Snapshot A 25-year-old medical student goes to an urgent care clinic for vomiting and nonbloody diarrhea. He is on a tight budget and has recently been relying on buying bulk amounts of rice and making fried rice. He makes a batch every Monday, and reheats it throughout the week. He finished off his last batch for lunch around 3 hours ago and admits that he had accidentally left that portion out overnight. He reports feeling nauseous. On physical exam, he is afebrile, has hyperactive bowel sounds, and abdominal tenderness. His physician reassures him that this disease is likely self-limited and suggests that he vary his diet. Introduction Classification Bacillus cereus an aerobic, gram + rod spore-forming and enterotoxin-producing bacteria transmission ingestion of spores or toxin Epidemiology risk factors ingestion of (fried) rice or pasta poor practices of handling and storing food Pathogenesis spores are heat resistant and thus can survive cooking rice especially seen with reheated rice, as spores germinate and produces enterotoxin produces “emetic toxin” cereulide causes emetic type Associated conditions emetic type associated with reheated rice and pasta within 1-5 hours after exposure diarrheal type associated with meats and sauces within 8-18 hours after exposure Prognosis both types starts and ends quickly the acute diarrhea is typically self-limited Presentation Symptoms emetic type nausea and vomiting diarrhea type watery and nonbloody diarrhea abdominal pain Physical exam hyperactive bowel sounds abdominal tenderness Studies Labs typically not necessary but may diagnose with stool culture Making the diagnosis most cases are clinically diagnosed Differential Giardiasis distinguishing factors patients often report bloating and foul-smelling fatty watery diarrhea and have a history of swimming in or drinking river/lake water typically patients do not vomit Treatment Management approach as the disease is usually self-limited, antibiotics are generally not necessary Conservative rehydration indication all patients Medical antibiotics indication severe diarrhea drugs clindamycin aminoglycosides Complications Severe dehydration Electrolyte disturbances