The aim of this study is to report a brain abscess presumably caused by Bacillus Simplex, a bacteria playing a minor role in human pathology and commonly considered merely responsible for food-borne diseases, here described for the first time in literature as possible cause of brain abscess.
A 51 years old man showing no relevant diseases except arterial hypertension , arrived, in May , at Emergency Room of our institute due to an acute onset right hemiparesis and temporospatial disorientation which gradually improved with intravenous antiedemigenous therapy. A brain CT scan highlighted an hypointense, round formation, with regular margins, in left frontoparietal area.
Therefore the patient was admitted at Neurosurgery Unit of our institute. The patient was apyretic. The blood and urine cultures were negative. Except for the high levels of CSF proteins and slightly elevated cell count, the lumbar puncture was in a normal range.
Total body CT scan ruled out the presence of neoplastic lesions or other abscess foci but showed a vast cavity in right lung apex opening in the right superior lobe bronchus, as for a previous tubercular infection. Cultures from Broncho-Alveolar Lavage and direct Ziehl- Neelsen staining excluded the presence of Koch bacilli or other bacterial strains. Quantiferon test ruled out a latent TB infection.
An echocardiogram and X-Ray dental panoramic scan also excluded respectively bacterial endocarditis or odontogenic infections. No evidences of HIV or other immunodepressive condition were observed at laboratory tests. A T1w, T2w, PWI, DWI and Gadolinium enhanced brain MRI scan was performed and confirmed the presence of a round lesion with a thin and uniform hyperintense periferic ring in Gadolinium enhanced sequences, and by restricted signal in DWI with diameter of 33 mm 48 mm, located in the frontoparietal white matter right below the rolandic and postrolandic cortical areas Figure 1.
A conservative strategy with a wide range antibiotic therapy with intravenous Vancomycin 2 gr per day, intravenous Meropenem 2 gr three times per day and after 15 days a brain MRI scan was repeated and confirmed the same findings without relevant modifications of the lesion. Right hemiparesis improved but did not resolve; for the proven drug resistance, for the dimensions greater than 2. The purulent content of the cyst was sent to routine microbiologic cultures and then repeated two times for the surprising results: cultures returned a Bacillus Simplex, an extremely uncommon strain in human infectious diseases, for the first time described as responsible of brain abscesses.
A postoperative antibiotic therapy with Meropenem 2 gr three times per day was mantained for 30 days. On seventh postoperative day blood examination showed no blood count abnormalities and a dramatic CRP and Procalcitonin improvement down to 2.
A 20 postoperative days brain MRI scan ruled out the presence of recurrent or residual brain abscess Figure 3. The preoperative motor deficit gradually recovered in days, and patient could turn back to his common daily activities and employment.
Simplex, denominated Biovar 1 and Biovar 2, which differentiate by sugar fermentation, have been classificated. In stressful environmental conditions, bacterial cells produce oval endospores which can remain quiet for long periods.
These spores are highly resistant to heat, cold, desiccation, radiation, and disinfectants, and enable the B. Simplex to resist in otherwise inhospitable environments, reactivating in favorable conditions producing vegetative cells. Most strains are strictly aerobic. These Bacteria are generally present in soil, but bacterial strains have been isolated from bread ingredients and bread 13 and, in one case, Genome Sequence of Bacillus simplex has been isolated from a human fecal sample Differently from Bacillus coereus , evident human patogenous activities have not been found; however a potential patogenous activity of the bacterium, related with the presence of thermoresistant toxins pre and post bread cooking, has been object of study.
Furthermore in a study Taylor et al. Have analyzed the capability of B. Simplex and other species of Bacillus of producing a toxin with physical features similar to those of the B.
To the best of our knowledge this is the first case of B. Simplex infection and, in particular, brain abscess reported in literature. The specific pathogenic mechanisms for the invasion of the brain tissue have not been previously described and they are not clear, but they have lead, in our case, to the genesis of a suppurative process that caused an early cerebritis, and after to a friable full-formed capsule at the moment of the operation, in which there was a purulent material.
Knowledge of the pathophysiology of the abscess capsule as a defense of the host toward the suppurative process, implies that pealing the capsule away is not necessary [ 16 ]. Furthermore this manoeuvre has proven to increase morbidity and mortality [ 17 ]. Surgical incision of the capsule and evacuation of the suppurative content is the current treatment of choice.
The stereotactic technique can lead to a safe and effective minimally invasive craniotomy for evacuation with minimal damage to healthy brain [ 18 , 19 ]. The methanol fractions were evaporated by speed-vac. The active fraction was further analysed using liquid chromatography-mass spectrometry as described in Supplementary Materials and Methods.
Protein fraction of the conditioned medium from 8-h-old B. For details please refer to Supplementary Materials and Methods. A single colony of B. To analyse the effect of contact between the two biofilms, B. The interacting biofilms were divided to three areas as mentioned in the analysis of bacterial population from the interaction.
A freshly prepared poly l -lysine-treated Sigma coverslip. Treated coverslip was used to monitor the B. To analyse the effect of the bioactive fraction eluted with methanol on B. A freshly prepared poly l -lysine-treated Sigma coverslip was used to immobilise the cells for membrane visualisation.
The cells were observed by Axio microscope Zeiss images were analysed by Zen software. Subsequently, samples were dried on filter paper Whatman overnight at room temperature, mounted and stored under vacuum. Interacted biofilms, treated as described in analysis of bacterial populations in the interaction, were divided, diluted and plated on LB-agar plates.
The bacterial biofilm were screened for biofilm defects. Biofilms with hereditable morphological defects upon re-inoculation were characterized as biofilm mutants. The mutants generated as a result of biofilms interactions were compared with mutants from of B.
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Download references. We thank Professor Ed Bayer for his helpful advices, and for suggesting the title for our manuscript. We thank Dr Assaf Vardi and his lab members for many helpful discussions.
Dan Kane; Ms. You can also search for this author in PubMed Google Scholar. Correspondence to Ilana Kolodkin-Gal. This work is licensed under a Creative Commons Attribution 4.
Reprints and Permissions. Rosenberg, G. Not so simple, not so subtle: the interspecies competition between Bacillus simplex and Bacillus subtilis and its impact on the evolution of biofilms. Download citation. Received : 01 June Revised : 11 October Accepted : 16 October Published : 27 January Anyone you share the following link with will be able to read this content:.
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Download PDF. Subjects Biofilms Environmental microbiology. Abstract Bacillus subtilis biofilms have a fundamental role in shaping the soil ecosystem. Introduction Soil bacteria have a central role in shaping soil ecology.
Results When grown on biofilm-inducing medium, both B. Figure 1.
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