to cause difficult-to-eradicate chronic skin infections, though less aggressive than necrotizing fasciitis. B. cereus can also cause keratitis. While often associated with gastrointestinal illness, B. cereus is also associated with illnesses such as fulminant bacterial infection, central nervous system involvement, respiratory tract infection, and endophthalmitis. Endophthalmitis is the most common form of extra-gastrointestinal pathogenesis, which is an infection of the eye that may cause permanent vision loss. Infections typically cause a corneal ring abscess, followed by other symptoms such as pain, proptosis, and retinal hemorrhage. While different from B. anthracis, B. cereus contains some toxin genes originally found in B. anthracis that are attributed to anthrax-like respiratory tract infections. A case study was published in 2019 of a catheter-related bloodstream infection of B. cereus in a 91-year-old male previously being treated with hemodialysis via PermCath for end-stage renal disease. He presented with chills, tachypnea, and high-grade fever, his white blood cell count and high-sensitivity C-reactive protein (CRP) were significantly elevated, and CT imaging revealed a thoracic aortic aneurysm. He was successfully treated for the aneurysm with intravenous vancomycin, oral fluoroquinolones, and PermCath removal. Another case study of B. cereus infection was published in 2021 of a 30 year old woman with lupus who was diagnosed with infective endocarditis after receiving a catheter. The blood samples were positive for B. cereus and the patient was subsequently treated with vancomycin. PCR was also used to verify toxins that the isolate produces. Diagnosis In case of foodborne illness, the diagnosis of B. cereus can be confirmed by the isolation of more than 100,000 B. cereus organisms per gram from epidemiologically-implicated food, but such testing is often not done because the illness is relatively harmless and usually self-limiting. Prognosis Most emetic patients recover within 6 to 24 hours, but in some cases, the toxin can be fatal via fulminant hepatic failure. In 2014, 23 newborns in the UK receiving total parenteral nutrition contaminated with B. cereus developed sepsis, with three of the infants later dying as a result of infection. Prevention While B. cereus vegetative cells are killed during normal cooking, spores are more resistant. Viable spores in food can become vegetative cells in the intestines and produce a range of diarrheal enterotoxins, so elimination of spores is desirable. In wet heat (poaching, simmering, boiling, braising, stewing, pot roasting, steaming), spores require more than 5 minutes at at the coldest spot to be destroyed.