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Fulminant Bacillus cereus food poisoning with fatal multi-organ failure
  1. Clinton M G Colaco1,2,
  2. Kerri Basile1,3,
  3. Jenny Draper1,3 and
  4. Patricia E Ferguson1
  1. 1Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Westmead, Sydney, Australia
  2. 2Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, Sydney, Australia
  1. Correspondence to Dr Clinton M G Colaco; clinton.colaco{at}


This case represents a rare fulminant course of fried-rice associated food poisoning in an immunocompetent person due to pre-formed exotoxin produced by Bacillus cereus, with severe manifestations of sepsis, including multi-organ (hepatic, renal, cardiac, respiratory and neurological) failure, shock, metabolic acidosis, rhabdomyolysis and coagulopathy. Despite maximal supportive measures (continuous renal replacement therapy, plasmapheresis, N-acetylcysteine infusion and blood products, and broad-spectrum antimicrobials) and input from a multidisciplinary team (consisting of infectious diseases, intensive care, gastroenterology, surgery, toxicology, immunology and haematology), mortality resulted. This case is the first to use whole genome sequencing techniques to confirm the toxigenic potential of B. cereus. It has important implications for food preparation and storage, particularly given its occurrence in home isolation during the COVID-19 pandemic.

  • infectious diseases
  • foodborne infections
  • hepatitis and other GI infections
  • adult intensive care
  • toxicology

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  • Contributors CMGC was the main author who saw the patient, was involved in clinical care and composed the case history and literature review. KB contributed the microbiological aspects of the case with a write-up on the whole genome sequencing (WGS). JD oversaw the WGS of the Bacillus cereus. PEF was the supervising medical consultant of the case and was involved in overseeing the write-up of the case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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