Bacillus cereus bacteremia and multiple brain abscesses during acute lymphoblastic leukemia induction therapy

J Pediatr Hematol Oncol. 2014 Apr;36(3):e197-201. doi: 10.1097/MPH.0b013e31828e5455.

Abstract

Bacillus cereus can cause serious infections in immunosuppressed patients. This population may be susceptible to B. cereus pneumonia, bacteremia, cellulitis, and rarely cerebral abscess. Here we report an 8-year-old boy undergoing induction therapy for acute lymphoblastic leukemia who developed multifocal B. cereus cerebral abscesses, highlighting the propensity for B. cereus to develop cerebral abscesses. A review of the literature over the past 25 years identified another 11 cases (3 children and 8 adults) of B. cereus cerebral abscess in patients undergoing cancer therapy. B. cereus cerebral abscesses were associated with a high mortality rate (42%) and significant morbidity. Notably, B. cereus bacteremia with concomitant cerebral abscess was associated with induction chemotherapy for acute leukemia in both children and adults (10 of 12 case reports). Our case report and review of the literature highlights the propensity for B. cereus to develop cerebral abscess(es). Therefore, early consideration for neuroimaging should be given for any neutropenic cancer patient identified with B. cereus bacteremia, in particular those with acute leukemia during induction therapy.

Publication types

  • Case Reports

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Asparaginase / administration & dosage
  • Bacillus cereus / pathogenicity*
  • Bacteremia / complications*
  • Bacteremia / drug therapy
  • Bacteremia / microbiology
  • Brain Abscess / complications*
  • Brain Abscess / drug therapy
  • Brain Abscess / microbiology
  • Child
  • Dexamethasone / administration & dosage
  • Gram-Positive Bacterial Infections / complications*
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Immunocompromised Host
  • Male
  • Opportunistic Infections / complications*
  • Opportunistic Infections / drug therapy
  • Opportunistic Infections / microbiology
  • Polyethylene Glycols / administration & dosage
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Prognosis
  • Remission Induction
  • Vincristine / administration & dosage

Substances

  • Anti-Bacterial Agents
  • Polyethylene Glycols
  • Vincristine
  • pegaspargase
  • Dexamethasone
  • Asparaginase