Feferman Benjamin, Fernandez Valentina, Tavernier Elsa, Fuseau Julie, Sembély-Taveau Catherine, Boennec Ronan, Cremades Agathe, Maakaroun-Vermesse Zoha, Follet Christelle, Mitanchez Delphine, Lanotte Philippe, Le Brun Cécile, Brunereau Laurent, Mereghetti Laurent, Morel Baptiste
Pediatric Radiology Department, CHRU of Tours, Clocheville Hospital, 49 Boulevard Beranger, 37000, Tours, France.
Methods in Patient-Centered Outcomes and Health Research, INSERM CIC 1415 and Université de Tours Et Nantes, Tours, France.
Pediatr Radiol. 2025 Apr;55(4):835-845. doi: 10.1007/s00247-025-06169-7. Epub 2025 Jan 22.
Cerebral infection with the opportunistic pathogen Bacillus cereus can lead to severe lesions, especially in premature newborns. Early diagnosis would be highly beneficial. The aim of this study was to describe the imaging findings associated with B. cereus infections.
We included all newborns with a positive B. cereus blood culture and transfontanellar ultrasound between 2012 and 2022 at the Tours University Hospital. Imaging was assessed by both a junior and a senior radiologist to differentiate between hemorrhages, leukomalacia, and lesions attributed to B. cereus.
Nineteen patients were enrolled (12 girls), of whom 18 were premature. Three patients did not survive. Six patients had normal ultrasound and brain magnetic resonance imaging (MRI) scans. Thirteen patients had ultrasound-detected lesions: 7 hemorrhages, 1 case of leukomalacia, 1 focal ischemic lesion, and 5 lesions attributed to B. cereus. The B. cereus lesions appeared as irregular (5/5), bilateral (4/5), asymmetric (5/5), and hyperechoic patches in the subcortical white matter. They were extensive, asynchronous, and rapidly progressive over a few days (central necrosis with peripheral enhancement, referred to as the "bear scratch sign"), while respecting the cortex and basal ganglia.
The presence of rapidly evolving white matter lesions should raise suspicion of B. cereus infection in newborns' brains. Imaging plays a crucial role in estimating the progression of this pathology.
机会性病原体蜡样芽孢杆菌引起的脑部感染可导致严重病变，尤其是在早产新生儿中。早期诊断将非常有益。本研究的目的是描述与蜡样芽孢杆菌感染相关的影像学表现。
我们纳入了2012年至2022年在图尔大学医院血培养蜡样芽孢杆菌呈阳性且接受经囟门超声检查的所有新生儿。由一名初级放射科医生和一名高级放射科医生对影像进行评估，以区分出血、脑白质软化和蜡样芽孢杆菌所致病变。
共纳入19例患者（12例女孩），其中18例为早产儿。3例患者死亡。6例患者的超声和脑磁共振成像（MRI）扫描结果正常。13例患者经超声检测出病变：7例出血、1例脑白质软化、1例局灶性缺血性病变以及5例蜡样芽孢杆菌所致病变。蜡样芽孢杆菌所致病变表现为皮质下白质中不规则（5/5）、双侧（4/5）、不对称（5/5）的高回声斑块。它们范围广泛、不同步，且在数天内迅速进展（中央坏死伴周边强化，称为“熊抓痕征”），同时不累及皮质和基底神经节。
快速演变的白质病变的出现应引起对新生儿脑部蜡样芽孢杆菌感染的怀疑。影像学在评估这种病理过程的进展中起着关键作用。
