Infectious Disease Compendium

Bacillus

Microbiology

Gram positive rods. B. alvei, B. anthrasis, B. cerus, B. circulans, B. laterosporus, B. megaterium, B. pumilus, B. sphaericus, B. subtilus, B. thuringenisis.

Epidemiologic Risks

Depends on the organism.

B. cereus group and Bacillus species are resistant to killing by alcohol and have caused health-care associated outbreaks, including contaminated alcohol pads (CDC).

Syndromes

B. anthrasis aka Anthrax (One of the many bands who are far worse than the entity after which they are named. Like Kansas. And the Dooby Brothers.

Cutaneous anthrax: large necrotic ulcer with lots of surrounding edema, can occur from making drums with goat hides (PubMed).

There is a case in a heroin user with sepsis from an injection site infection (PubMed) and an ongoing outbreak in Scotland (PubMed) and England (PubMed).

Shaving brushes. Well, at the turn of the 18th century (PubMed). But I use a shaving brush made with Badger hair. Gives one pause.

Respiratory: Acute respiratory failure and sepsis with hemoptysis and wide mediastinum on CXR.

GI: Bloody diarrhea with colonic necrosis and perforation.

B. cerus: food poisoning/diarrhea associated with fried rice. B. cerus can cause line related infections, in Japan it is a summer disease (PubMed).  Also CNS disease, perhaps from food, in neutropenic leukemics (PubMed). There has been an ongoing problem of anthrax in Scottish IVDA.

Ocular infections after penetrating trauma and IVDA.

Bacillus species can cause the usual hodgepodge of infections: meningitis, endocarditis, line infections etc etc and it can be a contaminant. You cannot necessarily blow it off, which, I suppose, is why you get the big bucks.

B. pumilus: causes a skin lesion in shepherds that mimics cutaneous anthrax (PubMed).

Treatment

Vancomycin or clindamycin, in that order. Combined with gentamicin in endocarditis. Duration depends on the site of infection. Say, just what is the number of your local ID consultant?

B. cereus and B. licheniformis isolates are susceptible to cefepime, carbapenems, aminoglycosides and vancomycin, but B. pumilus isolates are resistant to all antibiotics except for quinolones, amoxicillin./clavulanate,vancomycin (PubMed).

B. anthrasis

Disease: ciprofloxacin 400 iv bid or doxycycline 100 iv bid.Data in mice suggest nearly 100% survival in anthrax treated with anti-TNF antibodies that are used in RA etc.

Exposure: ciprofloxacin 500 po bid or doxycycline 100 po bid for 60 daysMMWR).

B. cerus

Treatment is supportive for GI symptoms.

Ocular infections : vancomycin, imipenem OR clindamycin, in that order.

Notes

B. anthrasis a potential marker of bioterrorism, see the CDC website http://www.bt.cdc.gov/ for complete up to date information.