P0828 - Bacillus cereus Bacteremia in Alcoholic Cirrhosis

Karim T. Osman, MD, Alissa Ali, MD, Leah DeCoste, MD, Ming V. Lin, MD
Lahey Hospital and Medical Center, Burlington, MA

Introduction: Bacillus cereus (BC) is a gram positive, spore-forming environmental bacteria that can be found as transient normal human gastrointestinal (GI) flora. While BC is a common blood culture (BCx) contaminant, it can cause emetic or diarrheal foodborne illness via enterotoxin. This often resolves with supportive care. BC has been implicated in rare yet serious nosocomial and opportunistic infections in patients (pts) with hematological malignancies, intravenous drug use (IVDU), or indwelling devices. We present a case of non-GI BC infection in an alcoholic cirrhotic pt without traditional risk factors.

Case Description/Methods: A 57-year-old female with diabetes (DM), alcohol use disorder, and alcoholic cirrhosis presented with malaise and worsening jaundice. Pt denied GI symptoms or fever. Pt received prednisone x 21 days for alcoholic hepatitis 2 weeks prior to admission and denied use since then. No history of IVDU. Pt was on spironolactone, thiamine, and folic acid. Physical exam showed stable vitals, intact mental status, non-distended and non-tender abdomen, and no cardiac murmur. MELD-Na on admission was 31 (Table 1). Toxicology screen, hepatitis A, B and C serology, EBV, and HIV were negative. Serum CMV PCR 27355 IU/mL. Multiple BCxs over 4 consecutive days were positive for BC. U/S abdomen was negative for hepatic lesions or ascites initially. Transesophageal echocardiogram was unremarkable. Pt was treated with IV vancomycin for 2 weeks. CMV treatment was deferred. Pt developed ascites during hospitalization without spontaneous bacterial peritonitis (SBP) and MELD-Na was 25 at discharge.

Discussion: Cirrhotic pts are susceptible to infections due to associated immune dysfunction. Non-GI BC infections could be acquired exogenously via bacterial entry of disrupted skin or endogenously via ingestion of contaminated food. There are rare reports of BC bacteremia in cirrhotic pts causing SBP and necrotizing fasciitis. The pathogenesis was attributed to translocation of colonized Bacillus in the GI tract via increased intestinal permeability and hypoalbuminemia resulting in bacteremia or peritonitis due to impaired phagocytosis that failed to eradicate the infection. Our case demonstrated alcoholic cirrhosis with compounded immunocompromised status such as malnutrition, DM, steroid use, and CMV viremia could pose as a risk factor for non-GI BC infection and contribute to acute on chronic liver failure. Prompt recognition and treatment of BC infection is vital in cirrhotic pts to prevent fatality.

Table: Table 1. Laboratory results on admission


Disclosures:
Karim Osman indicated no relevant financial relationships.
Alissa Ali indicated no relevant financial relationships.
Leah DeCoste indicated no relevant financial relationships.
Ming Lin indicated no relevant financial relationships.


Karim T. Osman, MD, Alissa Ali, MD, Leah DeCoste, MD, Ming V. Lin, MD. P0828 - Bacillus cereus Bacteremia in Alcoholic Cirrhosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.