Nadir Görülen Fırsatçı Patojen Bacillus pumilus’un Neden Olduğu Bir Sepsis Olgusu

Abstract

The high prevalence of Bacillus species in nature and the detection of these bacteria as contaminant in cultures may lead diagnostic dilemma, however they should still be considered as a pathogen particularly in case of repeated positive cultures from patients with risk factors. Bacillus pumilus is a bacteria, though rarely, been reported as the causative agent of various infections such as sepsis, endocarditis, skin infections and food poisoning in human. In this report, a sepsis case in an immunocompetent patient caused by B.pumilus was presented. A 38-year-old female patient was admitted to emergency service of our hospital with the complaints of headache, dizziness and diarrhea. She had not any risk factors except a history of heart valve replacement operation two years ago. In physical examination, she had abdominal retention, high fever and hypotension, together with the high levels of sedimentation rate (ESR) and C-reactive protein (CRP). The patient was hospitalized with the preliminary diagnosis of sepsis. Three sets of blood samples at two different periods were taken for the culture. All blood culture vials had a positive signal at the second day of incubation in BD BACTEC™ 9050 system, therefore subcultures were performed in sheep blood agar, chocolate agar and MacConkey agar, and incubated in aerobic and anaerobic conditions. Beta-haemolytic, gray-colored large colonies were isolated from anaerobic culture at the end of 18-24 hours incubation, and Gram staining from colonies showed gram-positive rods. The isolate was identified as B.pumilus with 99% accuracy rate by using BD Phoenix™ 100 identification system. This result was also confirmed by MALDI-TOF based VITEK® MS system and 16S rRNA sequencing by Illumina MiSeq® platform. Antibiotic susceptibility test performed by BD Phoenix™ 100 system and the isolate was found to be resistant against penicillin, while it was susceptible to vancomycin, erythromycin, clindamycin, levofloxacin, and trimethoprim-sulfamethoxazole. Initial treatment of patient was started with intravenous ceftriaxone and metronidazole empirically. Hypotension and fever returned to normal levels at the second and third days of the treatment, respectively. Metronidazole treatment was stopped at seventh day, and treatment was completed to 14 day with ceftriaxone alone. At the end of the treatment course, general condition of the patient was completely good, ESR and CRP were also decreased to normal levels. In conclusion, although most of the reported bloodstream infections that are caused by B.pumilus are intravascular catheter-related, artificial heart valves should also be considered as a risk factor even though vegetation was not detected in our patient.

Phenotypical characterization, and antibiotics susceptibility patterns of skin bacteria found in podoconiosis patients in the North West Region of Cameroon

“…In the case of podoconiosis, the legs are compromised by moss formation, folding, and wounds, and this may pave a good path for these bacteria to enter and cause more damage. Bacillus pumilus is a rare opportunistic pathogen that has been link to sepsis and the severity of LF in a case study [ 29 , 53 ]. Thus, the identification of these bacteria in podoconiosis may possibly indicate their participation in the severity of the disease.…”

Bacillus pumilus cellulitis with bacteremia in a person who injects drugs, living with HIV–HCV co-infection: a case report

“…Akin to Bacillus cereus (B. cereus), but to a much lesser extent, it has been associated with mild and self-limited foodborne illness caused by consuming toxin-contaminated foods [3,4]. Its association with invasive infections seems to be even rarer, with only 17 cases reported to date, including primary bloodstream infection [5][6][7][8], catheter-related bloodstream infection [1,5,9], skin and soft tissue infection [10,11], septic arthritis/osteomyelitis [12,13], foramen ovale patch endocarditis [14] and gastroenteritis-related bacteremia [15]. Of these, eight occurred in immunocompromised hosts.…”