Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia

Maha K. Arnaout, Robert F. Tamburro, Sara M. Bodner, John T. Sandlund, Gaston K. Rivera, Ching Hon Pui, Raul C. Ribeiro

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Purpose: Hemolysis is so rarely associated with Bacillus cereus sepsis that only two very well documented cases have been reported. This article reports two unusual cases of Bacillus cereus sepsis with massive intravascular hemolysis in patients who had acute lymphoblastic leukemia (ALL). Patients and Methods: A 20-year-old woman who was 9 weeks pregnant experienced a relapse of ALL. A therapeutic abortion was performed. During week 4 of reinduction the patient had abdominal pain, nausea, and vomiting, with severe neutropenia but no fever. Her condition deteriorated rapidly with cardiovascular collapse, acute massive intravascular hemolysis, and death within hours of the onset of symptoms. Blood cultures were positive for Bacillus cereus. Postmortem histologic examination and cultures revealed Bacillus cereus and Candida albicans in multiple organs. The second patient, a 10-year-old girl, presented with relapsed T-cell ALL. In the second week of reinduction, she had abdominal pain followed by hypotension. Again, no fever was noted. Laboratory studies showed intravascular hemolysis 12 hours after admission. Aggressive support was promptly initiated. Despite disseminated intravascular coagulation; cardiovascular, hepatic, and renal failure; and multiple intracerebral hypodense lesions believed to be infarcts, the patient recovered fully and resumed reinduction therapy. Conclusions: Bacillus cereus infection can have a fulminant clinical course that may be complicated by massive intravascular hemolysis. This pathogen should be suspected in immunosuppressed patients who experience gastrointestinal symptoms and should not be precluded by the absence of fever, especially if steroids such as dexamethasone are being given. Exchange transfusion may be lifesaving in Bacillus cereus septicemia associated with massive hemolysis.

Original languageEnglish
Pages (from-to)431-435
Number of pages5
JournalJournal of Pediatric Hematology/Oncology
Volume21
Issue number5
DOIs
StatePublished - Sep 1 1999

Fingerprint

Bacillus cereus
Hemolysis
Sepsis
Leukemia
Fever
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Abdominal Pain
Therapeutic Abortion
Precursor T-Cell Lymphoblastic Leukemia-Lymphoma
Disseminated Intravascular Coagulation
Liver Failure
Neutropenia
Candida albicans
Hypotension
Nausea
Dexamethasone
Vomiting
Renal Insufficiency
Autopsy
Steroids

Keywords

  • Bacillus cereus
  • Exchange transfusion
  • Hemolysis
  • Immunosuppressed host
  • Sepsis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Hematology

Cite this

Arnaout, M. K., Tamburro, R. F., Bodner, S. M., Sandlund, J. T., Rivera, G. K., Pui, C. H., & Ribeiro, R. C. (1999). Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia. Journal of Pediatric Hematology/Oncology, 21(5), 431-435. https://doi.org/10.1097/00043426-199909000-00018

Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia. / Arnaout, Maha K.; Tamburro, Robert F.; Bodner, Sara M.; Sandlund, John T.; Rivera, Gaston K.; Pui, Ching Hon; Ribeiro, Raul C.

In: Journal of Pediatric Hematology/Oncology, Vol. 21, No. 5, 01.09.1999, p. 431-435.

Research output: Contribution to journalArticle

Arnaout, MK, Tamburro, RF, Bodner, SM, Sandlund, JT, Rivera, GK, Pui, CH & Ribeiro, RC 1999, 'Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia', Journal of Pediatric Hematology/Oncology, vol. 21, no. 5, pp. 431-435. https://doi.org/10.1097/00043426-199909000-00018
Arnaout, Maha K. ; Tamburro, Robert F. ; Bodner, Sara M. ; Sandlund, John T. ; Rivera, Gaston K. ; Pui, Ching Hon ; Ribeiro, Raul C. / Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia. In: Journal of Pediatric Hematology/Oncology. 1999 ; Vol. 21, No. 5. pp. 431-435.
@article{2c16c12d4dc74cbf94057531ae40e90e,
title = "Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia",
abstract = "Purpose: Hemolysis is so rarely associated with Bacillus cereus sepsis that only two very well documented cases have been reported. This article reports two unusual cases of Bacillus cereus sepsis with massive intravascular hemolysis in patients who had acute lymphoblastic leukemia (ALL). Patients and Methods: A 20-year-old woman who was 9 weeks pregnant experienced a relapse of ALL. A therapeutic abortion was performed. During week 4 of reinduction the patient had abdominal pain, nausea, and vomiting, with severe neutropenia but no fever. Her condition deteriorated rapidly with cardiovascular collapse, acute massive intravascular hemolysis, and death within hours of the onset of symptoms. Blood cultures were positive for Bacillus cereus. Postmortem histologic examination and cultures revealed Bacillus cereus and Candida albicans in multiple organs. The second patient, a 10-year-old girl, presented with relapsed T-cell ALL. In the second week of reinduction, she had abdominal pain followed by hypotension. Again, no fever was noted. Laboratory studies showed intravascular hemolysis 12 hours after admission. Aggressive support was promptly initiated. Despite disseminated intravascular coagulation; cardiovascular, hepatic, and renal failure; and multiple intracerebral hypodense lesions believed to be infarcts, the patient recovered fully and resumed reinduction therapy. Conclusions: Bacillus cereus infection can have a fulminant clinical course that may be complicated by massive intravascular hemolysis. This pathogen should be suspected in immunosuppressed patients who experience gastrointestinal symptoms and should not be precluded by the absence of fever, especially if steroids such as dexamethasone are being given. Exchange transfusion may be lifesaving in Bacillus cereus septicemia associated with massive hemolysis.",
keywords = "Bacillus cereus, Exchange transfusion, Hemolysis, Immunosuppressed host, Sepsis",
author = "Arnaout, {Maha K.} and Tamburro, {Robert F.} and Bodner, {Sara M.} and Sandlund, {John T.} and Rivera, {Gaston K.} and Pui, {Ching Hon} and Ribeiro, {Raul C.}",
year = "1999",
month = "9",
day = "1",
doi = "10.1097/00043426-199909000-00018",
language = "English",
volume = "21",
pages = "431--435",
journal = "Journal of Pediatric Hematology/Oncology",
issn = "1077-4114",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia

