The adhesion of Bacillus cereus spores to epithelial cells might be an additional virulence mechanism.

Four out of ten Bacillus cereus strains produced spores able to adhere to monolayers of Caco-2 cells (human epithelial cells). One of these strains has been involved in an outbreak of food poisoning where the symptoms were more severe and persisted for longer than a normal B. cereus food poisoning. The hydrophobicity of the spores is a contributing factor for the adhesion to occur. The spores are able to germinate in an environment similar to that of the small intestine and then the vegetative cells can produce the enterotoxin directly at the target place. A concentrated and active form of the enterotoxin will be taken up by the epithelial cells in the small intestine. Spore adhesion could be an important virulence factor for some B. cereus strains.