Abstract
Bacillus cereus (B. cereus) is a gram-positive aerobic or facultative anaerobic spore-forming bacterium. It is known as a casual agent of food-borne disease, and causes a self-limiting gastroenteritis. A few cases of fatal encephalopathy due to emetic toxin of B. cereus have been reported in the literature. We report a patient who developed B. cereus-associated encephalopathy in Japan. A 5-year-old boy developed acute gastroenteritis after eating fried rice that had been prepared a day before. Within an hour, he vomited five times and developed generalized tonic convulsions. He had fever and was comatose upon admission. A fecal culture revealed B. cereus, and he was diagnosed with acute encephalopathy. Intracranial pressure (ICP) was monitored after admission, and was maintained lower than 20 mmHg with cerebral perfusion pressure (CPP) above 45 mmHg. The ICP was controlled by whole-body hypothermia, barbiturate infusion, and osmotic diuretics. Although his life was saved, he exhibited severe neurological defects. In the present case, it was difficult to control ICP. ICP monitoring may have significantly contributed to control ICP/CPP, and, by doing so possibly avoided complications of B. cereus encephalopathy. We conclude that ICP monitoring in patients with encephalopathy is useful for detecting aggravation of brain edema and may improve prognosis.
