Bacillus cereus bacteremia and meningitis in immunocompromised children

Two cases of Bacillus cereus meningitis in immunocompromised children at ou r hospital within a 2-month period prompted us to review B. cereus-related invasive disease. We identified 12 patients with B. cereus isolated in bloo d cultures from September 1988 through August 2000 at our institution. Thre e of these patients also had B. cereus isolated from CSF specimens; 1 addit ional patient had possible CNS involvement (33%, group A), whereas 8 patien ts had no evidence of CNS involvement (67%, group B). Patients in group A w ere more likely to have neutropenia at the onset of sepsis and were more li kely to have an unfavorable outcome. They were also more likely to have rec eived intrathecal chemotherapy in the week before the onset of their illnes s. Two patients from group A died. One survived with severe sequelae. The f ourth patient had mild sequelae at follow-up. No sequelae or deaths occurre d among patients in group B. In patients with unfavorable outcomes, the int erval from the time of recognition of illness to irreversible damage or dea th was short, which demonstrates a need for increased awareness, early diag nosis, and more-effective therapy, particularly that which addresses B. cer eus toxins.