Bacillus Cereus Osteomyelitis in an Athlete: Case Report and Review of the Literature

Bacillus cereus is an aerobic Gram-positive, spore-forming rod, widely distributed in the environment. Although, most commonly known to cause gastrointestinal infections, B. cereus can also cause osteomyelitis and other deep-seated infections. Here we describe the case of an athlete who presented with B. cereus osteomyelitis following surgery for closed displaced mid shaft fracture of tibia and fibula sustained during a football match. The patient had internal reduction and fixation of the fracture; Cephazolin was given as prophylaxis. 9 weeks later he developed osteomyelitis, B. cereus was isolated from specimens collected during surgery which was treated with Teicoplanin and Ciprofloxacin. After initial improvement X-ray showed progressive posterior bone bridge at the site of the fracture and no obvious evolution of the distal aspect of the tibia in comparison with the previous radiography. The patient was then transferred to a referral hospital where he had another surgery to drain the pus and remove the intramedullary prosthesis. At this stage Clostridium aerotolerans and Propionibacterium acne were isolated from the tissues, treated successfully with metronidazole. Bacillus cereus osteomyelitis should be considered in the differential diagnosis for infection following limb trauma. It is prudent to use for prophylaxis Vancomycin or Teicoplanin in such situation instead of Cephazolin to which B. cereus is usually resistant due to the production of beta lactamases.