{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T14:39:36Z","timestamp":1791470376208,"version":"4.3.4"},"reference-count":32,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T00:00:00Z","timestamp":1640217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002428","name":"FWF Austrian Science Fund","doi-asserted-by":"publisher","award":["I 4497"],"award-info":[{"award-number":["I 4497"]}],"id":[{"id":"10.13039\/501100002428","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Bacillus cereus foodborne intoxications and toxicoinfections are on a rise. Usually, symptoms are self-limiting but occasionally hospitalization is necessary. Severe intoxications with the emetic Bacillus cereus toxin cereulide, which is notably resistant heat and acid during cooking, can cause acute liver failure and encephalopathy. We here present a case series of food poisonings in five immunocompetent adults after ingestion of fried rice balls, which were massively contaminated with Bacillus cereus. The patients developed a broad clinical spectrum, ranging from emesis and diarrhoea to life-threatening acute liver failure and acute tubular necrosis of the kidney in the index patient. In the left-over rice ball, we detected 8 \u00d7 106Bacillus cereus colony-forming units\/g foodstuff, and cereulide in a concentration of 37 \u03bcg\/g foodstuff, which is one of the highest cereulide toxin contaminations reported so far from foodborne outbreaks. This report emphasizes the potential biological hazard of contaminated rice meals that are not freshly prepared. It exemplifies the necessity of a multidisciplinary approach in cases of Bacillus cereus associated food poisonings to rapidly establish the diagnosis, to closely monitor critically ill patients, and to provide supportive measures for acute liver failure and\u2014whenever necessary\u2014urgent liver transplantation.<\/jats:p>","DOI":"10.3390\/toxins14010012","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T21:40:21Z","timestamp":1640295621000},"page":"12","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Acute Liver Failure after Ingestion of Fried Rice Balls: A Case Series of Bacillus cereus Food Poisonings"],"prefix":"10.3390","volume":"14","author":[{"given":"Nikolaus","family":"Schreiber","sequence":"first","affiliation":[{"name":"Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Hackl","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5773-5695","authenticated-orcid":false,"given":"Alexander C.","family":"Reisinger","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines","family":"Zollner-Schwetz","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6214-5008","authenticated-orcid":false,"given":"Kathrin","family":"Eller","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Schlagenhaufen","sequence":"additional","affiliation":[{"name":"Department for Nutritional Microbiology, Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety (AGES), 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariane","family":"Pietzka","sequence":"additional","affiliation":[{"name":"Department for Nutritional Microbiology, Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety (AGES), 8010 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6455-987X","authenticated-orcid":false,"given":"Christoph","family":"Czerwenka","sequence":"additional","affiliation":[{"name":"Institute for Food Safety Vienna, Austrian Agency for Health and Food Safety (AGES), 1220 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6502-173X","authenticated-orcid":false,"given":"Timo D.","family":"Stark","sequence":"additional","affiliation":[{"name":"Food Chemistry and Molecular Sensory Science, Technische Universit\u00e4t M\u00fcnchen, 85354 Freising, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9273-8341","authenticated-orcid":false,"given":"Markus","family":"Kranzler","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Fickert","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5537-3646","authenticated-orcid":false,"given":"Philipp","family":"Eller","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7384-0594","authenticated-orcid":false,"given":"Monika","family":"Ehling-Schulz","sequence":"additional","affiliation":[{"name":"Institute of Microbiology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1007\/s40588-018-0095-9","article-title":"Bacillus cereus\u2014A multifaceted opportunistic pathogen","volume":"5","year":"2018","journal-title":"Curr. 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