A Rare Case of Native Mitral Valve Bacillus Cereus Endocarditis Culminating Into a Cerebrovascular Infarction

Abstract

We report a case of a 56-year-old man who presented initially with a sudden onset of right-sided facial droop and weakness, aphasia, and confusion with no associated fever, chills, syncope, fatigue, weight loss, night sweats, nausea, vomiting, diarrhea, odontalgia, palpitations, cough, or dyspnea. Code stroke was called and the patient received tissue plasminogen activator (tPA) with subsequent resolution of his symptoms. Cranial magnetic resonance imaging showed left frontal punctate cortical restricted diffusion consistent with subacute to acute infarction. Transesophageal echocardiogram showed a severely thickened anterior mitral valve leaflet with a shaggy echodensity consistent with a vegetation. Blood cultures grew Bacillus cereus sensitive to clindamycin, trimethoprim sulfamethoxazole, and vancomycin. He was initially treated with ampicillin, clindamycin, and vancomycin and was eventually maintained solely on vancomycin. He had complete return of his neurological function and was discharged on intravenous antibiotic to complete a 6-week course.

The Food Poisoning Toxins of Bacillus cereus

“…Often neonates, elderly or immunosuppressed patients are affected [ 347 , 348 ], but infections of immunocompetent persons are also known [ 349 ]. These include local, especially post-operative skin and wound infections [ 347 , 349 , 350 ], septicemia [ 350 , 351 , 352 , 353 , 354 , 355 , 356 , 357 , 358 , 359 , 360 ], meningitis [ 361 , 362 , 363 , 364 , 365 , 366 , 367 , 368 , 369 , 370 , 371 , 372 ], pneumonia (often by B. cereus strains exhibiting B. anthracis toxin genes) [ 373 , 374 , 375 , 376 , 377 , 378 ] and endocarditis [ 379 , 380 , 381 , 382 , 383 , 384 , 385 , 386 , 387 , 388 ]. Several studies focus on B. cereus -associated endophthalmitis, which occurs mainly following post-traumatic injuries and often leads to loss of vision or even of the eye in less than 48 h. Severe inflammation is caused by the concerted action of rapid bacterial replication, migration and toxin production […”

Bacillus cereus meningoencephalitis in an immunocompetent patient

“…It is one of the most common causes of food poisoning but infrequently can result in invasive extra-intestinal infections such as wound, eye, and respiratory tract infection [1] , [2] , [3] . It can also cause systemic infections including bacteremia and endocarditis [4] , [5] . Central nervous system (CNS) infection from B. cereus is rare and usually associated with invasive CNS devices or immunosuppressed status.…”

Epidemiological Evaluation of <i>Bacillus cereus</i>-Induced Foodborne Outbreaks — China, 2010–2020

“…B. cereus produces a spectrum of toxins that can be primarily classified into vomiting-type and diarrheatype enterotoxins based on symptoms they cause (4)(5). Its foodborne infections manifest as severe symptoms, such as nausea, vomiting, and diarrhea; in some instances, it can be fatal and typically presents sudden onset (6)(7)(8). Consequently, the results of our analysis can be efficiently utilized to direct and allocate public health resources to mitigate B. cereus associated foodborne diseases.…”