and recommendations for treatment. Burns 2010; 36:9.
  75. Centers for Disease Control and Prevention (CDC). Outbreak of cutaneous Bacillus cereus infections among cadets in a university military program--Georgia, August 2004. MMWR Morb Mortal Wkly Rep 2005; 54:1233.
  76. Dancer SJ, McNair D, Finn P, Kolsto AB. Bacillus cereus cellulitis from contaminated heroin. J Med Microbiol 2002; 51:278.
  77. Sada A, Misago N, Okawa T, et al. Necrotizing fasciitis and myonecrosis "synergistic necrotizing cellulitis" caused by Bacillus cereus. J Dermatol 2009; 36:423.
  78. Meredith FT, Fowler VG, Gautier M, et al. Bacillus cereus necrotizing cellulitis mimicking clostridial myonecrosis: case report and review of the literature. Scand J Infect Dis 1997; 29:528.
  79. Darbar A, Harris IA, Gosbell IB. Necrotizing infection due to Bacillus cereus mimicking gas gangrene following penetrating trauma. J Orthop Trauma 2005; 19:353.
  80. Schricker ME, Thompson GH, Schreiber JR. Osteomyelitis due to Bacillus cereus in an adolescent: case report and review. Clin Infect Dis 1994; 18:863.
  81. Marley EF, Saini NK, Venkatraman C, Orenstein JM. Fatal Bacillus cereus meningoencephalitis in an adult with acute myelogenous leukemia. South Med J 1995; 88:969.
  82. Mori T, Tokuhira M, Takae Y, et al. Successful non-surgical treatment of brain abscess and necrotizing fasciitis caused by Bacillus cereus. Intern Med 2002; 41:671.
  83. Berke E, Collins WF, von Graevenitz A, Bia FJ. Fulminant postsurgical Bacillus cereus meningitis: case report. J Neurosurg 1981; 55:637.
  84. Gaur AH, Patrick CC, McCullers JA, et al. Bacillus cereus bacteremia and meningitis in immunocompromised children. Clin Infect Dis 2001; 32:1456.
  85. Vodopivec I, Rinehart EM, Griffin GK, et al. A Cluster of CNS Infections Due to B. cereus in the Setting of Acute Myeloid Leukemia: Neuropathology in 5 Patients. J Neuropathol Exp Neurol 2015; 74:1000.
  86. Van Der Zwet WC, Parlevliet GA, Savelkoul PH, et al. Outbreak of Bacillus cereus infections in a neonatal intensive care unit traced to balloons used in manual ventilation. J Clin Microbiol 2000; 38:4131.
  87. Weisse ME, Bass JW, Jarrett RV, Vincent JM. Nonanthrax Bacillus infections of the central nervous system. Pediatr Infect Dis J 1991; 10:243.
  88. Davey RT Jr, Tauber WB. Posttraumatic endophthalmitis: the emerging role of Bacillus cereus infection. Rev Infect Dis 1987; 9:110.
  89. Hemady R, Zaltas M, Paton B, et al. Bacillus-induced endophthalmitis: new series of 10 cases and review of the literature. Br J Ophthalmol 1990; 74:26.
  90. Miller JJ, Scott IU, Flynn HW Jr, et al. Endophthalmitis caused by Bacillus species. Am J Ophthalmol 2008; 145:883.
  91. Lam KC. Endophthalmitis caused by Bacillus cereus: a devastating ophthalmological emergency. Hong Kong Med J 2015; 21:475.e1.
  92. Das T, Choudhury K, Sharma S, et al. Clinical profile and outcome in Bacillus endophthalmitis. Ophthalmology 2001; 108:1819.
  93. David DB, Kirkby GR, Noble BA. Bacillus cereus endophthalmitis. Br J Ophthalmol 1994; 78:577.
  94. Pinna A, Sechi LA, Zanetti S, et al. Bacillus cereus keratitis associated with contact lens wear. Ophthalmology 2001; 108:1830.
  95. Basak SK, Deolekar SS, Mohanta A, et al. Bacillus cereus infection after Descemet stripping endothelial keratoplasty. Cornea 2012; 31:1068.
  96. Granum PE, Brynestad S, Kramer JM. Analysis of enterotoxin production by Bacillus cereus from dairy products, food poisoning incidents and non-gastrointestinal infections. Int J Food Microbiol 1993; 17:269.
  97. Das S, Surendran PK, Thampuran NK. PCR-based detection of enterotoxigenic isolates of Bacillus cereus from tropical seafood. Indian J Med Res 2009; 129:316.
  98. Fricker M, Messelhäusser U, Busch U, et al. Diagnostic real-time PCR assays for the detection of emetic Bacillus cereus strains in foods and recent food-borne outbreaks. Appl Environ Microbiol 2007; 73:1892.
  99. Terranova W, Blake PA. Bacillus cereus food poisoning. N Engl J Med 1978; 298:143.
  100. Shandera WX, Tacket CO, Blake PA. Food poisoning due to Clostridium perfringens in the United States. J Infect Dis 1983; 147:167.
  101. Kaplan JE, Feldman R, Campbell DS, et al. The frequency of a Norwalk-like pattern of illness in outbreaks of acute gastroenteritis. Am J Public Health 1982; 72:1329.
  102. Holmberg SD, Blake PA. Staphylococcal food poisoning in the United States. New facts and old misconceptions. JAMA 1984; 251:487.
  103. Chu WP, Que TL, Lee WK, Wong SN. Meningoencephalitis caused by Bacillus cereus in a neonate. Hong Kong Med J 2001; 7:89.
  104. John S, Neary J, Lee CH. Invasive Bacillus cereus infection in a renal transplant patient: A case report and review. Can J Infect Dis Med Microbiol 2012; 23:e109.
  105. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49:1.
  106. Block CS, Levy ML, Fritz VU. Bacillus cereus endocarditis. A case report. S Afr Med J 1978; 53:556.
  107. Ngow HA, Wan Khairina WM. Bacillus cereus endocarditis in native aortic valve. J Infect Chemother 2013; 19:154.
  108. Thomas BS, Bankowski MJ, Lau WK. Native valve Bacillus cereus endocarditis in a non-intravenous-drug-abusing patient. J Clin Microbiol 2012; 50:519.
  109. Barraud O, Hidri N, Ly K, et al. Pacemaker-associated Bacillus cereus endocarditis. Diagn Microbiol Infect Dis 2012; 74:313.
  110. Berner R, Heinen F, Pelz K, et al. Ventricular shunt infection and meningitis due to Bacillus cereus. Neuropediatrics 1997; 28:333.
  111. Gigantelli JW, Torres Gomez J, Osato MS. In vitro susceptibilities of ocular Bacillus cereus isolates to clindamycin, gentamicin, and vancomycin alone or in combination. Antimicrob Agents Chemother 1991; 35:201.
  112. Choudhuri KK, Sharma S, Garg P, Rao GN. Clinical and microbiological profile of Bacillus keratitis. Cornea 2000; 19:301.