Article Figures & Data
Figures
- Fig 1.
Case 3. A, Coronal sonography (8.5 MHz) on day 15 with hyperechogenicity of subcortical white matter with a shift of the midline and the beginning of necrosis of the left hemisphere. B, Coronal sonography on day 23 showing thickening of ependyma and septae due to ventriculitis.
- Fig 2.
Case 1. MR on day 7 has characteristics of hemorrhage in the white matter on (A) sagittal T1-weighted (TR 780 ms; TE 14 ms) and (B) axial T2-weighted (TR 3000 ms; TE 120 ms) images. C, Axial FLAIR (TR 9000 ms; TE 105 ms) image shows the extensive hemorrhagic meningoencephalitis. D, DWI (EPI sequence TE 128 ms; b = 1000 mm2/s) also showed restricted diffusion at the thalamus and cortex at the perisylvian and calcarine area and cerebellum.
- Fig 3.
Case 2. T1-weighted (A) (TR 780 ms; TE 14 ms) with hyperintensities right parietal and left frontal and T2-weighted (B) (TR 3000 ms; TE 120 ms) images, showing diffuse hypointensities at the level of the centrum semiovale, right frontal and left occipital and some hyperintensity right periventricular occipitally. On DWI (C) images (EPI sequence TE 128 ms; b = 1000 mm2/s), hyperintensity is seen on the left parietal, insular area, calcarine cortex, and thalamus at the left side and at the level of the mesencephalon.
- Fig 4.
Case 3. On day 15 axial T1-weighted SE (A), axial T2 TSE (B), and coronal FLAIR (C) images show hemorrhagic liquefactive necrosis of the left hemisphere (case 3). D, Diffusion-weighted image (TR, 1440 ms; TE, 146 ms; b = 756 mm2/s) shows restrictive diffusion in the calcarine area.
Tables
Case 1 Case 2 Case 3 Gestational age (wk) 30 6/7 28 3/7 34 1/7 First day of disease signs 5 5 13 Death (day) 10 8 15 Prenatal Chorioamnionitis Neg Neg Neg Monozygous twinning Neg Neg Neg Perinatal Apgarscore 5` 8 8 9 pH umb art 7.23 Postnatal GBS, listeria, Gram negative Neg Neg Neg PDA No No No Hypotension during infection Yes Yes Yes Other sepsis parameters (blood pressure, acidosis, WBC) Yes Yes Yes Blood culture Bacillus cereus Bacillus cereus Bacillus cereus Cerebrospinal fluid culture Bacillus cereus Bacillus cereus Neg Meningoencephalitis Yes Yes Yes Ventriculitis No No Yes - TABLE 2:
Reports in the literature of infection of the central nervous system with Bacillus cereus
Study Sex/Gestation/ Weight Age at Onset Predisposing Factors Nature of Infection Treatment Outcome Leffert et al, 1970 Not reported 18 wk Dandy-Walker cyst, ventricular shunt Meningitis Ampicillin, gentamicin, shunt removal No sequelae Raphael and Donaghue, 1976 Not reported 8 mo Ventricular shunt Meningitis Ampicillin, gentamicin, shunt removal No sequelae Turnbull et al, 1977 Female/32 wk/1320 g 4 d Necrotizing enterocolitis, cerebral hemorrhage Meningitis Ampicillin, gentamicin Died Hendrickx et al, 1981 (12) Female/32 wk 8 d Respiratory distress syndrome, central line Meningitis Ampicillin, gentamicin, erythromycin Died Feder et al, 1988 Female/32 wk/1500 g 7 wk Infected intravenous catheter Meningitis Chloramphenicol Cerebral palsy Patrick et al, 1989 Female/26 wk/830 g 7 d Bilateral thalamic hemorrhage Encephalitis Vancomycin, amikacin Died Weisse et al, 1991 Male erm/3700 g 3 wk None Meningitis Gentamicin, chloramphenicol No sequelae Weisse et al, 1991 Male/36 wk/2710 g 5 d Myelomeningocoele sac ruptured Meningitis Vancomycin No sequelae Chu et al, 1997 Male/26 wk/1500 g 4 wk Bronchopulmonary dysplasia, dexamethasone used Meningitis Vancomycin, amikacin Died Present report, case 1 Female/31 wk/1500 g 5 d None Meningo-encephalitis Amoxilline/clafuran vancomycin, amikacin Died Present report, case 2 Female/29 wk/976 g 5 d Respiratory distress syndrome Meningo-encephalitis Vancomycin, amikacin Died Present report, case 3 Female/34 wk/1565 g 13 d Duodenal atresia, malrotation, central line Meningo-encephalitis Ventriculitis Amoxilline/clafuran vancomycin, clindamycin Died