AU - Arnaout, Maha K.

AU - Tamburro, Robert F.

AU - Bodner, Sara M.

AU - Sandlund, John T.

AU - Rivera, Gaston K.

AU - Pui, Ching Hon

AU - Ribeiro, Raul C.

PY - 1999/9/1

Y1 - 1999/9/1

N2 - Purpose: Hemolysis is so rarely associated with Bacillus cereus sepsis that only two very well documented cases have been reported. This article reports two unusual cases of Bacillus cereus sepsis with massive intravascular hemolysis in patients who had acute lymphoblastic leukemia (ALL). Patients and Methods: A 20-year-old woman who was 9 weeks pregnant experienced a relapse of ALL. A therapeutic abortion was performed. During week 4 of reinduction the patient had abdominal pain, nausea, and vomiting, with severe neutropenia but no fever. Her condition deteriorated rapidly with cardiovascular collapse, acute massive intravascular hemolysis, and death within hours of the onset of symptoms. Blood cultures were positive for Bacillus cereus. Postmortem histologic examination and cultures revealed Bacillus cereus and Candida albicans in multiple organs. The second patient, a 10-year-old girl, presented with relapsed T-cell ALL. In the second week of reinduction, she had abdominal pain followed by hypotension. Again, no fever was noted. Laboratory studies showed intravascular hemolysis 12 hours after admission. Aggressive support was promptly initiated. Despite disseminated intravascular coagulation; cardiovascular, hepatic, and renal failure; and multiple intracerebral hypodense lesions believed to be infarcts, the patient recovered fully and resumed reinduction therapy. Conclusions: Bacillus cereus infection can have a fulminant clinical course that may be complicated by massive intravascular hemolysis. This pathogen should be suspected in immunosuppressed patients who experience gastrointestinal symptoms and should not be precluded by the absence of fever, especially if steroids such as dexamethasone are being given. Exchange transfusion may be lifesaving in Bacillus cereus septicemia associated with massive hemolysis.

AB - Purpose: Hemolysis is so rarely associated with Bacillus cereus sepsis that only two very well documented cases have been reported. This article reports two unusual cases of Bacillus cereus sepsis with massive intravascular hemolysis in patients who had acute lymphoblastic leukemia (ALL). Patients and Methods: A 20-year-old woman who was 9 weeks pregnant experienced a relapse of ALL. A therapeutic abortion was performed. During week 4 of reinduction the patient had abdominal pain, nausea, and vomiting, with severe neutropenia but no fever. Her condition deteriorated rapidly with cardiovascular collapse, acute massive intravascular hemolysis, and death within hours of the onset of symptoms. Blood cultures were positive for Bacillus cereus. Postmortem histologic examination and cultures revealed Bacillus cereus and Candida albicans in multiple organs. The second patient, a 10-year-old girl, presented with relapsed T-cell ALL. In the second week of reinduction, she had abdominal pain followed by hypotension. Again, no fever was noted. Laboratory studies showed intravascular hemolysis 12 hours after admission. Aggressive support was promptly initiated. Despite disseminated intravascular coagulation; cardiovascular, hepatic, and renal failure; and multiple intracerebral hypodense lesions believed to be infarcts, the patient recovered fully and resumed reinduction therapy. Conclusions: Bacillus cereus infection can have a fulminant clinical course that may be complicated by massive intravascular hemolysis. This pathogen should be suspected in immunosuppressed patients who experience gastrointestinal symptoms and should not be precluded by the absence of fever, especially if steroids such as dexamethasone are being given. Exchange transfusion may be lifesaving in Bacillus cereus septicemia associated with massive hemolysis.

KW - Bacillus cereus

KW - Exchange transfusion

KW - Hemolysis

KW - Immunosuppressed host

KW - Sepsis

UR - http://www.scopus.com/inward/record.url?scp=0033496772&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033496772&partnerID=8YFLogxK

U2 - 10.1097/00043426-199909000-00018

DO - 10.1097/00043426-199909000-00018

M3 - Article

C2 - 10524460

AN - SCOPUS:0033496772

VL - 21

SP - 431

EP - 435

JO - Journal of Pediatric Hematology/Oncology

JF - Journal of Pediatric Hematology/Oncology

SN - 1077-4114

IS - 5

ER -