Fulminant postsurgical Bacillus cereus meningitis

Abstract

✓ A 25-year-old woman presented with decreased level of consciousness, bilateral papilledema, and bitemporal hemianopsia. While receiving oxacillin prophylaxis, she underwent ventriculostomy and a transsphenoidal approach for the removal of a growth hormone- and prolactin-secreting adenoma of the pituitary. Within 4 days, fever, symptoms of meningitis, and marked cerebrospinal fluid (CSF) pleocytosis developed, associated with many large Gram-positive rods in the CSF, subsequently identified as Bacillus cereus. This case emphasizes the potential for Bacillus species to cause serious disease following surgery, including meningitis after intracranial surgery. Meningitis may be severe, and organisms are often resistant to standard surgical prophylactic regimens, which might include penicillin or cephalosporin derivatives. Isolation of Bacillus species from the CSF requires evaluation; these organisms should not be dismissed as contaminants or “non-pathogens,” particularly when isolated from CSF of patients who have recently undergone neurosurgical procedures.