The Delaware Division of Public Health (DPH) announced last week that it has been notified of four cases of Bacillus cereus (B. cereus) bloodstream infection between July and August of 2016 in New Castle County.

Typically a foodborne illness, these bacteria usually do not cause blood infections. Three of the four cases of B. cereus reported to DPH occurred in individuals who are intravenous (IV) drug users and currently use heroin. Symptoms of bloodstream infection may include fever, chills, body aches, rapid heart rate, diarrhea, vomiting, and nausea. If untreated, bloodstream infections can affect multiple organs and even be fatal.


As a result, DPH is encouraging health care providers to carefully monitor IV users who are actually ill for bloodstream infections and to consider B. cereus bloodstream infection a possible diagnosis. DPH recommends that antibiotics be started promptly after blood cultures are drawn and health care providers consider antibiotics that are active against B. cereus.

Two of the four individuals who had B. Cereus bloodstream infection described the heroin they used as having the street name “Butter” and having an image of a butterfly stamped on the packaging. They reported purchasing the heroin from a dealer in the Wilmington area.

“Complications from this illness can include eye infections, risk of blindness, heart valve damage, and musculoskeletal, respiratory, and central nervous system infections,” said DPH Director Dr. Karyl Rattay. “While this infection does not spread from one person to another, it is possible that the heroin itself is contaminated and there may be additional infections from the use of the contaminated drug.”

Bacillus cereus Image/CDC

There is no risk to the general public from these infections.

Other infections such as HIV and Hepatitis C are easily acquired through illicit IV drug use.

If B. cereus bloodstream infection is identified in any patient (IV drug user or not), health care providers are urged to obtain consultation with infectious disease physicians early in the course of patient care because these infections can sometimes be difficult to treat and antibiotics to treat this infection must be chosen carefully. In addition, serious complications of the infection can occur if not treated early and with appropriate antibiotics.

If B. cereus bloodstream infection is identified in any patient (IV drug users or not), providers are encouraged to contact DPH’s Office of Infectious Disease Epidemiology at 888-295-5156 or 302-744-4990 to report.

Any heroin or illicit IV drug use could carry risk of a variety of infections regardless of where it is purchased.