A 66-year-old woman with a heart pacemaker developed a serious infection caused by Bacillus cereus, a bacterium commonly found in rice. This case is unusual because this type of bacteria rarely infects the heart, and it’s normally associated with food poisoning. Doctors discovered the infection during surgery to remove her old pacemaker and successfully treated it with special antibiotics given weekly over several weeks, plus additional antibiotics to clear the bacteria from her digestive system. This case teaches doctors to think about rare infections and consider patients’ eating habits and lifestyle when diagnosing serious infections.

The Quick Take

  • What they studied: How a rare bacterium from rice contaminated a woman’s heart pacemaker and what antibiotics successfully treated the infection
  • Who participated: One 66-year-old woman who had a cardiac resynchronization pacemaker (a special type of heart pacemaker) implanted since 2017
  • Key finding: Bacillus cereus, a bacterium usually found in rice, caused a serious heart device infection that was successfully treated with a combination of intravenous and oral antibiotics over 4 weeks, with no infection returning during 3 months of follow-up
  • What it means for you: If you have a heart device and eat a lot of rice, proper food storage and handling are important. If you develop signs of infection (fever, chills, fatigue), seek medical attention promptly. This case suggests doctors should ask about dietary habits when investigating unusual infections.

The Research Details

This is a case report, which means doctors documented the medical history, diagnosis, and treatment of one specific patient. The patient was a 66-year-old woman who had a heart pacemaker that needed replacement due to battery depletion. During surgery to remove her old device, doctors found an infection on the pacemaker leads (the wires connecting the device to the heart). They took samples during surgery and sent them to the laboratory for testing to identify the exact bacterium causing the infection.

The doctors used a special imaging technique called transoesophageal echocardiography (a camera inserted down the throat to see the heart) to visualize the infection. They then treated the patient with antibiotics chosen specifically for the bacteria they found. The patient was followed for 3 months after receiving a new pacemaker to ensure the infection didn’t return.

Case reports are valuable for documenting rare or unusual medical situations that doctors might not encounter frequently. They help alert the medical community to new patterns or causes of disease.

This research matters because Bacillus cereus infections of heart devices are extremely rare, and doctors might not initially suspect this bacterium as a cause. By documenting this case, doctors can learn to consider unusual bacteria when standard treatments don’t work. The case also highlights how a patient’s lifestyle factors—in this case, eating a lot of rice and improper food storage—can contribute to serious infections.

As a case report involving only one patient, this study cannot prove that rice consumption causes these infections in general. However, it provides important clinical observations that can guide future research and clinical practice. The strength of this case is that doctors identified the exact bacterium through laboratory testing and documented the successful treatment. The main limitation is that findings from one patient cannot be applied to all patients with heart devices.

What the Results Show

The patient initially received standard antibiotics (oritavancin and gentamicin) that are typically used for heart device infections. However, laboratory testing revealed the infection was caused by Bacillus cereus, a bacterium that doesn’t respond well to many common antibiotics. The doctors continued oritavancin, a newer antibiotic, given as weekly injections at doses of 1200 mg, then 800 mg for three additional weeks.

To eliminate the bacteria from the patient’s digestive system (where the infection likely originated), doctors also prescribed oral vancomycin, a different antibiotic, taken by mouth four times daily at 125 mg per dose. After 4 weeks of this combined treatment, the infection was cleared. The patient then received a new pacemaker, and importantly, the infection did not return during the 3-month follow-up period.

The doctors identified risk factors that likely contributed to this infection: the patient ate a diet high in rice, stored rice dishes improperly, and had chronic constipation. These factors may have allowed Bacillus cereus spores from contaminated rice to survive in her digestive system and eventually enter her bloodstream, reaching the pacemaker.

The case demonstrates that Bacillus cereus, while normally associated with food poisoning from contaminated rice, can cause serious invasive infections in certain circumstances. The bacterium is resistant to many common antibiotics (beta-lactams), which is why standard treatments initially didn’t work. However, it responds well to glycopeptide antibiotics like vancomycin and oritavancin. The use of oritavancin, a newer long-acting antibiotic, proved particularly effective because it can be given less frequently (weekly) while maintaining therapeutic levels in the bloodstream.

Bacillus cereus infections of cardiac devices are extremely rare in medical literature. Most heart device infections are caused by common bacteria like Staphylococcus aureus or Staphylococcus epidermidis. This case is notable because it represents an unusual presentation of a bacterium that typically causes mild food poisoning. The case aligns with growing awareness that immunocompromised patients and those with certain lifestyle factors may be susceptible to rare or opportunistic infections that were previously considered unlikely to cause serious disease.

This is a single case report, so the findings cannot be generalized to all patients with heart devices or all people exposed to Bacillus cereus. We cannot determine how common this type of infection is or what percentage of people eating contaminated rice develop serious infections. The patient’s specific combination of risk factors (high rice consumption, improper storage, constipation, and an implanted device) may be unique. Additionally, we don’t know if other patients with similar risk factors would respond as well to the same antibiotic treatment. Longer follow-up beyond 3 months would strengthen confidence in the cure.

The Bottom Line

For patients with heart devices: Practice proper food storage and handling, especially for rice and starchy foods. Maintain good digestive health and address chronic constipation. Seek immediate medical attention if you develop fever, chills, fatigue, or shortness of breath. For healthcare providers: Consider rare bacteria like Bacillus cereus when standard antibiotic treatments fail in device infections. Ask patients about dietary habits and food storage practices. Consider using newer antibiotics like oritavancin when standard options are ineffective. Confidence level: Moderate (based on one case, but with clear clinical reasoning).

This case is most relevant to: (1) Patients with implanted heart devices who eat large amounts of rice or have digestive issues; (2) Healthcare providers treating device infections that don’t respond to standard antibiotics; (3) People in regions where rice is a dietary staple; (4) Immunocompromised individuals with heart devices. This case is less relevant to people without heart devices, as Bacillus cereus typically causes only mild food poisoning in healthy individuals.

In this case, the infection was cleared after 4 weeks of intensive antibiotic therapy. The patient remained infection-free during 3 months of follow-up. However, longer-term follow-up would be needed to confirm permanent cure. Prevention through proper food handling could reduce risk immediately.

Want to Apply This Research?

  • Users with heart devices should track: (1) Body temperature daily, (2) Symptoms like fatigue, shortness of breath, or chest discomfort, (3) Antibiotic adherence if prescribed, (4) Food storage practices and rice consumption frequency
  • Set reminders to: (1) Store cooked rice in the refrigerator within 2 hours and use within 3-4 days, (2) Reheat rice to steaming hot before eating, (3) Monitor bowel regularity and address constipation promptly, (4) Report any fever or unusual symptoms to your doctor immediately
  • Create a weekly checklist tracking: digestive health, food storage compliance, temperature readings, and any infection symptoms. Set alerts for any fever above 100.4°F (38°C). Schedule monthly check-ins with healthcare provider if you have risk factors. Keep a food diary noting rice consumption and storage methods.

This case report describes one patient’s experience and should not be considered medical advice. Bacillus cereus infections of heart devices are extremely rare. If you have a heart device and develop symptoms like fever, chills, fatigue, or shortness of breath, contact your healthcare provider immediately. Do not change your diet or antibiotic use based on this case alone. Always consult with your cardiologist or infectious disease specialist about your individual risk factors and appropriate preventive measures. This information is educational and not a substitute for professional medical diagnosis or treatment.